There’s a lot in the news these days about doctor burnout. More specifically, neurologist burnout.
In a 2012 survey study , about 53% of neurologists reported burnout, which was third among all specialties surveyed, behind emergency medicine physicians and general internists. Neurologists also reported the fourth lowest job satisfaction with work-life balance, with about 41% satisfied that work leaves enough time for personal or family life. Neurology was the only one out of five specialties with the highest rates of burnout that was also among the five specialties with the lowest work-life balance.
Granted, the term “burnout” can mean a lot, but these days seems to refer to the fall of the American physician: Overworked, with rising costs, and falling reimbursements, sandwiched between patients who want to be cured immediately and those who want to sue us, and even on a good day facing a litany of terrible diseases.
Heck, I’d be burned out, too. Maybe I am.
Some say this is from the worries of solo practice, since we’re usually more pressed for time and money. I disagree, as I’ve seen it on both sides.
Recently, I saw my own internist. Six months ago she closed her own solo practice to join a large, hospital-owned group. She looked exhausted, worse than I’d ever seen her. She told me that she now gets a secure paycheck, but her stress level is worse. The hospital sets her schedule, tells her how much time she can spend with each patient, gives her quotas she has to meet, and has supplied an electronic health record (EHR) system that’s less than user friendly. (Personally, all of the ones I’ve tried are terrible.) When she goes home, she told me that now after dinner she still has to log on and do 2-3 more hours of charting just to catch up.
The grass is always greener. In her, I see a doctor who doesn’t have to watch each penny and worry about whether she’ll get a paycheck next week. In me, she looks at someone who’s free to pick their vacation days and isn’t chained to a quota system and a burdensome EHR.
Who’s right? I suppose it depends on what your life preferences are. Are we both burned out? We probably are, but in different ways.
But why the high rate of burnout for neurologists? Likely because of the issues I mentioned above. For myself, I’ve seen my salary drop 50% since its highest point in 2005. We’re faced with rising costs (like many other businesses). Unlike other professions, however, we don’t have much control over our reimbursement. Peculiar to medicine is the simple fact that what we charge has no bearing on what we get paid. Those rates are set by factors over which we have no control. Worse, they’re often set by politicians and insurance executives, who see us as the enemy.
There’s also the way reimbursements are set-up: they still favor docs who do a lot of procedures. While neurologists have a few, most of our job is thinking. And that’s not compensated nearly as well as jabbing needles and scalpels in people.
Then you get beyond financial issues. Many of us go through the day feeling like we have a target on our backs, in fear of patients becoming plaintiffs. What else? The nature of our field is such that we deal with diseases that are often challenging to diagnose and sometimes difficult, if not impossible, to treat. Yet, we still have to put on our best show and attitude for those afflicted. Part of why they come to us is to have questions answered and be given any glimmer of hope we can find.
In spite of this, the majority of us go on. Even burned out, we came here to help others. It’s part of what makes us tick and drives us to look in the mirror and head to the office. I wouldn’t trade what I do for anything. But I wish I could do it in a less adversarial world where I’m forced to choose between freedom and a (even temporary) sense of security.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
