Much has been written of late regarding physician burnout. And why not? The rates of burnout are astronomical and the consequences are scary. Consider these statistics: Medscape Physician Lifestyle Report 2015 notes that almost half of physicians report experiencing burnout. The Physicians Foundation’s 2014 Survey of America’s Physicians reveals that physicians are far more likely to burn out than professionals in any other line of work, and that only 40% of physicians over 46 years of age describe their professional morale to be even somewhat positive.
By far, the most consistent and alarming driver of burnout is loss of control—and it’s hitting our profession from every angle. Every regulation, compliance requirement, hospital mandate, “standard operating procedure,” and reimbursement rule saps the positivity and distracts the purpose from our profession. Every patient satisfaction survey, utilization review, payer denial, MACRA, MIPS, and PIPs sucks the last drops of joyful energy we have left in our chosen profession.
As a clinical manager, I know this. Because I enforce every single one of these, every day, to the dismay of my colleagues who are desperately clinging to even a semblance of control. You see, any organization or business must manage to eliminate or at least minimize the outliers. By the very nature of the number of people you employ, you are trying to manage a risk pool, and the only way to do that is to mandate compliance with every rule and regulation, and every consumer expectation, so as to mitigate the damage an outlier could cause. Consequently, the individual providers necessarily lose their freedom to make independent decisions in most every area in which there is exposure for the group. This is an inescapable reality that will follow you wherever you go.
But, it’s not all gloom and doom. There are strategies we can implement to tackle burnout and regain control in our individual practices. Research shows that if we protect 10% to 20% of our time for something we are passionate about, then the risk of burnout decreases dramatically (Shanafelt T. Arch Intern Med. 2009;169(10):990-995). To achieve this, we may need to change our focus a bit. Let’s stop deliberating about all the things we no longer control in our practices (the 80%) and learn how to celebrate what we still control (the 20%). Despite all the steps we have to take to survive in practice, there remains one step of every encounter that is wholly owned and impenetrable. It’s the doctor-patient relationship, of course! This is the 10-15 minutes of every 60-minute encounter that we control. If we choose to focus on what we do best, we can make a difference in the life of every patient we see. It need not be dramatic, but it should be consequential. Perhaps it’s as simple as validation of the life challenges underlying, or contributing to, nearly every visit. Perhaps it’s identifying an opportunity to link behavior, stress, and illness. Perhaps it’s actually a chance to make a clinically significant intervention.
Whatever it is, seize the moment. Grab control of what you can and forget the rest, if only for a few minutes. You will be rewarded with gratitude and a flood of meaningful encounters. Your patients will be surprised that you care this much (shocking, but true). And you will actually be making a difference again.
This is your opportunity if you choose to take it. No one is going to hand you your profession back, and no one is going to give you control. You have to take it where you can. The 80% will consume you if you’re not careful. While you can’t ignore it, you can manage through it, controlling your emotions and conserving your energy for the 20%.
Lee A. Resnick, MD, FAAFP
Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine
