The Flawed Payment System
Comment From Robert M. Centor, MD (Internist)
Physician burnout has great current interest. Many authors are worrying about burnout and therefore are writing about this problem. What are the common root causes of burnout?
• Primarily, burnout comes from loss of control and overwhelming undesirable activities.
• Burnout occurs when the job becomes overwhelming.
• Some physicians will develop burnout in any situation. Most of these physicians have chosen a specialty that does not fit their personality. Obviously, if the specialty does not fit the physician, burnout is inevitable.
• Burnout likely is increasing because too often the current finances of medicine "force" physicians to spend inadequate time with patients.
Regarding the last point, administrators often encourage this behavior. Too many administrators have examined overhead and income, and their analysis argues that physicians should spend less time with each patient. But good physicians know that their professional responsibility requires more time with each patient. This conflict, in my opinion, leads to burnout.
I write often that our payment system is flawed. While I have not been this explicit before, I would argue that our payment system, especially for outpatient internists and family physicians, is a leading cause of burnout!
Physicians are high achievers. We want to do our best possible job. When external forces prevent us from doing the job properly, then we have psychological distress.
Talk with a physician who leaves the "grind" and turns to retainer medicine. These physicians are much happier with their patient interactions.
We can and should decrease burnout through a better understand of who physicians are. Therefore, I accuse both the Centers for Medicaid & Medicare Services (CMS) and the major insurers of a major unintended consequence. We have too many physicians leaving or avoiding outpatient practice because they have developed burnout, or they understand that the job as currently constructed would cause burnout.
Until we improve the working conditions for family physicians and outpatient internists, we will continue to promulgate this problem.
If my diagnosis is correct, then the treatment is clear.
Medscape Family Medicine © 2012 WebMD, LLC
Cite this: Robert M. Centor, Robert W. Morrow, Roy M. Poses, et. al. Doc Burnout -- Worse Than Other Workers' - Medscape - Nov 13, 2012.