Gregory A. Hood, MD


March 25, 2015

What's Going Wrong?

Burnout is a demon. The effects of medicine's rigors, training, schedules, policies, and so many more influences threaten to empower this demon, as it stalks each of us throughout our careers.

Medscape recently published its 2015 Internist Lifestyle Report. In it, there is a specific discussion of burnout.

The demon may be winning.

Burnout is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. Medscape's study showed that 50% of physicians in internal medicine say they are "burned out." This rate, which is compatible with other similar surveys, exceeds the rate found with other US workers. Perhaps it is that physicians have selected their profession and view their work as "more than a job."

Burnout for internists is among the most severe when compared with other physician specialties. Internal medicine faces the highest combination of prevalence and intensity of burnout among the specialties analyzed. Perhaps this is because of a high idealism among internists, who not only chose what they wanted to do in their professional lives but accepted doing this work knowing that they were accepting a lower relative valuation of their services, economically and noneconomically. Idealism can predispose for disappointment, particularly when the locus of control is outside that of the physician.

What are the demon's tools?

Physicians principally blame bureaucracy in all of its forms, the study finds. Bureaucracy is not merely that of governmental bodies. It also involves the American Board of Internal Medicine (ABIM), which recently belatedly admitted that they "were wrong" about maintenance of certification (MOC) as well as bureaucracy of group practices, hospital/Joint Commission requirements, and so forth.

Time is a very potent mechanism by which burnout burns. It is a hot but slow burn. The hours spent devoted to work, separate from face-to-face time with patients, include documentary paperwork (the form of which doesn't routinely augment patient care, as I wrote earlier), an endless flow of forms (many of which are smoke screens by insurers who sometimes appear to have no intention of seriously considering the patient's need), the requirements of MOC (which are well addressed in this New England Journal of Medicine conversation,[1] which predates the ABIM's recent MOC about-face), and other forms.


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