COMMENTARY

Endocrinologists Struggle to Find Rewards

Cyrus V. Desouza, MBBS

Disclosures

December 03, 2015

Too Much This, Too Little That

Many of us in the field of endocrinology appreciate the fact that we are able to practice medicine at a more relaxed pace than those in some other specialties, allowing us to enjoy a higher quality of life. So why, then, did 46% of endocrinologists say they are "burned out" in a Medscape lifestyle survey earlier this year?

"Burnout" is defined as the loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. When asked about the severity of burnout on a scale of 1-7, where 1 was defined as "does not interfere with my life" and 7 was "so severe that I am thinking of leaving medicine," endocrinologists scored 4.12, close to the highest burnout rate for any specialty (which was 4.3, for nephrologists). Obviously, this does not fit the profile of a specialty that offers a high-quality lifestyle.

Several important factors seem to be driving the burnout: too much regulatory and other paperwork, work hours that are too long, compensation that's too low for the amount of work done, and the expectation of seeing too many patients in a day.

A separate Medscape report on endocrinologist compensation found that more than two thirds of endocrinologists spend 10 hours or more on paperwork each week. Add to that the pressure to see a larger volume of patients, and the amount of time spent per patient has continued to shrink. At the same time, electronic medical records seem to threaten what's left of the physician/patient interaction.

A neighbor described his recent encounter with his physician: "My doctor was looking at his computer screen the entire 10 minutes that he spent with me. I did not feel he was really interested in me but was just trying to get his job done." Although this reveals the patient's perspective, it probably also reflects the physician's stress and decreased job satisfaction.

Diabetes Care Takes a Toll

Endocrinologists increasingly are treating a large number of patients with type 2 diabetes, a chronic condition that requires lifestyle changes in order to prevent complications. Initiating and overseeing these changes, in addition to managing these patients' medications, can be a daunting task.

In addition, the volume of inpatient diabetes is also increasing, and these patients tend to be even more complex and require a lot of support. Many endocrinologists, especially those in private practice, may not have the infrastructure of dietitians, diabetes educators, exercise physiologists, and other adjunct staff to help them address these issues.

At the same time, endocrinologists generally are not well compensated for treating diabetes patients. In the overall Medscape compensation report, endocrinologists ranked third from the bottom among all specialties.

As a colleague said to me, "We do a lot in terms of preventing diabetes complications, but it's the interventional specialties that try to fix the complications after they have occurred who get compensated at a much higher level. Is this fair?"

This is a debate that has been going on for a long time and may eventually be addressed when compensation is not determined solely by volume, but by quality and prevention metrics, too.

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