Why Family Medicine Burnout Is Different (and How Docs Fight Back)

Interviewer: Laurie Scudder, DNP, NP; Interviewee: H. Clifton "Clif" Knight, MD, FAAFP


September 06, 2017

Editorial Collaboration

Medscape &

Family Medicine in Today's Environment

Medscape: Is the continuum of care that has historically been so important in family medicine still possible in today's practice environment?

Dr Knight: We should systemically implement a process that allows family physicians to maintain a relationship with their patients across that care continuum. It is important for us to maintain, as a specialty, our comprehensiveness. In my time as a family physician, I have witnessed the switch from family physicians caring across a lifetime and a continuum, from outpatient to inpatient, to the prevailing model today. In this hospitalist model, a patient is admitted to the hospital and the family doctor isn't involved in their care, and then the patient comes back to the family doctor after being in the hospital. That is potentially fraught with hand-off problems.

As an example, if a family physician recognizes that a patient needs to be admitted to the hospital, the hospitalist may well take over care of the patient in the hospital. But the family physician who knows that patient best must continue to serve as a resource. And at the time of discharge, the family physician should be involved in the discharge planning to ensure that he or she, as the primary care provider, understands the next steps in care and is fairly seamlessly able to then resume that primary care in the outpatient setting. That will smooth those transitions from outpatient to inpatient and back out again.

Right now, in general, family physicians aren't paid to do that. It's not the business model. And so we have systemically set up a fragmentation that is dissatisfying and scary for the patient, and very dissatisfying for a physician who was trained in a continuity model.

Medscape: Certainly family medicine practice is affected by the broader changes in the healthcare arena, from federal policy to payer practices to societal changes. Many of these may be out of the control of the individual physician. How do you cope with this rapid-fire change, and what do you suggest to your colleagues who may be a bit whiplashed?

Dr Knight: I think that we have to keep our eye on the prize and focus on what's important. And that is to improve the health and well-being of the patients, families, and communities we serve. So that should always be the lens that we look through as we're trying to bring about the needed change in our healthcare system. Currently, the system places many burdens on physicians—documentation, reporting, and administrative requirements—that don't result in meaningful improvement in care. This non-value-added effort is demoralizing. System dysfunction results in the high levels of burnout that we are witnessing. Organizations like the AAFP and others are working to find ways to influence broad improvements. Until the system is changed for the better, we must find ways, individually and collectively, to support the well-being of physicians. I believe that an activated family medicine community can make a significant difference in these efforts. We need to demand, support, and lead improvement at the system, organization, and practice levels. We must practice self-compassion and be a source of support for our colleagues. A healthy, happy family physician workforce will result in healthier patients, families, and communities.

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