Reasons Doctors are Leaving Their Calling: Burnout

Ever since the implementation of electronic health records and the restraints of the Affordable Care Act, doctors have been leaving the workforce in increasing numbers. Many doctors have said it is because of with the electronic records they are always waiting for someone to put the information in the system, creating sometimes life-threatening delays in care. In addition, there has been a decrease in the numbers of young adults entering medical schools. This combination creates the shortage of manpower and the greater chance of burnout.

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In just three years physician burnout has increased from 45.5% to 54.4% according to a paper from the University of California-Riverside School of Medicine. It isn’t that the doctors are depressed or less content at home. The study found rather, the doctors were less happy at work. The study found three prevalent reasons for this trend.

The patient-doctor relationship has morphed into the insurance company-client relationship that limits the amount and type of care the doctors can provide. Feelings of cynicism due to patients no longer expecting a continuity of care and routinely are changing doctors due to costs. And lack of general enthusiasm for work.

The areas that showed the most burnout were emergency medicine, family medicine, internal medicine, and pediatrics. The study found hospital purchases of medical groups, rising drug costs, the Affordable Care Act, and mandated electronic health records (EHR). With the implementation of the EHR, a vast monster has been created. Instead of assessing their patients, they are stuck filling out EHRs. This paper found that many doctors felt like overworked robots.
Another issue is doctors feel EHRs should not be the focus of the patients' visit. In addition, many physicians are opposed to patient-doctor time has been changed to following the insurance billing diagnosis rather than the actual assessment (Alexander & Ballou, 2018).

Many medical graduates feel unprepared for clinical practice when confronted with the realities of the wide array of duties the job entails. This includes managing acutely ill patients and stressful workloads. The study found for some this led to psychological stress that affects their functioning along with job-life dissatisfaction. Doctors who are emotionally exhausted, cynical about their occupation or show diminished interest in their work are experiencing features identified as burnout.

The study states that burnout is identified by three layers: Emotional exhaustion, depersonalization, and reduced personal accomplishment. The significance of burnout to the individual is great. Personal health is often neglected with some 65% of medical practitioners who felt they could not take time off when sick and 92% self-prescribed medication. Burnout, depression and sleep deprivation have also been shown to increase the odds of a motor vehicle accident. Burnout also has a trickledown effect on patients. This condition has been related to deferring clinical decisions making and increasing in perceived errors. Stress levels affect judgment and technical ability. Fatigue distress and depression each have been linked to medical errors. Long work hours, poor balance between work and life and being unable to commit to personal/social activities outside of work also contribute to the problem of burnout.

Becoming a doctor remains one of the most challenging jobs. It requires extensive and expensive schooling followed by intensive and demanding residences before finally on their feet. It is generally thought that all the hard work and money put into becoming a doctor will eventually pay off; both financially and be being happy with the job. So why are doctors leaving this highly esteemed job? One possible reason is fewer people are interested in pursuing a medical degree. The other is that once the people who survived all the training leave is for a different job where the new grad has difficulty in securing a residency in a reasonable amount of time (Gunasingam et al, 2015)

Estimates of burnout in doctors often yield high figures and vary between countries, area worked, and sector-public/private, rural/urban. There is a need to study the effects of burnout and address the issues in order to reduce the numbers of doctors leaving the field.

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One key finding is that electronic health records (EHRs) are leaving many doctors to feel more like scribes than practitioners. In addition, there has been frustration voiced by doctors in the hospital setting who when trying to treat a critical illness could not get the required medications because the patients' chart wasn’t in the hospital computer system yet. And in most hospitals, the only one who can enter this information is the ward secretaries. This can create a large logjam of charts and patients needing care having to wait hours for their information to be put into the system.

Burnout among doctors is a global issue as well. Burnout among doctors can lead to poor quality of care delivered to patients, an increase in medical errors and poor retention. Once burnout has set in there is little that can be done to turn it around (Kumar, 2016).

In a study conducted in India, it was found an increase in quarrels among doctors. This was one of the ways that burnout appeared to them. It has proved to be the major contributor to this friction. Resident doctors have major responsibility but little autonomy. This state appears to contribute greatly to the doctors developing burnout. According to this study, a perception of stress, depression and problematic patient-care were all seen to be part of the disorder of burnout.
Burnout among the medical group as an area of concern especially because of the shortage of manpower is going to increase as fewer people become doctors and more leave the field. Some recent studies have found perceived working conditions are more important than the workload in explaining burnout. In addition, other studies looked at by this group found a change in work hours did little to change the number of those with burnout.

This study indicated that though burnout among resident doctors is associated with their workload there may be other factors. Simple things like limiting work hours, proper scheduling of work, and a rest break between duties could all be part of the solution. And while the authors admit there could be some bias due to the small group they studied, they have provided a direction for further study and follow-up (Swami et al, 2013).

Works Cited
Alexander, A.G. & Ballou, K.A. (2018). Three Factors That Could Explain Physician Burnout. American Journal of Medicine. The University of California-Riverside. http://www.ucr.edu

Gunasingam, N. Burns, K. Edwards,J. Dinh, M. Walton, M. (2015). Reducing Stress and Burnout in Junior Doctors: The Impact of Debriefing Sessions. Postgrad Medical Journal. Doi:10.1136/postgradmedj-2014-132847

Kumar S. (2016). Burnout and Doctors: Prevalence, Prevention, and Interventions.Healthcare,4(3). Doi:10.3390/healthcare4030037

Swami, M.K. Mather, D.M. Pushp, B.K. (2013). Emotional Intelligence, Perceived Stress and Burnout Among Resident Doctors: An Assessment of the Relationship. National Medical Journal of India, 26(4). https://www.researchgate.net/publication/261837056

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Comments

As a nurse of 41 years, I am saddened by the number of doctors who have retired in the past 10 years. Of the ones I have asked, the biggest reason is the fact they can't care for their patients the way they need to be treated as it becomes a question of whether the insurance will cover it.
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