Is your doctor burned out? Probably. According to a recent “Physician Burnout and Wellness” survey conducted by Medical Economics, two out of every three physicians (68%), are feeling burned out. Should you care? As a patient, absolutely. Read on.

“I feel a loss of empathy and compassion for my patients,” said one burned-out doctor.

“Everyone I know wants to leave medicine,” said another. “The paperwork and administrative burden of charting keep us from spending quality time with patients.”

Not the best of news, is it? When you consult with your doctor, you expect that person to be alert and competent, but individuals with burnout, physicians included, often find it difficult to concentrate; they become irritable. They under-perform. A clear and detailed discussion of burnout appears on the Mayo Clinic website, see that by clicking here. Please note: Although I cited the Mayo reference, burnout is NOT a medical diagnosis.

More discouraging quotes

“It makes it hard to fully engage in my practice,” said one doctor. “I’m counting the days until retirement,” said another

How times have changed! When I entered medical school, which admittedly was a very long time ago (late 1950s), medical practice was one of the most prestigious of occupations, right up there with being a justice on the Supreme Court.

And why not? During the first sixty years of the Twentieth Century, physicians had considerable professional autonomy. In that golden age of medicine, doctors controlled their practices. They were independent and provided professional care directly to patients. Physicians performed a meaningful service, and the patient usually paid for that service. If the patient could not pay, the debt usually was written off. Doctors still made good money.  They were highly respected, they usually developed close doctor/patient relationships, and their work was lucrative. Satisfaction among doctors was, not surprisingly, high.

Doctors still are generally well compensated (although there is great variability among specialties), but burnout has replaced satisfaction in many cases. Why? Primarily, I think, because doctors have lost much of their independence. After having undergone four rigorous years of medical school, new M.D. graduates now continue their training in residencies that traditionally last from three to seven years, depending up on the speciality a young physician chooses.

In short, doctors have never been better trained than they are now. They are intimately acquainted with the human body. They know in detail how it functions in both health and disease. Today’s doctors have mastered a variety of medical or surgical skills within the speciality they have chosen. They are exceedingly well-equipped to diagnose and treat whatever ails their patients.  Nevertheless, after all of that preparation, most physicians now work under constraints, and they follow orders from people who know little or nothing about medicine.

As one surgeon wrote, he had “watched as medicine slowly evolved into the domain of technicians, bookkeepers, and clerks.”

Today’s altered environment

In today’s altered environment, most patients do not pay directly for their personal health care (although they may pay partially through a co-pay). Rather, the government (Medicare or Medicaid), or an insurance company, pays the bulk of today’s medical charges. These soulless payers obviously are not grateful recipients of the care, of which they receive none. Insurance companies are in the health game to “make” money and they are eager to limit their payments for such care. The government wants to “save” money, and it also strives to limit payments. So, both government and insurance agencies have set up rules and guidelines as to what they will pay for. Pre-authorization may needed before treatment can begin.

The government and insurance companies clearly now rule the roost. Medical care has transformed into the healthcare industry. Think of all the government employees, insurance employees, hospital employees, and more (basically administrators of one sort or another) who earn their livelihoods today from the “healthcare industry” by providing rules for doctors to follow, and by monitoring how well physicians comply. So, the earnings of this growing crowd of employees have greatly increased the total cost of medical care (as I’ve pointed out earlier, see here, the the New England Journal of Medicine reported that U.S. national health care expenditures increased from 4% of the gross domestic product in 1950 to nearly 18% of GDP in 2019. Now nearly one dollar out of every five spent in the USA now goes to “healthcare,” yet I would argue that this dramatic explosion of healthcare employees has not improved medical care one whit. But, sadly, the rules and regulations cooked up by these administrators are a major cause of physician burnout. (New advances in medical equipment have, of course, also contributed to the dramatic increase in medical costs, but the additional personnel costs are substantial.)

One burned out physician was blunt. “We need less paperwork and regulations.” “We need less busy work,” echoed another. Have you ever wondered whether your doctor enjoys looking at his computer screen while talking with you?

A volcanic shift, government induced

This volcanic shift was initiated decades ago, it seems clear, by the federal government, the same government responsible for the exorbitant costs of today’s college tuitions (see here for my discussion of how the federal government set in motion the explosion in college costs). Government is vital for a free society, but there are areas, in my opinion, where it blunders in and mucks things up.

Medicare, enacted into law in 1965, began the inexorable encroachment on the practice of medicine. As the government began to pay for certain forms of medical care, it also added regulations. Not surprisingly, with government money came government control. An excellent discussion of the depressing changes in medical care over decades may be found in the thoughtful observations of a general surgeon (see that here). This is an excellent review of how governmental interventions “have yielded a cascade of perverse incentives, bureaucratic diktats, and economic pressures that together are forcing doctors to sacrifice their independent professional medical judgment, and their integrity.”

Is your doctor burned out? If so, the details above probably played a role.