Physician Burnout

Being a good doctor has been especially tough lately. It seems like there are so many obstacles to being able to provide quality care without completely sacrificing your own mental and physical health. Fortunately for me, I consider myself to be very strong of mind and body and my love for my patients and my job still far outweighs all the negative impact of the obstacles. I am very grateful for that, but, some are not so lucky.

You ask yourself, what kind of obstacles could doctors really have? Don’t they have it made? I mean, don’t they just make a ton of money off of the rest of us and live these amazing extravagant lives? Don’t they just get to direct us like sheep with all of their recommendations, procedures, and prescriptions etc? I hate to burst your bubble, but it is not like that at all, at least not for me.

Did you know that the rate of physician burnout is set to hit and all time high this year? The final numbers are not in yet, but it doesn’t look good. On top of that, Ob Gyn as a specialty has the fourth highest rate of burnout among all the specialties. 46% of Ob Gyn physicians report feeling burnout. So, what is burnout anyway? Physician burnout is classified as a psychological syndrome that is a prolonged response to chronic occupational stressors. Heh? What? It means that the stresses of the job potentially get so overwhelming and so stressful that you kind of break down and just don’t want to do it anymore. Yikes! Sounds awful doesn’t it? I mean anything with the word burn in it can’t be good right?

So, what are the symptoms of burnout? 1) Feeling tired and drained all the time is one of them. 2) Fatigue that does not budge no matter how much sleep you get is another. 3) Feeling sick all the time is yet another. 4) Changes in appetite or sleeping habits 5) Drop in libido or sexual desire 6) frequent back pain, muscle aches, headaches with no other apparent cause.

What do physicians have to be so stressed out about you ask? There are a ton of potential stressors. Let’s start off with the fact that your incredibly high medical school loans offset by the lower average salaries for most physicians means that your debt is not paid off until you are nearing 50. How about the fact that reimbursements for physicians, particularly in my specialty continue to drop, regardless of manhours spent or level of difficulty to the point that I find myself wondering if I am going to be the one paying to do procedures on patients instead of the patients…lol. Let’s think about the hours for a minute. For me, a solo practicing obgyn, I am essentially on call 24 hours a day and 7 days a week. My ability to do anything with my family completely depends on what is happening with patients. I find myself getting coverage if I decide to go to the bathroom in a town that’s greater than 30 miles away, much less if I am going on an actual vacation. I just can’t risk missing a call. For those of you with 9 to 5 jobs, most of you get to be done when you go home. I am never really done. I am always responsible for my patients. I am not complaining. I chose this life and this specialty. I am just clarifying.

Another stressor is the fact that there has been a huge breakdown in the concept of the doctor patient team relationship. Patients are now viewed as consumers rather than patients and as such, this wave of consumer-oriented thinking has brought a wave of bossy, entitled, demanding behavior that is often hard to stomach. I am extremely fortunate that I do not have a lot of these patients, but when I do, it is very exhausting. I have spent too much time invested in my education and have worked too hard and too long to have patients shake their finger at me, dictating their own care without listening as if I am their secretary or sales rep, rather than their doctor. It’s just not right.

One of the biggest stressors is the fact that doctors, even with all of their training and medical knowledge, do not really have the final say in what they can recommend for patients. The insurance companies do. The expenses do. The patient’s ability to pay does. I cannot tell you how many thousands of times in the last 25 years that I have had to change the optimum management, prescription, procedure, etc for a patient because of insurance and cost. Most of the time, my poor patients have to go through multiple treatment failures, medication side effects, extra office visits, etc before I am allowed to finally do the right thing for them because of some insurance criteria. To make it worse, most of them do not understand that I am not the one dictating these delays. They are under the impression that I am just “nickel and diming” them. Nothing could be further from the truth, yet I bear the brunt of their frustration and mine anyway.

Last but not least, let’s touch on the impact of COVID 19 for a minute. Wow talk about a stressor! Now we have to worry about exposure, like the rest of the world. We can’t hug our patients, hold their hand or comfort them in any way except with words, which is just not enough for some patients. If you thought insurance companies were bad about dictating care, they have nothing on COVID. We are being told when we can do procedures. I didn’t operate for months. We are being told what care is essential and what care isn’t. (Apparently vaginas fell in the isn’t category for awhile, unless a baby was coming out.) Our businesses are shut down and employees are sent home because there weren’t enough patients to keep them. Employees are afraid to come to work even when we have enough patients. We are told to do virtual consults instead of bringing patients to the office. How exactly are you supposed to do that with ObGyn patients? Hold their vaginas up to the screen? Generalization and conformity rules over sense and applicability. Even now when we are allowed to see patients, fear keeps most of them home anyway, crippling my ability to adequately care for them. I can say 100 times that it has never been safer to go to the office with all the precautions and prescreening, but I cannot force them to come in.

Long story short, physician burnout is a real thing. It affects nearly half the physicians in a lot of different specialties, and obgyn is no exception. I just want everyone to keep in mind that we doctors realize that everyone is struggling right now, but we need you to realize that we are right there with you.

Have a thoughtful day.

Dr. Katz