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

What are the real costs of no show appointments?

There is nothing a doctor’s office hates more than no shows. Let’s define a no show. A no show, like it sounds, happens when a client or patient misses an appointment without calling and notifying the office at least 24 hours ahead of time.

Doesn’t sound like much of a big deal right? One missed appointment…life goes on….no one gets hurt and it costs nothing…..Wrong! That is the wrong way to look at it. There are actually multiple costs associated with this undesirable scenario. The first and most important cost is to the patient. The patient misses out on getting the treatment that they need and the attention that they deserve. The second cost is to the office. Every appointment slot costs money in salaries, staff time, and supplies. When a patient does not show up, all those resources go to waste if we don’t have the opportunity to re-book that slot. This brings me to the third cost. This cost goes to the patient that didn’t have the opportunity to get an appointment because the slots were already filled, or so we thought. So, in one small and fairly inconsiderate swoop, multiple people are affected.

Sadly, I think that most patients do not even stop to consider any of these costs, until they get notified that they will be charged a small no show fee of 25 dollars, which doesn’t even come close to what the office has already spent. We aren’t even allowed to charge it to all insurances. Then it’s all hands on deck. The tables are turned quickly. The no show patient becomes an instant victim in their own mind. They become irate and refuse to pay it. Righteous indignation rears it’s ugly head. They yell and scream at the staff regarding the unfairness of the situation. Sometimes they even threaten to never come back, as if that will really teach us a lesson and discourage us from ever holding them accountable for anything. I regret to say, it won’t work. We are just going to keep on charging no show fees and attempting to hold patients accountable. We are still going to try to make ourselves available to as many patients as we can and plan ahead to make each visit as fruitful as possible, as if every patient is just as invested in their health as we are. Have a great day everyone.

Dr. Katz

Grade Whore

Yes. I know you have seen this title before but something happened today that made me feel like this post was worth a second look….so here goes..

Hi my name is Dr. Laura Katz and I have been a doctor for 24 years. I signed up to care for people 24 hours a day, 7 days a week, regardless of how much I get paid. I signed up for a lifelong commitment to the health of others, sometimes at the sacrifice of my own health and my family life. I signed up to compassionately listen, problem solve, give 110% and guide people every day into better futures for themselves and their infants. I did not sign up to be a grade whore!

OK. That was a strong word, but it is fitting nonetheless. So, what the heck am I talking about? No worries. I am about to explain. We now live in a society in which patients do not seem to be thought of as patients anymore. They are thought of as clients or consumers, which changes the whole flavor and mentality of the doctor patient relationship. ( I personally am kind of stuck on the patients as patients idea. However, I am behind the times to say the least.) I think that this kind of thinking is potentially very harmful. The kind of thinking involved that classifies patients as consumers or clients lets loose a whole wave of entitlement behavior on the part of the patient. The old adage ” The customer/client is always right” has really run amuck here. Patients now think that they should be able to go to their doctor’s office and demand what they want for their medical care or demand what pills they should have prescribed , just like they can demand what hair cut they want or what good they want at a restaurant. If they don’t get what they want, they have complete free reign to go on Google, Health grades, Vitals and attempt to destroy that doctor’s reputation with little to no recourse available on the part of the physician. Sure, we can go to Google and attempt to reply or prove why the stated comments are skewed or not factual, but the chances of that review coming down are slim to none in my experience. What’s worse, said patient who is posting the bad review does not have to really be accountable for it or even prove that they have ever actually been to that doctor’s office! What?! How is that ok? How did this review process get so out of hand? I am all for having input in your medical care and having patients advocate for themselves and insist on quality, but these rampant reviews when things do not go their way? No. I think that is wrong. Reviewing the wrong doctor? This could actually ruin someone’s career. I have had some reviews in the past that were awful and caused anguish and concern, only to find out after extensive research that that person had never actually seen me! I am sure that they are still out there somewhere and they still haunt me. I never want anyone to be hurt or wronged by me, but I cannot help rectify a problem with someone that I have never met. Still, these reviews are treated as gospel by those patients who carefully comb through online resources when selecting a doctor. They may not stop to question whether they could actually be true or not. They will just keep looking. I have to admit, as a patient, I look for reviews as well when selecting a physician, but if I can speak to someone directly who has seen the physician, that holds a lot more weight in my decision-making process. I am much more a fan of fact, not potential fiction.

We are all obsessed with reviews even at a hospital-wide level. We have things like HCAHPS and Press Ganey reviews that survey patients in a whole hospital environment. Hospitals then turn around and use these reviews to grade themselves and physicians and somehow use them as a judgement of worth. Now I will admit that these reviews at least require some documentation that a patient actually received care at that institution, but there are still too many factors not under the physician’s control that they are being lumped together and used to judge them. Patient’s will return a poorly rated survey if they didn’t like their hospital food or if they did not like their nurse for example. These are things that the doctor does not have any control over. There are some patients that you can bend over backwards and sideways for and they still will not be satisfied. Are you supposed to go against your medical judgement to do something that a patient wants in the hope of a better survey score? This is not supposed to be some sort of contest in which the 5 out of 5 score is the only objective. Did you know that places like John’s Hopkins have done studies regarding this kind of patient/consumer driven care and that outcomes tended to be worse when patients dictated their own care and doctors complied for fear of a bad review? Think about that.

This kind of culture sends us doctors scurrying and begging for positive reviews from our patients in the office as well on a daily basis because now we are worried what could be out there on all the public sites and how many of them could potentially apply to us. I have to admit, I have stopped looking at those reviews because they really mess with my head at times and actually get in the way of me providing quality care to my patients. I understand the concept of healthy feedback and its potential utilization in betterment of myself and my practice, but that does not seem to be the intent of the review process as we know it today. It feels like I am begging for a good grade or asking patient’s to sign some invisible report card when it really does not matter. I will give them 110% whether they leave me a review or not. Now having said that, we do conduct in-house reviews every day. Every single patient is given an option to review our practice and myself every single day. Every single patient decides whether or not they want their review to be shared. Now these reviews I look at carefully, each and every one. I take these to heart because I know that these are the patients that I am actively taking care of. We have been very lucky in that this review process has been very informative and that patients have been very thoughtful in their reviews. This has allowed our practice to take all appropriate action when necessary. I do believe in the review process, but it has to be done the right way to be constructive and true to it’s original intent.

I think that our culture of the patient as the consumer has also led to a huge breakdown in the respect that patient’s show to their physicians. No, I am not yearning for patriarchal 1950s medicine when gruff physicians dictated to their patients and patients followed without question. But, there is a part of me that thinks it is worse to have patients running amuck and dictating their own care. The customer/patient is not always right in these situations. Sometimes patients want things that are actually dangerous for them and would put both of us in danger. I actually have the medical degree and the training. Please let me use it and guide you. I like patients to be on their own team. I like to make decisions together. I like them to advocate for themselves, but not yell at me when I don’t do what they want even if it would be bad for them. I think we need to compromise somewhere in the middle. Have a fantastic day everyone!

Dr. Katz

Don’t you wish your gyno was hot like mine?

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Initial disclaimer: Before you read this, please understand that this is intended for humor only.

So, I hear from men all the time that I must have the greatest job in the world! This leads me to believe that, in their mind, I spend my days with hot, sexy, naked women and their perfect bodies and private parts all day long to my heart’s desire. In addition, I am sure that these same fine gentleman wish that they were a hot, male gynecologist like in the 1989 SNL sketch Mel Gibson: Dream Gynecologist. (Yes it’s real. Look it up. )

I hate to burst your bubble gentleman, but first of all…Ewww….and COME ON! These kind of comments just exemplify ignorance regarding what I actually do and what attracts women to a particular physician. First of all, let me clear up what I do all day long. I see women of all body types, ages and colors for every kind of health and pelvic issue that you could imagine from incontinence to infections to cancer. Yes that’s right gentleman. It is much harder to get them in for routine maintenance when everything is perfect ” down there” like the vaginas you are dreaming about as opposed to when something is “amiss.” That includes elderly women who bring me their crusty underwear, wondering what that discharge is all about and women with STDs that have gone untreated for a long time. It’s not all fun and games gentleman. This is a serious job, not some endless beauty pageant of genitalia. You may not believe this, but once you stare at anything consistently for a long time, day in and day out, the excitement wains. I guarantee it.

Now let’s deconstruct the hot male gynecologist ideal. Be prepared to have your mind blown. Did you know that multiple patient surveys have been conducted regarding possible gender bias in patient selection of a gynecologist? Most patients said that they picked their gynecologist based upon experience, not gender. Those that did pick based on gender usually picked a female because they felt that a female would be better capable of understanding what they were going through. There were still a few that picked a male, yearning back for the days of 1950’s patriarchal medicine, but they were not the majority. Now add on top of that the fact that patients have said that they would feel too intimidated if they picked a gynecologist that was too good looking. In other words, the odds may be ever NOT in your favor if you are a hottie. Sorry.

Well, I hope that I was able to clear up some of your misconceptions about the real world of gynecology. For now, I will just keep on keepin on with my frumpy, female badass self. Cheers!

Dr. Katz

The Art of Slogging

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OK, now that I have your attention. What the hell is slogging? The word slog is a verb meaning to work hard over a period of time. It also means to hit forcefully and typically wildly, especially in boxing. For the purposes of this blog, we are going to stick with the first definition. Personally, I also find the word imbued with a trace of difficulty or struggle as well, as if the work being done is innately more challenging than usual and that more effort is required. I also think that it implies a certain lack of joy in the task to be completed. Even the word itself has a heaviness to it, at least mentally and emotionally. I don’t find myself using it unless I am referring to a state in which I am struggling to get the basic requirements completed day to day. One final potentially positive component of the word slog is the implication of a necessary process, like slogging to get somewhere.

I think that this word perfectly describes the world at large today with all of the changes in restrictions, work environments, and day to day life. The level of unpredictability and the lack of control has brought out the worst in some and brought out the best and most altruistic in others. I even find myself struggling to get up, get dressed, and get psyched up to face the day, not knowing if I am going to be at the hospital for 25 hours or 4 hours, or if anyone is even going to show up. It is a conscious, sometimes burdensome mental effort to go to work and strive each day. This is by no means a reflection of how much I love my job. I LOVE MY JOB. I always will. I LOVE MY PATIENTS. I am grateful to even have a job. I have always embraced the role of the uplifting, caring, compassionate superhero to women. It’s my favorite thing in the whole world to help save someones life, make it better or bring new life into the world. It’s just that the positive level of variety that first attracted me is not the same. The variety I now encounter has more to do wondering who if anyone is going to show up on a given day. On top of that, my hands are tied with regard to what services I am ALLOWED to provide for patients. Some of the best aspects of my job in terms of preventative care and early diagnosis are severely limited right now because I do not have a crystal ball to predict what a patient needs without a procedure, exam or surgery. It is very frustrating to go to work every day knowing that I am not able to give patients everything they need. I worry every day about what I am potentially missing because of these limitations. Last, but not least, let’s not forget the mental burden of economic insecurity. There is no unemployment for bosses and business owners. There are some loans with a mountain of paperwork and extensive stipulations, but even those have no guarantee of ensuring the survival of your business of 20+ years. There you go, slogging at it’s best. I am getting through every day and working hard, but it is a struggle and the joy factor is more limited, not because I don’t love what I do, but because I am not allowed to completely do what I do. And yet, I keep slogging away in order to be able to eventually get back to running my practice as I see fit.

I get the same kind of feeling at home too. Most days, I manage to get myself motivated to at least attempt a project that has been hanging over my head( sometimes for years) and then other times I feel like I would rather scream than clean one more thing and I just don’t feel like doing anything. The difficulty rating of just going to the store has now been elevated to a ten out of ten between masking, gloving, making lists and figuring out a strategy to get the most with the least trips, knowing that I might not leave the house for an errand for another few weeks at best. Then there is the daily feeling hanging over your head that leaves you wondering if this truly is the new normal? On top of that is the constant barrage of input from all directions of conspiracy and control theories that only serve to add to the overall panic and disrupt any logical progression of thought. You cannot get away from them. You turn off the news and they appear on you social media instead. You turn away from social media and just listening to music and your broadcast is interrupted with another update. Whew! It’s a bit much. Again, slogging at it’s best. But, right now, there is no other choice. I have to keep slogging through on my way back to the way things used to be. It’s part of the process right now. It’s part of the process of doing my part in order to flatten the pandemic curve. If I quit or rebel, I am not making anything go any faster. Maybe if we all slog together, we may just get to the end of this thing a little faster. Let me leave you with this quote from Walter Annenberg, philanthropist, businessman, and ambassador:

” I want to remind you that success in life is based on hard slogging. There will be periods when discouragement is great and upsetting, and the antidote for this is calmness and fortitude and a modest yet firm belief in your competence. Be sure that your priorities are in order so that you can proceed in a logical manner, and be ever mindful that nothing will take the place of persistence.”

Dr. Katz

Isn’t it strange that it’s ok that I’m human now, but it wasn’t ok before?

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Traditionally, it seems that most patients do not view their physicians as actual, potentially flawed human beings. It’s just too uncomfortable a concept. If patients viewed their doctors as humans, that would mean that they would have to acknowledge the fact that they can make mistakes, have emotions, have physical ailments, and emergencies as well. To most patients, that is an untenable thought. Their doctors need to be superhuman, infallible, and infinitely available at a moment’s notice. This kind of thinking allows patients to engage in demanding, unreasonable, and entitled behavior at times and puts a significant burden on the doctor patient relationship.

Interestingly, this seems to have turned around somewhat now in the time of COVID. Now it seems like patients are attaching themselves more to doctors who are showing their human side. The videos I post of myself at home in regular clothes or talking about how I finally figured out how to do my nails by myself get tons of views. Patients are listening with baited breath to see how I might be struggling with all of these changes. It’s as if listening to me is giving them tacit consent that it’s ok not to be ok right now. I feel like giving them a glimpse into me as a person is actually helpful right now. I can potentially help guide them through the proverbial tunnel to the other side of this thing. I get excited when I post my Facebook live daily video in the morning and all those people tune in. Knowing that I am able to reach all those people in a positive way helps me too. Personally I am loving it. If I can be myself with patients and still help them at the same time, I am all in! I would prefer to be that way all the time, within reason of course. I still stand by what I have said in previous blogs. Patients who are suffering or have just been given a terrible diagnosis do not necessarily care how I am feeling at the moment. Common sense still has to reign supreme here. I guess what I am really saying is that I hope the compassion doesn’t die out when the pandemic does. Have a great day everybody!

Dr. Katz

Mom you’ve got 4 eyeballs!

Well that’s not something you hear every day! Nope. Only when your poor child is post anesthesia from oral surgery and is laying there somewhere between laughing and crying and begging for chicken nuggets….which you know would be an absolute disaster. Sometimes you get lucky and they also start spouting about how much they love you and that you are the best mom ever. So, it must be true right? Yup, those are the times ripe for future blackmail material. The temptation to pull out my phone and take a quick video is strong. I just want a few minutes to save for later maybe when all hope seems lost in the middle of a teenage argument devoid of reason. What harm could it do? Well, no harm except for your teenager vowing to never speak to you again, but how many times have you heard that one only to have them yelling at you about something else moments later? Oh yes. Empty threats at best. We have all been there.

So, let’s talk a little bit about anesthesia for a minute. Anesthesia is somewhat of a magical and frightening creature at the same time. It allows us to drift off to another place to allow necessary and painful procedures to be performed safely. It allows us as physicians to get a glimpse into the uninhibited treasure trove of thoughts that are racing around in a patient’s mind, the things that we never get to hear at the office. Sometimes these anesthesia ramblings help physicians with a diagnosis or help us uncover a stressful social situation for the patient that we didn’t know about. As patients, it also somehow absolves us of any accountability for what we might say or do under it’s effects. On the other hand, it is kind of a frightening thought that you could have carried on a whole conversation, done terrible things and had no idea that it even happened. I have been under anesthesia many times for different reasons and each experience has been a little different. I have felt like I was thrown abruptly back into my own body from somewhere in the hinterlands while struggling to rejoin a conversation that I had apparently been having for the last 20 minutes. I have woken up bawling my eyes out for no apparent reason. I have woken up surrounded by staff members looking really somber, thinking that I must have just been diagnosed with something terrible, only to find out that they were just disappointed that I wasn’t funnier under anesthesia that time. (Apparently I am quite the cut up usually.)

I have to admit, I have heard some juicy tidbits over the years from patients that could fill a whole book of memoirs. And yet, all their secrets remain safe with me. It’s a code of ethics and honor man. Sometimes I get lucky with patients and they say wonderful things about me and about the staff and how much they love me. I have to admit, these are pretty great moments. I stand there thinking okay! This is what they really think! Yes! I must have done something right! Whoo! I already said that anesthesia was like truth serum right? Then, those same patients wake up fully and are as crabby and onerous as ever and you think to yourself, ” Oh well. We’ll always have Versed. “

Have a fantastic day everyone!

Dr. Katz