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Is your doctor burnt out and why should you care?

Every day in this paper and on this site, we read stories about the radical changes under way in the US health care system. Beyond the continuing advances in medical technology, we are undergoing a major realignment of healthcare payment systems. While focusing on the impact to patients and communities, we can miss the impact of this disruption on the professionals who work in the field.

Every day in this paper and on this site, we read stories about the radical changes under way in the US health care system. Beyond the continuing advances in medical technology, we are undergoing a major realignment of healthcare payment systems. While focusing on the impact to patients and communities, we can miss the impact of this disruption on the professionals who work in the field.

Healthcare providers are increasingly paid for the value of the care delivered rather than just the number of services. Demonstrating value is not as easy as billing for procedures. It requires complex and intrusive monitoring systems. Ever notice how much time your doctor and nurse spend typing and clicking into a computer? A good part of this is to document the value of the care they provide to the people who pay the bills, authorize the bonuses, and penalize them for missing established performance measures.

All of this analysis is very expensive. A single hospital can spend hundreds of millions of dollars on new computer systems. So in healthcare today, bigger is better. Health systems are consolidating to better leverage resources and increase market share. Physicians are merging practices or selling outright to become employees of some larger entity because they can't afford to keep up with the IT arms race. This marks a radical shift from the days of the Marcus Welby family doctor/small business owner.

All of this disruption puts significant stress on the healthcare professional. Studies find that 30 to 68 percent of physicians exhibit some sign of burnout. The signs include "emotional exhaustion", "depersonalization" and a "low sense of personal accomplishment". The nature of medical training and the high-achieving, self-reliant personality of its practitioners make it less likely that they will seek help for what ails them. Stressors such as the rigors of medical education lead to a physician suicide rate twice as high as that of the general population.

It may be hard to feel sympathy for a highly paid professional who can cry all the way to the bank, but burnout affects the care you receive. Burnt-out docs are more likely to make mistakes and their patients are less likely to be satisfied with their care or achieve appropriate treatment goals. An unhappy doctor is bad for your health.

Much of the responsibility for fixing this problem rests on the shoulders of the medical community. They need to look out for each other and change the culture of medical training and practice to encourage resilience and mutual support. Doctors and nurses need to acknowledge that they are human like anyone else and seek care when needed. Physician heal thyself.

Policymakers can also acknowledge that the radical pace of health care delivery system change is causing pain for the people who care for us. These changes are good and necessary, but they shouldn't diminish the care or the caregivers.

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