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Physician Burnout: Alarming but not Surprising

Posted By Dan Marlowe, Tuesday, September 25, 2012

Alarming, but not surprising, are the comments made in a recent news story on the American Medical Association’s website that nearly half of all physicians struggle with burnout. Even less surprising is the fact that primary care physicians (e.g., family medicine and general internal medicine) experience some of the highest rates when compared to other specialties. What this seems to translate into is an impending exodus from the field of clinical medicine by many physicians who have simply run out of steam and desire a higher quality of life overall.

Here is a link to the full article.

While this may be a problem facing medicine in general, as the article alludes to, it becomes particularly troublesome for primary care given the mounting workforce shortage the field is already experiencing. In order to meet the target of one physician for every 2000 patients, an additional 35,000-44,000 primary care providers will be needed by 2025 (Carrier, Yee, & Stark, 2012). This shotage is only compounded by the expansion of converage under the Patient Protection and Affordable Care Act (PPACA), which is projected to increase that deficit of from 25,000-45,000 by 2020.
Dan Marlowe
Dan Marlowe is the co-editor of the Growing MedFT Blog, and the Director of Applied Psychosocial Medicine for the Duke/Southern Regional AHEC Family Medicine Residency Program in Fayetteville, NC.

There have been various proposals of how to address this shortage from the proliferation of advanced practice providers (e.g., nurses practioners and physician assitants), to team-based care, to increased reimbursement rates, to the creation of primary care ‘pipelines’ that increase the number of health professionals who enter the field. However, it would seem that these solutions do not address the issue of burnout directly and treat it as a more tacit outcome of these workforce and system-based changes. The question of how to address burnout in clinical medicine is an important one, and more importantly for us, what can medical family therapists offer in this area given our systemic/relational outlook?

Carrier, E., Yee, T., & Stark, L. B. (2011). Matching Supply to Demand: Addressing the U.S. Primary Care Workforce Shortage. Retrived from http://www.nihcr.org/PCP_Workforce.html

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Lisa Zak-Hunter says...
Posted Thursday, September 27, 2012
Dan,

First of all, thank you for the article. I'm now working as behavioral science faculty in a family med residency and will be discussing burnout in one of our meetings with the first year residents.

Secondly, while I agree that decreasing workload will help decrease burnout, I don't see it as a long term solution. Personally, I would rather spend therapy sessions with 4-5 'easy to manage' patients than 2 challenging patients with relatively complex concerns that leave me drained. The relationship I have with the challenging patients is different from the less challenging ones and I face different self-care needs based on who I'm seeing.

One thing that comes to mind is to extend all my systems and self-of-the-therapist training into medicine by framing the doctor-patient relationship as just that- a RELATIONSHIP. It is one thing to be a good diagnostician and another to be a good 'doctor'. Ideally, you have a good balance of diagnostic and relational abilities. However, some physicians (at least some that I know) are uncomfortable acknowledging and addressing how this relational piece impacts their well-being and self-care (i.e., not much self-of-the-physician exploration and care). This is a door that is open for us as MedFTs. We have an understanding of how complex relational systems impact patient well-being, provider well-being and patient/care provider interaction. We also have been trained to examine our own selves as tools for healing. I'm still trying to figure out how to put this into practice in my residency, but I think this is an avenue worth exploring.
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