Friday, November 23, 2018

BURNOUT AND THE PACIFICATION OF PHYSICIANS

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The "Pacification of Physicians" is the process used by insurers, adjusters, politicians, and others to take down physicians who fail to behave like lapdogs to paymasters. 


"Burnout" is the name given to physicians who because of increasingly arduous demands quit the profession, at least, the care-giving part of it.


Physicians, afraid of consequences if they speak up, step aside from controversy.  That's when administrative managements rush to the front. When that happens physicians find that their treasured professionalism gets trampled. Consultatons are simply eliminated from Medicare. In Workers Comp, Utilization Review is used to demolish treatment protocols.             


Physicians have had a modicum ot success in repelling the likes of Maintenance of Certfication (MOC) even though opposed by smooth talking para-professionals buttressed by self-inflation and the crafty infusion of money advanced by slick corporate interests. 

As for "burnout" talk, The American Medical Association (AMA) points out that burn-out of physicians leads to increasingly early retirements. The American Academy of Neurology (AAN) tags along, going so far as to install a Burnout Task Force. A recent quote from NEUROLOGY TODAY was that women are more burned out than men. It was discovered that women who responded to a survey on burnout were about 7 years younger than their male counterparts. Factors contributing to burnout were listed, e.g., "emotional exhaustion" and "fatigue." The link to disappointing remuneration -- we mean payment -- was acknowledged.

It was mentioned that male neurologists tended to take refuge in personal hobbies while the women shifted their attention to teaching and administration. In a symposium sponsored by the Union of American Physicians and Dentists (UAPD) the increased proclivity to suicide was discussed. In fact, the UAPD recently sponsored an interdepartmental CME on "burnout" at Harbor Hospital. In NEUROLOGY TODAY, 11/15/18, it was stated that "women were more likely to mention suicidal ideation." Men tended to dwell on the suicides of colleagues as opposed to their own morbid thoughts. 

In PRACTICAL PAIN MANAGEMENT, April/May 2018, the AMA was credited with helping physicians "by advancing initiatives that enhance efficiency, professional satisfaction, and the delivery of care." For this writer, that's hogwash, not clout. It is clout that's needed, not effete efforts from the parlor.

While debate and legislative effort has a place what physicians need is a fight-back model. That means organizational protests and job actions. Active protest is the name of the game. Absent a high level of protest physicians will end up providing increasingly efficient and depersonalized care at their own expense. That means squeezing more and more patients into increasingly narrowed time slots. Legislators haven't a clue because nobody tells Senator Blowback that he has used up his RVS allotted time and that he has to get out so the next patient can enter. 

The inevitable result is disappointment among physicians and patients alike. Better to follow the example of Macbeth: "Whiles I see lives the gashes do better on them." 

Physicians need to adopt this combative mode while there's still a combat in which to engage. 

References

UAPD Triennial Convention, 26 Oct 2018

Documentary movie on burnout, "Do No Harm," by Robyn Symon (feature length film exposing the silent epidemic of physician suicide, winner of 2016 Roy W. Dean Grant for feature film  documentary)

Practical Pain Management, April/May 2018, "Dousing the Physician Burnout Epidemic: An AMA Perspective," by David Barbe, MD


Neurology Today, 15 November 2018, "Feeling Burned Out? Why Your Age and Sex May Make a Difference," by Gina Shaw





4 comments:

  1. Before and after medical school, physicians behave as individuals. They are challenged with exams, get their degree, match up into residency programs, and attain board certification.

    They are not use to playing as a team. So when hospitals and insurance companies pick us off using sham peer review, falsification of data, or the brunt of their powerful legal teams, we doctors fight them as individuals.

    This posting highlights the challenges, but not the solutions.

    Will those few physicians who fight against hospital and insurance bullies take leadership for those who can’t or won’t fight back?

    Attrition from our profession will continue, with some retiring, going into administration, or even suicide.

    Only a team effort will be able to fight this Goliath, but doctors have been inculcated as individuals, and not as team members. Until someone forms a team, bring them into a huddle, and come to the line of scrimmage with a game plan, “Burnout and the Pacification of Physicians” will keep the American doctor on the sidelines.

    Gene Uzawa Dorio, M.D.
    Santa Clarita, CA

    ReplyDelete
  2. Well said, Dr. Dorio -- a proposed solution is job actions. This concept can be extended to positions by medical staffs against hospital administratios such as the San Jose hospital that voted down MOC. Employers and paymasters have vulnerabilities waiting to be exposed. How legislaltors get funded is a known scandal that goes underutilized. That legislators and staff members get better health care benefits than their constituents is an open sore that begs to be explored.

    Robert Weinmmann, MD, Editor, San Jose

    ReplyDelete
  3. Translation: beleagured parties must learn to engage in legal collective action or
    effectively as individuals outside the governance of standard organizations or suffer the consequences. - rlw, ed

    ReplyDelete