Obamacare Fuels Burnout: Running for Cover and Finding Nowhere Left to Hide

As the Affordable Care Act (ACA) is implemented this week, many physicians are beginning to take stock in their own professional and personal lives.  The practice of medicine is a privilege but it is also an occupation that can consume nearly all aspects of a physician’s life.  In the past I have struggled with my own “work-life balance” and I have shared my thoughts on burnout in my previous blogs.  As a healthcare provider, I am absolutely dedicated to my patients and their well being–However, with the new demands that the ACA places on physicians, it may be difficult for many healthcare providers (including myself) to continue to find balance. Loss of balance will ultimately increase physician burnout rates and place an already burdened healthcare system under even greater stress.

Physician burnout rates are currently at all time highs.  Symptoms of burnout include emotional exhaustion, feelings of depersonalization and a low sense of personal accomplishment.  According to a 2012 publication in the Archives of Internal Medicine, physician burnout occurs at much higher rates than other occupations.  In fact, American Medical News reported that nearly 50% of all physicians suffer from the symptoms of burnout.  Decreasing reimbursement, increased workloads and loss of autonomy have fueled much of the current discontent.  Now, the ACA will add millions of newly insured patients to the system along with more paperwork, restrictions and mandates/benchmarks in order to obtain better reimbursement levels.  I am afraid that many providers may be so focused on “checking boxes” for the government that they forget about the patients. Additionally, physicians will be asked to see more patients in less time.  As I mentioned earlier, reimbursement levels continue to fall and overhead costs continue to rise.  Many private practices have given up their autonomy and “sold out” or integrated with large health systems in order to survive.  Now, with the ACA, there are going to be more patients and thus more efficient throughput required in physician’s offices.  There will be a consistent need for additional staff to manage the increased patient volumes as well as the government mandated paperwork.  However, most practices are finding it financially non viable to hire additional workers. Ultimately, the shortfalls in staff affect the very people the ACA is established to protect–our patients.

In preparation for the implementation of the ACA, many practitioners are already making changes.  As reported on FoxNews.com yesterday, many internists are considering giving up their primary care practice in favor of boutique like practices that focus on hormonal therapies or weight loss.  As reported in Forbes in January 2013, one in ten physicians are moving into concierge medicine where they charge a limited number of patients an annual fee up front for 24-7 access to care.  One of the basic principles of Obamacare is access to care–unfortunately, many primary care physicians are leaving the marketplace just as demand is increasing to an all time high.  Physicians that leave traditional practice cite numerous reasons for their exit and many suffer from burnout.  Most of us who have chosen a career in medicine do so because of an interest in serving others–selfless behavior throughout one’s career.  Service to others in our daily practice provides enormous fulfillment and improves job satisfaction.  But now, with the ACA in effect, we are no longer able to spend as much time in the service of our patients–we spend more time with government forms, rules and regulations and are paid little or nothing for the increased administrative duties.  The ACA is now one of the primary drivers of healthcare provider burnout and will ultimately result in a physician shortage in the US.

The idea of providing affordable healthcare to all citizens is an important goal.  However, haphazard planning and rushed rollout will most certainly doom the ACA to failure.  Unfortunately for all of the uninsured, lawmakers (including our President) have focused more on legacy (and what the history books may say about their time in office) rather than on producing real healthcare reform that has a chance to succeed and serve those who need it most.  Key components of an effective healthcare system reform include provisions that satisfy the needs of patients, payors/insurers, hospitals (and other centers for care), as well as physicians.  Physicians and other healthcare providers are key components to the delivery of quality care–although it appears that our current reform has not accounted for nor planned for physician attrition due to burnout.  Failure to provide adequate resources and support for care providers will not only result in quality providers leaving medicine but may also discourage bright young college students from entering the noble profession of medicine in the first place.  As many physicians continue to “run for cover” there appears to be nowhere left to hide….

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4 responses to “Obamacare Fuels Burnout: Running for Cover and Finding Nowhere Left to Hide

  1. Dr. Campbell. You are a thoughtful and caring physician and a credit to the profession. Your comments are from the heart and are

  2. Reblogged this on drdain's blog and commented:
    Quite inciteful!

  3. Well, I agree with the current physician reactions you have described. However, look at the positive reactions that some physicians are having as they look to the future (10 years). The ACA, and the patient- and provider-focused changes that will follow, will move us as a society to a much more comfortable place to practice medicine. How?…other “players”, not physicians, will drop out of the health care market making patient care so much easier to provide for providers, patients, and employers.

    Who will drop out? Health insurers and thousands of variations of health plans! Administrators and staff who have never had anything to do with the delivery of health care can be removed from the health care cost equation. And, employers will not have to be burdened with ‘selecting’ health plans for their employees; employee premiums will simply pass through employers to a local health care administrator. And the number of health plan options will be minimized to make the business of running a doctor’s office more efficient and less costly.

    Hospital will no longer have large rooms full of claims processing staff who fight with insurance companies to get paid. Patients will no longer get notices that say ‘this was a not-covered services” because everyone will know what a covered service is. Fewer benefit plans will lead to better administration, management, and patient care.

    Imagine a patient coming to your office and the first question you ask is “how are you feeling today?” or “Where does it hurt?” There will be no need to ask “What is your health plan? Who is your employer? Do they cover my services?” The environment will encourage good service, compassionate care, efficient use of resources, and reliable payment for physicians and other providers. This is where we are heading: a better world for all providers, patients, and employers. Sure there will be some growing pains. All changes of this magnitude are difficult. But the old/current system is broken beyond repair.

    Where does it hurt? In the insurance industry. Many people of the next 10 years will leave the insurance industry to find better work and reduce the cost of health care premiums. A few insurance companies will survive to process claims under contract with the federal government, not unlike Medicare, which is currently the most efficient health care insurance system in the country; though it can use some improvement too.

    Yes, right now, some doctors do not see how the ACA will help them. They are worried about loss of income and increased costs. They are right to worry about these things. But, they should not blame the new health system; instead, strip away the costly overhead and problems from the old one and promote a better future.

    So, let’s get to work and make our health care system better. Go forward, not back!
    Richard

    • Dear Richard,
      Thanks so much for your thoughtful comments. You are absolutely correct! Our system needs help! WE must go forward in a way that makes sense for patients, payors and physicians.
      Best regards
      Kevin

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