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….