-“If they decide to study Medicine, I won’t pay for it…Should flip burgers for it.”

The unusually radical statement by the successful Miami gastroenterologist—referring to his aversion that his children may eventually follow his career’s path—came as not a real surprise for us. He expressed what most practicing physicians feel. The unrelenting micromanagement of our practices by the payors and the increasing demands of patients on time and attention has literally “burned out” the caregivers. Progressively physicians are becoming strongly disenchanted with their profession.

In a 2008 Health Affairs article, Donald M. Berwick, Thomas W. Nolan and John Whittington coined the term “triple aim” to define the necessary simultaneous pursuit of three objectives—improving the experience of care, improving the health of populations and  reducing per capita costs of health care—to fix the US system. In 2014, Drs. Bodenheimer and Sinsky argued that, considering the increasing burn-out and dissatisfaction of physicians, nurses and other staff with the medical practice, proposed that: “the Triple aim be expanded to a Quadruple Aim, adding that the goal of improving the work life of health care providers, including clinicians and staff.”

Professional burn-out is characterized by this most evident and ignored tragic triad:

  1. High emotional exhaustion
  2. High depersonalization
  3. Low sense of personal accomplishment

High emotional exhaustion – The increasing demands of payors, administrators and patients on the time and resources of the health care personnel produces a generalized dissatisfaction with the perceived quality of their delivered care services. The level of resilient frustration is so pervasively high in our system that physicians, nurses, technicians, receptionists and other ancillary personnel are literally “counting the days” until finally the day of salvation arrives—their retirement date.

High depersonalization – The negative feelings and bad vibe will inevitably foster the emergence of cynicism and sarcasm in the ranks of providers, with the resultant degradation of their rapport with the patients and their families. It’s a vicious circle. Patients complain that they are being ignored and/or mistreated, which triggers more negativity and disdain for the staff. As a result, the latter keeps worsening attitudes.

Low sense of personal accomplishment – For the majority of us who have chosen the medical career, profit and social standing are usually secondary considerations. What we most value is the possibility of helping our fellow human beings and at  the same time enjoy the unique standing conferred by possessing a voice of authority. With the onslaught of “bean counters” and their henchmen in both the public and the private payor system, our maneuvering room is being steadily curtailed in practice. The decreasing satisfaction not only engenders early retirement but also drug and alcohol abuse in the physician workforce plus the very real possibility of Suicide.

Shanabelt et al. studied the prevalence of burnout and satisfaction with work-life balance in the US physician and general workforces in 2011 and 2014 to compare the results and significant trends, using the Maslach Burnout Inventory; they invited more than 35,000 physicians to participate and 19% completed the survey. They said that; “ 54.4 % (n=3680) of the physicians reported at least 1 symptom of burnout in 2014 compared with 45.50 % (n=3310) in 2011.Substantial differences in rates of burnout and satisfaction with work-life balance were observed by specialty.” The researchers found minimal differences in the general workforce between those years. Nurses and residents (physicians in training) show similar or higher levels of emotional frustration with their professions and firm intentions to defect. Almost 2,500 physicians retire yearly in the USA and they are not being replaced fast enough, compromising the delivery of efficient Primary Care services for under-served rural or inner-city communities.

This modern-day drama that is being played out daily in all—we repeat IN ALL— the health care delivery facilities in the USA has major and minor consequences for the well-being of patients, which we will discuss in the second part of our series.

What do you think? Please tell us.

Don’t leave me alone.





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