Hitting a nerve
Burnout takes its toll on neurology
Publish date: October 19, 2017
By: Allan M. Block, MD
I’m burned out.
Heck, what doctor isn’t? Politicians say we get paid too much. Lawyers say we make too many mistakes. Insurance companies say we order too many tests and too many expensive treatments. And the patients, while generally good people looking for help, can also on occasion be angry and unreasonable. The bad apples may be in the minority, but it only takes one to ruin a day full of rewarding visits.
On top of all that, a recent study found that the burnout rate among neurologists was one of the highest among physicians. This is driving many of us to consider early retirement or consider leaving the field and is keeping medical students away from neurology. This comes at a time when the projected future demand for our specialty is already 20% under what the population will need by 2025.
That can’t be good.
Some of the study’s listed reasons for burnout are very familiar: complaints about maintenance of certification and about calling insurances to authorize tests and medications, crappy reimbursement for time-consuming visits, having to spend more time at work just to break even, and the constant feeling of never being caught up. I leave work, come home, have dinner with my family, do dictations, go to bed, and do it over again. No matter where I am, I’ve never left the office.
Other common complaints aren’t as much an issue for me. I don’t have, or want, an electronic health record that qualifies for meaningful use; I designed the one I have, and it works fine for me. I don’t have a nonmedical administrator telling me how many patients I’m required to see each day, and my patient population is, overall, appreciative and polite.
There are always trade-offs. When my kids have school breaks, I take that time off from the office to be with them. I enjoy it – I mean, that’s what we’re here for as parents, isn’t it? Of course, the drawback comes a few weeks later when my income drops because I wasn’t working. In solo practice, cash flow is king. I may have more freedom and control than my employed colleagues, but the downside is that I have no guaranteed salary, either. I’m the last one here who gets paid.
I see plenty of columns on how to avoid burnout, none of which seem to be written by someone who’s in a real-world practice. They all recommend taking time off for yourself, maybe seeing a counselor, finding a hobby you enjoy … Really?
All of those things involve taking time off work, and in my self-employed world, that’s money lost. What pays the bills (and barely, at that) is sitting in my office seeing patients. Even my colleagues who work for health care systems, with their guaranteed paychecks (at least, for the duration of their contracts), tell me similar things. A nonmedical administrative person quietly reminds them that their productivity is always under review and that there are new grads who’d be happy to replace them. So they shut up and keep spiraling down.
There’s no easy answer, either. We’re stuck with decreasing reimbursements, a gradual whittling away of our profession, a demand to keep putting time we don’t have into our jobs, and many other issues. It’s even worse for those who are coming out of training and are facing these same challenges with six-figure student loans over their heads and, often, the demands of young families. The idealism and energy of youth are all that seem to sustain them, and that can’t last.
I like being a doctor. I enjoy being a neurologist. I love being able to help people and have a sense of service in doing so. But the worsening financial picture for us, and the increasing demands on our often already nonexistent free time, are destroying the field. Like many other docs, I look at my savings here and there and wonder how long until I can retire. That is sad because, as we all gradually leave practice (for whatever reason), new people will need to come in and pick up the mantle. But current conditions are such that I suspect many will find something else to do unless things change.
Dr. Block has a solo neurology practice in Scottsdale, Ariz.
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