Feel the Burnout: Medicare reform and increased burnout of physicians


Periodically in this blog we discuss physician burnout. A recent medscape survey showed a fairly significant increase in burnout among all physicians, but especially those in primary care. The burnout rate in primary care now exceeds 50%; more than half of primary care doctors are burned out. This leads to worse patient care and satisfaction, as well as more general unhappiness among physicians. A lot of patients now are contending with grouchy, overworked, and frustrated doctors.

Pay is part of this. Primary care doctors are paid far less than other doctors while working more hours. It is not an equation that translates to a satisfactory outcome, and it is also not something that is improving any time soon. In fact, with the 10% primary care cut having just passed, with cuts being imposed on us by meaningful use, and with an estimate by the AMA of a 13% cut looming in the near future, primary care doctors will continue to exist in the basement of the physician pay scale. Not that any doctors are paid poorly; but when you look around the corner and see what cardiologists and dermatologists are earning, and you see how Medicare is trying to save money by strangling doctors with increased regulations as it continues to enable specialists to charge a fortune for often unnecessary procedures and tests, and continues to encourage and pay for hospitalization, it can be very frustrating.

Still, pay is but one of many factors cited as a cause of burnout, and it does not even rank at the top. As Bernie Sanders and others call for “Medicare for all,” it is time we truly evaluate the pros and cons of Medicare, and how that program (and its reforms) has done more than anything else to increase the burnout rate among physicians. Of the top 5 reasons for burnout, all have at least some tie to Medicare changes that have occurred recently in the name of reform. Bureaucratic chores ranked number one, computerization 4, the ACA itself 5. Number 2 was increased hours (very much related to the increased tasks being imposed on primary care doctors by Medicare/ACA reform), and number 3 was concern about pay (something also tied to fears of cuts that are occurring even now by virtue of ACA and Medicare changes). As reform progresses, burnout increases. That is no coincidence.

There is no question that reform is absolutely necessary. Our current system is bloated, ineffective, and fails to allow for patient choice or best practices. That is why “Medicare for all” can never work, and would do even more to exacerbate physician burnout and patient frustration. (This is one way to Feel the Bern-out, but not one we doctors seek to subscribe to, even those of us who support Bernie Sanders on many fronts!) To simply impose a dysfunctional Medicare system on the entire nation would be fiscally suicidal and medially irresponsible. So we do have to reform the system, but Medicare cannot be fixed on the back of primary care doctors, which is exactly what is going on now.

In my new version of Curing Medicare, to be published by Cornell University Press in May 2016, I spend much more time dissecting ways Medicare needs to change, how current reform efforts are very often making problems worse, and how we can fix the system for the benefit of doctors, patients, and Medicare’s fiscal survival. Maybe then a Medicare for all system could work.

Bottom line, though, is that reformers, patients, and everyone in the health care provision network should be concerned about the increasing burnout among physicians. As Medicare and the ACA continue to enact complicated schemes that only burden doctors with more busy-work nonsense and score-cards while having no proven positive impact on patient care, burnout intensifies. This is no way to fix our medical system, and we collectively have to wake people up to that reality.

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