7/10/2023 0 Comments Be focused![]() 2023’s banking failures: a wake-up call for an unstable financial system and potential solutions Christopher H.How popular culture has historically portrayed tech in health care and what we can learn from it in the ChatGPT era Jennifer Lycette, MD | Tech.Not treating addiction in criminal justice settings violates the 4 ethical principles in medicine Casey Grover, MD and Reb Close, MD | Physician.Thriving in an AI-driven health care system: essential skills for medical professionals to stay relevant and make a difference Harvey Castro, MD, MBA | Tech.Medicine is a joke, except no one is laughing Arthur Lazarus, MD, MBA | Physician. ![]() Love in medical education: Why it’s vital to nurturing empathy and compassion The Podcast by KevinMD | Podcast.The truth about hard cases and abortion: Separating fact from fiction Michael McCutchen, MD, MBA | Physician.Physician burnout solutions should be focused on subtraction not addition Kent DeLay, MD | Physician.The insurance denial process: one oncologist’s fight against a broken system Jennifer Lycette, MD | Physician.Uncovering the controversial debate surrounding climate change Martin C.Binary medicine harms our gender-expansive patients Alexandra Beem | Policy.Here’s how to fix the public health system in the U.S.America’s ailing health care system: How it’s failing patients and doctors Jen Baker-Porazinski, MD | Policy.The inherent problems with emergency medicine that make it contradict new values and behaviors Anonymous | Physician.Why doctors are burning out: the missing piece in medical education Curtis G.Why HIPAA isn’t enough to protect your health data Brian R.The growing threat to transgender health care: implications for patients, providers, and trainees Carson Hartlage | Policy.But when we finally get the stakeholders interested in burnout, the solutions must be about subtracting burdens and not giving us more “wellness” to engage in. Surgeon General Vivek Murthy has spoken about making physician burnout a priority. There are some signs that those in power are starting to get it. Yet we can all agree that the balance of what fills the bucket and what depletes it is off. Being a physician is hard work, and not every aspect of work as a doctor will have a positive emotional impact. They cannot change the fact that our health care system errs more on satisfying payors than treating patients. Administrators can develop good culture, open communication, and hire adequate support staff, but they cannot fix the larger regulatory and clinical staffing environment. The amount of help they can provide, unfortunately, is limited. They hear daily about staffing and provider shortages and know firsthand that there are no easy solutions. Health care administrators, like most physicians I think, sincerely want to improve burnout. These are helpful steps, but we must find more ways to subtract from the burden on physicians. They do this by assisting with setting boundaries (i.e., doing less work) and improving our mindset and framing of problems. Burnout coaches are also useful, specifically when they help you subtract. Another useful form of subtraction is a good scribe, in that certain documentation elements can be delegated (although this may be a double-edged sword as the physician is ultimately responsible for the entire work product). The maze of ever-shifting requirements in the HPI, ROS, and physical exam were finally gone, and we could focus on the medical decision making. The 2021 E/M coding changes for outpatient care were a recent victory in this arena. The biggest improvements in “subtraction” must come from payors and the regulatory apparatus. As long as all these burdens are present, no additional self-driven “wellness” will remedy our burnout. These issues compound our burnout, and we must subtract some of them. These include, at a minimum: coding challenges, prior authorizations for procedures and tests, “peer to peer” phone calls to ensure proper patient care, endless box clicking, billing queries, and detailed responses to patient messages that should require a clinic appointment but can’t because your next available visit is too far away. Yet we spend a lot of time worrying about things that aren’t directly tied to the care of patients. Our work is going to be challenging no matter what, and we chose that work because it is interesting and valuable. We see lots of patients in the clinic, take some of them to the operating room, juggle inpatient and outpatient care, and take calls for emergencies, all while dealing with a significant shortage of other urologists. I work as a urologist, and in recent years my specialty has ranked at the highest end of burned-out physicians.
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