Re: random thought re: primary care burnout

[Guest guest]

,Interesting provocative questions. How can we measure stress of different occupations? Is burn out stress more of a problem in primary care? If the teeter-totter of reward versus stress tilts toward the stress too much for too long, burn out becomes more likely. What is that pivot point for a pcp?I'm trying to think back to the times when I worked as a waitress during college. I was so happy when I graduated, because I wouldn't have to do that anymore. Highly stressful, not always rewarding even at the places where tips were high, very little control over anything. However, I could go home after a shift, not be on call, not have to worry that if I mixed up who got what salad dressing, someone might die. Also I knew that I would not be waitressing for the rest of my life. I might not have been as relieved after shifts if I thought that was all I going to do for the rest of my life. I suspect that's what gets us through internship and residency. We know it won't be that way for the rest of our lives. Random thought observation here. A non-medical teacher friend went to school to become a massage therapist. She said that it does wear on her because every person "wants me to fix them", even though it is very rewarding because most of the time she feels like she's helped someone. She's smart about the stress reward balance, she takes very good care of herself so she can continue. I'm thinking I would not like to be in the hands of an angry massage therapist. Ouch. I'm guessing that a pcp is likely to have at least an order of magnitude more of the stressor, "everyone wants me to fix them".Anything we can learn here? I always try to think in terms of "what would make it better". If I think in terms of what would completely fix something, I start to feel a little trapped because most things are rarely perfectly fixed, forever. It's much more fluid than that. Hills and valleys. So. Do we need more reward? refreshing breaks? Do we need to feel that the bad times won't last the rest of lives? Do we need to feel like we have some control? Or at least the illusion of control. Does the IMP model of practice mitigate some of the stressors on a pcp? Does the IMP model produce more (or less) stress? I submit that having at least the illusion of some control is helpful. Can we make it better? Thinking in Beantown,Kathleenwe obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

Great questions. I’m sure or will be able to

find the literature on this, but here are my thoughts.

1)

I think there is an inverse relationship between burnout and

involvement in patient’s care. The more we are involved, the less burn

out we have.

2)

I think traditional docs burn out more because they do not have

the appropriate “breathing room” to assess what the patient’s

needs are, work to address all those needs, all the while trying to see and

understand where they fit in the larger picture

The system sucks. The system

is miserable. But IMP practices have at their very core the doctor patient

relationship. That longitudinal relationship with the patient is really what

makes practicing medicine fabulous and worthwhile. As I grow older with my

patients, as I welcome in new ones and, sadly, bury some of the elders, I have

a sense of community that was totally missing from my previous churn and burn

practice. Committing to this relationship is not for wimps—there are

emotional swings which sometimes makes me feel bipolar, but I feel sustained by

the positive comments and the positive impact I feel I am having on many of my

patients. The breathing room built into most days also gives me a chance to

constantly re-evaluate how things are going and what I might need to do to make

things better. I have been at my practice now for over 7 years and feel

(nearly) as energized now as I did on the first day. Of course, the real problem

is the constant weighing of this strong relationship with the economic

realities of the business of medicine.

From:

[mailto: ] On Behalf Of Gordon

Sent: Friday, May 07, 2010 7:05 PM

To: practiceimprovement1

Subject: random thought re: primary care burnout

we obviously talk a lot about burnout in primary care docs due to all the

various well known factors I need not reiterate.

However, I wonder...(and this may be just cuz of the day I'm having)

Is there some inherent burn out of primary care physicians due to the fact our

job essentially is people coming to us every day with problems, complaints and

things we need to solve? Obviously with better focus on preventative

care, complaints lessen over time. But in reality, there basic premise of

our job will not likely change that much. As IMP's where we're immensely

more accessible and involved in patient's care than in traditional practices, are

we even more vulnerable?

[Guest guest]

RE burnout

I feel the same.

But would also caution on the numbers of pts you can see -- if you have 50 pt contacts like I do a week, you need SOME staff to help you do the job without burnout.

If you can survive on less than 50 pts a week, good for you, and you have either VERY LOW staff, or cash payors in an area where there is a relative doctor shortage, or, like me, the insurers pay MORE THAN Medicare and I dropped Medicaid 2 years ago. I have few cash payors, but then I need staff to help me stay sane (1.5 FTE).

This also helps me to sustain my balance.

Be well all!

Matt in Western PA

Solo since Dec 2004

FP residency completed in 1988

random thought re: primary care burnout

we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

Back in 1987, I was considering running my car into the overpasses as I drove

back from the hospital to see patient. Total burnout, almost cost me a marriage.

Now at 37 years. In my current practice, partner with my daughter MD and no

employees, I can easily see 40-50 patients a week and be fully happy. Before she

got here, I was seeing 75 a week, allowing the practice to grow. That was too

many, and I do think that there was no way to sustain that. On the other hand, I

could see 40- 50 a week and do it better than when I was seeing 100 a week and

had full staff. For me the notion of paying staff more and more, and being on

the hampster wheel is more of a burnout than this.

at least I know I can say no, and any money I make stays with me.

________________________________________

From:

[ ] On Behalf Of Dr Levin

[dr_levin@...]

Sent: Friday, May 07, 2010 8:55 PM

To:

Subject: Re: random thought re: primary care burnout

RE burnout

I feel the same.

But would also caution on the numbers of pts you can see -- if you have 50 pt

contacts like I do a week, you need SOME staff to help you do the job without

burnout.

If you can survive on less than 50 pts a week, good for you, and you have either

VERY LOW staff, or cash payors in an area where there is a relative doctor

shortage, or, like me, the insurers pay MORE THAN Medicare and I dropped

Medicaid 2 years ago. I have few cash payors, but then I need staff to help me

stay sane (1.5 FTE).

This also helps me to sustain my balance.

Be well all!

Matt in Western PA

Solo since Dec 2004

FP residency completed in 1988

random thought re: primary care burnout

we obviously talk a lot about burnout in primary care docs due to all the

various well known factors I need not reiterate.

However, I wonder...(and this may be just cuz of the day I'm having)

Is there some inherent burn out of primary care physicians due to the fact our

job essentially is people coming to us every day with problems, complaints and

things we need to solve? Obviously with better focus on preventative care,

complaints lessen over time. But in reality, there basic premise of our job

will not likely change that much. As IMP's where we're immensely more

accessible and involved in patient's care than in traditional practices, are we

even more vulnerable?

[Guest guest]

RE limited practice, keeping overhead low with limited/no staff.

Curious --

I'm ramping up to 50 but lots of hospital owned practice models my area, so

I have more difficulty attracting pts. Recently, slowly growing again some

due to disaffection from large " clinic practices " owned by hospital, but

mainly from a PCP passing away with no " exit strategy " .

Anyway, I find I still work better with limited staff but am increasing

automation so keeping staff costs low. However I outsource billing at 8% of

recovered money, and moonlight 2 AMs a week for hourly.

Each has to find their own way.

I like the computerization as well as having happy parttime staff, so this

has been working ok... just brought on a 1 day a week staffer who used to be

an X-ray tech/office manager for an ortho group that closed up, she's happy,

closer to 65 and I'm happy to get her.

Matt solo in Western PA

random thought re: primary care burnout

we obviously talk a lot about burnout in primary care docs due to all the

various well known factors I need not reiterate.

However, I wonder...(and this may be just cuz of the day I'm having)

Is there some inherent burn out of primary care physicians due to the fact

our job essentially is people coming to us every day with problems,

complaints and things we need to solve? Obviously with better focus on

preventative care, complaints lessen over time. But in reality, there basic

premise of our job will not likely change that much. As IMP's where we're

immensely more accessible and involved in patient's care than in traditional

practices, are we even more vulnerable?

------------------------------------

[Guest guest]

All physicians, not just primary care physicians, are at risk of burning out, if they break, faster than they heal, in response to the work at hand. The work involves trying to help people who have problems, searching to see if problems are there already, trying to see problems coming around the bend, recognizing that we all die, and not always suddenly/sweetly ... Some problems are soluble, but in primary care, a whole lot of problems are still going to be there, even after definitive diagnosis, and we maybe can only contain them somewhat, or hold somebody's hand while he dies. It is wonderful work. My father once told me that his definition of Happiness is this: " solving problems". That means, you have to have problems, or you will never be happy. Whether a flower burns out or blossoms, is mostly decided by the balance of factors -- how much sunshine, how much rain. Doctors have to find balance, just as do their patients. Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003. we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

There is a wonderful group which is dedicated to supporting physicians so they can avoid burnout and stay attached to the more altruistic reasons they chose medicine in the first place. Some of you may find inspiration or solace here as I have over the years. Happy Mothers Day to all. Kathy aka beanswww.theheartofmedicine.org

[Guest guest]

Rian,You write like a poet. The trick is the balance. We need shock absorbers for our minds and spirits. KathleenAll physicians, not just primary care physicians, are at risk of burning out, if they break, faster than they heal, in response to the work at hand. The work involves trying to help people who have problems, searching to see if problems are there already, trying to see problems coming around the bend, recognizing that we all die, and not always suddenly/sweetly ... Some problems are soluble, but in primary care, a whole lot of problems are still going to be there, even after definitive diagnosis, and we maybe can only contain them somewhat, or hold somebody's hand while he dies. It is wonderful work. My father once told me that his definition of Happiness is this: " solving problems". That means, you have to have problems, or you will never be happy. Whether a flower burns out or blossoms, is mostly decided by the balance of factors -- how much sunshine, how much rain. Doctors have to find balance, just as do their patients. Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003. we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

My office partner sees 35 patients a day. Aside from that, he works as a

hospitalist about twice a month. He works at hospice. He is also the chair of

our hospital's family practice division.

Yesterday, we were talking about how we all are " wired " differently. He sees

patients every 10 minutes and cannot undersatnd why it takes other docs 30 to 60

minutes. He has a big panel and his patients love him.

I guess " burn out " happens when we have a " wrong match " , meaning if our job

description does not match our personality. I have been there and done that. As

a family doc in northwestern Minnesota with 10,000 people, I worked in the ER,

delivered babies, went to the hospital and nursing home, After 3 years, I was

completely burned out.

There are 2 other family docs there who are still practicing. I hope that they

are doing well.

A physician-doctor relationship should be mutual. We, as doctors, give our care

and compassion. They, as patients, give us their trust, respect and sometimes a

good joke for us to continue the work of the day. I had a good laugh yesterday

with a patient who could not hit the golf ball after going for a golf lesson....

Ben C.

> >

> > we obviously talk a lot about burnout in primary care docs due to all the

> > various well known factors I need not reiterate.

> >

> > However, I wonder...(and this may be just cuz of the day I'm having)

> >

> > Is there some inherent burn out of primary care physicians due to the fact

> > our job essentially is people coming to us every day with problems,

> > complaints and things we need to solve? Obviously with better focus on

> > preventative care, complaints lessen over time. But in reality, there basic

> > premise of our job will not likely change that much. As IMP's where we're

> > immensely more accessible and involved in patient's care than in traditional

> > practices, are we even more vulnerable?

> >

>

[Guest guest]

Certainly there are times when fuctioning "alone" makes me have crazy days where I do feel the creeping of burn out. But this list serv is filled with people have supported me and that's tremendous. I think the threat of burnout is much less as a solo solo because of the autonomy -- my pracitice is full for home visits and no boss or contract can make me take more home visit patients, it's also full for new patients til I get a better handle on the billing. I'm also careful to not put my PTSD patients or borderlines close together in the schedule. If I've got a puzzling patient, i.e.possible neuro Bechets I put that one before lunch so I can recover from delivering the bad news before seeing another patient. So, personally, I think that providing care this way is way

less likely to cause burnout as opposed to the hamster wheel practices. It's vital to remember to do whatever "refills our wells" as part of the balance that lets us give and receive honor in caring for patients.

To: Sent: Sat, May 8, 2010 11:21:13 AMSubject: Re: random thought re: primary care burnout

Rian, You write like a poet.

The trick is the balance. We need shock absorbers for our minds and spirits.

Kathleen

All physicians, not just primary care physicians, are at risk of burning out, if they break, faster than they heal, in response to the work at hand. The work involves trying to help people who have problems, searching to see if problems are there already, trying to see problems coming around the bend, recognizing that we all die, and not always suddenly/sweetly ... Some problems are soluble, but in primary care, a whole lot of problems are still going to be there, even after definitive diagnosis, and we maybe can only contain them somewhat, or hold somebody's hand while he dies. It is wonderful work.

My father once told me that his definition of Happiness is this: " solving problems". That means, you have to have problems, or you will never be happy.

Whether a flower burns out or blossoms, is mostly decided by the balance of factors -- how much sunshine, how much rain. Doctors have to find balance, just as do their patients.

Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003.

we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]



Risk is also higher as you have to take ALL calls EVERYDAY from all pts.... use group here as support, but try to set up "private time" for yourself too.

Matt in Western PA

Lite staffing 1.5 FTE, still glad to have some but I support them well too!

Re: random thought re: primary care burnout

Rian, You write like a poet.

The trick is the balance. We need shock absorbers for our minds and spirits.

Kathleen

All physicians, not just primary care physicians, are at risk of burning out, if they break, faster than they heal, in response to the work at hand. The work involves trying to help people who have problems, searching to see if problems are there already, trying to see problems coming around the bend, recognizing that we all die, and not always suddenly/sweetly ... Some problems are soluble, but in primary care, a whole lot of problems are still going to be there, even after definitive diagnosis, and we maybe can only contain them somewhat, or hold somebody's hand while he dies. It is wonderful work.

My father once told me that his definition of Happiness is this: " solving problems". That means, you have to have problems, or you will never be happy.

Whether a flower burns out or blossoms, is mostly decided by the balance of factors -- how much sunshine, how much rain. Doctors have to find balance, just as do their patients.

Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003.

we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

Yep.

Some other tips for others to prevent the pitfalls I have fallen into:

1. don't put off what you hate doing til it gets to be too big

2. when taking calls keep your boundaries and be directive: "that needs a visit I can see you at 2" and keep repeating that everytime the patient begs you to treat them over the phone. Keep the calls under 5 minutes. But I also think taking all the calls saves me some work too - I can hear if a patient is short of breath and get them in right now. I know that over time I no longer get the 3 and 4 messages from the same person with the same question because patients have learned that I answer them so they don't panic about are they going to get me.

3. embrace the technology a bit faster

4. post the office as closed 2 hours before I leave gives me un disturbed time to wrap up (so the office is open T-F 8:30 - 2 but on T & Th I stay til 4)

5. don't take volunteers -- done it twice and both times burned me for billing and computer repair --- I take that back, take experienced volunteers only. (Volunteers can be wonderful --one set up my network, others rebuilt the apartment where my daughter stays, another repaired my driveway, and my office sign was donated, snowplowing is done, and intiial cleaning and planting of bushes in front of the office all done by volunteers!)

6. for billing spend the money on a practice managment system (I didn't thinking AC would have it within 6 months of opening and they still don't) and use Office Alley

7. close the practice when the work is taking too much private time away

To: Sent: Sat, May 8, 2010 11:23:31 PMSubject: Re: random thought re: primary care burnout

 Risk is also higher as you have to take ALL calls EVERYDAY from all pts.... use group here as support, but try to set up "private time" for yourself too.

Matt in Western PA

Lite staffing 1.5 FTE, still glad to have some but I support them well too!

Re: [Practiceimprovemen t1] random thought re: primary care burnout

Rian, You write like a poet.

The trick is the balance. We need shock absorbers for our minds and spirits.

Kathleen

All physicians, not just primary care physicians, are at risk of burning out, if they break, faster than they heal, in response to the work at hand. The work involves trying to help people who have problems, searching to see if problems are there already, trying to see problems coming around the bend, recognizing that we all die, and not always suddenly/sweetly ... Some problems are soluble, but in primary care, a whole lot of problems are still going to be there, even after definitive diagnosis, and we maybe can only contain them somewhat, or hold somebody's hand while he dies. It is wonderful work.

My father once told me that his definition of Happiness is this: " solving problems". That means, you have to have problems, or you will never be happy.

Whether a flower burns out or blossoms, is mostly decided by the balance of factors -- how much sunshine, how much rain. Doctors have to find balance, just as do their patients.

Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003.

we obviously talk a lot about burnout in primary care docs due to all the various well known factors I need not reiterate.However, I wonder...(and this may be just cuz of the day I'm having)Is there some inherent burn out of primary care physicians due to the fact our job essentially is people coming to us every day with problems, complaints and things we need to solve? Obviously with better focus on preventative care, complaints lessen over time. But in reality, there basic premise of our job will not likely change that much. As IMP's where we're immensely more accessible and involved in patient's care than in traditional practices, are we even more vulnerable?

[Guest guest]

Ditto. I have one FTE and I don't think I would want to do everything

all the time without some help. But, yes, I set the rules

and I decide how many pts I want to see and when. It makes all the

difference.

Ellen son, MD

Dr Levin wrote:

>

> 

>

> Risk is also higher as you have to take ALL calls EVERYDAY from all

> pts.... use group here as support, but try to set up " private time "

> for yourself too.

> Matt in Western PA

> Lite staffing 1.5 FTE, still glad to have some but I support them well

> too!

>

> * Re: random thought re: primary

> care burnout

>

> Rian,

>

> You write like a poet.

> The trick is the balance. We need shock absorbers for our minds

> and spirits.

> Kathleen

>

>

>

>> All physicians, not just primary care physicians, are at risk of

>> burning out, if they break, faster than they heal, in response to

>> the work at hand. The work involves trying to help people who

>> have problems, searching to see if problems are there already,

>> trying to see problems coming around the bend, recognizing that

>> we all die, and not always suddenly/sweetly ... Some problems are

>> soluble, but in primary care, a whole lot of problems are still

>> going to be there, even after definitive diagnosis, and we maybe

>> can only contain them somewhat, or hold somebody's hand while he

>> dies. It is wonderful work.

>>

>> My father once told me that his definition of Happiness is this:

>> " solving problems " . That means, you have to have problems, or

>> you will never be happy.

>> Whether a flower burns out or blossoms, is mostly decided by the

>> balance of factors -- how much sunshine, how much rain. Doctors

>> have to find balance, just as do their patients.

>> Rian Mintek, M.D. -- seeking solo balance in Michigan since 2003.

>>

>>

>>> we obviously talk a lot about burnout in primary care docs due

>>> to all the various well known factors I need not reiterate.

>>>

>>> However, I wonder...(and this may be just cuz of the day I'm having)

>>>

>>> Is there some inherent burn out of primary care physicians due

>>> to the fact our job essentially is people coming to us every day

>>> with problems, complaints and things we need to solve? Obviously

>>> with better focus on preventative care, complaints lessen over

>>> time. But in reality, there basic premise of our job will not

>>> likely change that much. As IMP's where we're immensely more

>>> accessible and involved in patient's care than in traditional

>>> practices, are we even more vulnerable?

>>>

>>>

>>

>>

>

>

>

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