Physician burnout is a hot topic these days. A number of causes have been documented, such as the additional demands of the electronic medical record added on top of an already very busy and hectic work schedule. Additional demands include recent marked increases in administrative tasks, such as prior authorization approvals for a variety of diagnostic and therapeutic interventions. Each of these burdens is associated with a significant amount of extra work time. Thus, one of my internist friends recently told me that he has between 1.5 and 2.0 hours of extra paperwork to do at the end of each workday and that this was never the case in the past.
Having survived an every other night and every other weekend on-call training regimen, I am well aware of the stresses engendered by excessive workload demands. I distinctly remember the occasional feeling that what was being asked of me was “cruel and unusual punishment” associated with a sense of being overwhelmed by work demands. I suspect 0that this sensation is one of the key components of modern-day physician burnout.
So, what are the possible solutions to this serious issue? The American Journal of Medicine has previously published a number of articles reviewing the factors that lead to physician burnout along with suggestions to relieve the stresses that cause this condition.1, 2, 3 Suggestions include paying more attention to one’s health and sense of well-being alongside a variety of other support mechanisms at the work place, in the community, and at home.
I would like to suggest an additional simple intervention that could help to relieve the symptoms stemming from stressful employment: decrease the workload! My father was an extremely busy community dentist with a very large practice. He would close the office on Wednesday afternoons, all day on Fridays, and Saturday afternoons. He was meticulous about ending his work day at 5 PM on other days in order to be present for our family dinner at 5:30. He felt that work was very important but so was time with my mother, my brother, and me.
I have observed that many of today’s physicians fail to take off adequate time from work. Personal observations include one of my former colleagues who left university employment to take over a busy private practice. When leaving the medical center at the end of the day (usually at 6 or 6:30 PM), I frequently encountered him coming in to see one or more of his private patients. During one of our encounters, he informed me that he still had another hospital to visit that evening and a large pile of electrocardiograms to interpret. When I commiserated with him, he told me that he was rarely home before 8 PM most weeknights. I said nothing about this obviously excessive workload but had a sense that this was not in my colleague’s best interest. By the way, he died of metastatic cancer in his early 60’s.
My suggestion is to modestly reduce physician workload—See fewer patients each day and insist on saving time for oneself, friends, and family. Yes, this will mean a modest reduction in income. However, let’s face it, we are all well paid, especially in comparison with physicians in other countries. Physicians who complain about their workload often drive the most expensive cars (eg, a Jaguar costing $60,000 to $100,000 or more depending on the model). Why not be satisfied with a less expensive car (eg, a Toyota costing $20,000 to $30,000) and work fewer hours? There are a variety of other modest examples of thrift that can be implemented in order to decrease an excessive daily workload. For example, one might spend the family summer vacation in an apartment on one of the Hawaiian Islands rather than taking a 5-star cruise to Tahiti. Vacation rental apartments are not expensive and usually come with kitchens, thereby obviating the need to eat every meal in a costly restaurant. Indeed, there are a variety of other simple measures that could and would reduce personal expenses and yet allow for a continued wonderful lifestyle. Another example is purchasing clothes from less expensive stores during sales. A number of other simple measures to reduce conspicuous consumption are easily imagined. Another benefit that results from modest thrift includes dispelling the commonly held idea that all doctors are “rich cats.” We should take a lesson from Sam Walton, the founder of Walmart, who was extraordinarily wealthy but always drove an old pickup truck!
Perhaps, I have arrived at this approach to life because I grew up in New England where thrift is a virtue and with parents whose families had survived the Great Depression by strictly economizing their lives. Nevertheless, I think that we would all benefit by simply reducing our workload and instituting some modest personal and family economizing. I believe that this will lead to less work stress, greater personal happiness, and a reduced risk for burnout. As always, I welcome responses to this commentary at jalpert@shc.arizona.edu or on our blog at amjmed.org.
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-Joseph S. Alpert, MDa,b
