Vania Manipod, DO (left), talks with her colleague Brittany Byron, a coordinator/technician, at her psychiatry practice in Ventura, California. Burnout led Dr. Manipod to reduce her work hours in 2014, a career change she says has greatly improved her quality of life.
Battling burnout

More than half of US family physicians are burned out, according to survey

Learn the top physician-identified causes of burnout and what some doctors are doing to address them.

More than half of family medicine physicians feel burned out, according to a Medscape survey of nearly 16,000 U.S. physicians. Survey respondents listed the following as the top causes of burnout:

  • Bureaucratic tasks.
  • Working too many hours.
  • Not earning enough income.
  • Computerization of the practice of medicine.

When a physician feels burned out, it’s important to step back, examine the work environment and figure out what’s working and what’s not working, says Heather Fork, MD, a physician career coach and former dermatologist.

“You can even look at it as if it’s a marriage,” she says. “Ask yourself: How do I feel about this relationship? Do I need counseling? Do I need to get a divorce?”

Many of Dr. Fork’s clients come to her unsure if they want to continue practicing medicine. But the majority of them end up staying in practice once they figure out how to adjust their work lives to reduce burnout-causing stressors.

Below are a few potential solutions for the most-identified sources of physician burnout, tailored to family physicians.

Bureaucratic tasks

Physicians often want to say “yes” and can end up with an abundance of duties that become overwhelming, Dr. Fork notes.

Heather Fork, MD

Dr. Fork suggests family physicians make a list of all their tasks, including nonessential work, and consider whether some duties can be delegated or dropped altogether.

She recently worked with a family physician to create such a list. “As soon as the physician decreased her optional participation on administrative committees, she was able to finish her charts and go home at a normal time,” Dr. Fork says. “It took her just a few weeks to make those changes.”

Working too many hours

A heavy workload and lack of control over her schedule were the major reasons Vania Manipod, DO, a psychiatrist in Ventura, California, quit her full-time job at a large group practice in 2014. She now works about 27 hours per week at a small private practice, compared to more than 40 in her previous position. This change has significantly affected her career satisfaction and exponentially improved her quality of life, she says.

Going this route will be scary for many physicians, but Dr. Manipod, who has written about her experience for KevinMD.com, suggests overworked doctors consider switching to a reduced schedule for a year or two to give themselves time to determine the type of work environment they enjoy.

“For me, it’s been very feasible financially,” she says. “Taking a pay cut and not having benefits was worth it for me in the long run.”

Not earning enough income

Many physicians working long hours feel their take-home pay doesn’t align with their efforts. Dr. Fork suggests physicians examine their compensation against the actual hours they work each week to determine their real hourly income. If it’s significantly lower than they’d like it to be, one option would be to reduce clinical hours and pick up side jobs that pay for hours of work completed.

Potentially lucrative options for side work include the following, Dr. Fork says:

  • Chart review.
  • Expert witness work in medical trials.
  • Third-party assessment on disability and worker’s compensation claims.

Computerization of practice

Physicians who find working with electronic health records to be a daily struggle should track their usage and efficiency for one week, Dr. Fork says. Then, they should try different approaches to handling EHR entry and compare the various methods. For instance, if you always complete data entry after each patient visit, try starting it during the patient visit instead.

Hiring a scribe is another option, she notes.

Many EHR systems offer tech support and training, notes Robert DeLuca, DO, a member of the American College of Osteopathic Family Physicians’ Board of Governors. “It’s important to have someone you can call when you hit a technical roadblock,” he says.

29 comments

  1. I burned out about five years ago after 30 years in private practice. Sold my practice to young doc for nil. Took a year off and rejected many offers to work and finally settled on part time consulting. Big pay cut but life is good again. Simpler lifestyle is enriching and fun again. Gave up many professional positions. Wish I would have done it 10 years ago. The smile on my face is real again.

    1. I’m feeling ya!!! I did the same thing, just this past year. Very grateful to still be able to help and serve those in need of good medical care, doing so from my caring heart.

  2. This article and its “solutions” are a bunch of nonsense. Here are the REAL reasons for physician burnout:

    #1 reason: Government interference in medicine.
    #2 reason: Our associations, such as the AOA, keep throwing us and our patients under the bus.
    #3 reason: Our associations, such as the AOA, are pilfering tons of money from us, and providing us no benefit in return.

    1. The AOA needs to get itself a new direction and try to improve its members’ lives . Making membership in AOA a mandatory part of Board Certification – really ? Obviously the AOA realizes no one would belong based solely on loyalty . That speaks volumes about its methods .

  3. I agree as well. You know, most of us know our jobs pretty well. But we have bureaucrats and government bean counters who feel that they are better qualified than we are to practice medicine. I find it additionally astounding that we are forced to use an electronic medical record that directly takes away from our time with patient care AND THEN is used to quantify the quality of care that we provide for the patient! Utterly astounding! You want to know the reason for burnout? It is non-medical entities crippling our ability to do our jobs, and then paying us less for the work that we do, while multiplying the obstacles to affordable, compassionate, and efficient care.

  4. Government, insurance companies and other 3rd party payors keep increasing administrative tasks as they continually look for excuses not to pay. The solutions listed above are largely unworkable for family physicians in rural areas. I am also seeing a shift away from our associations advocating for us and toward “giving us solutions”, ostensibly indicating that we physicians are the problem.

      1. Hit the nail on the head Dr. Damon. It’s like a mafia protection racket. You pay us “protection” money, and we’ll let you keep working.

  5. The requirement that DO’s maintain full membership at $700+
    In order to maintain board certification after retirement unfair. Would like to provide indigent care but my “taxes on being a DO” make that less attractive. The MD’s have long criticized the bureaucracy of the AMA. The AOA has an opportunity to lead in this area. A M Ernst, DO, MBA

    1. There is a privileged class in the AOA – those DO’s certified prior to March 1997 have made themselves so. They doubled down with the utter farce that is OCC, making themselves exempt also.

      Enough is enough. OCC is a hold up for money and does nothing to protect the profession or the public interest.

  6. All of the above comments, ring in truth. Unfortunately, I believe no one really cares, who are in a position to help us.

  7. There is something wrong when our own professional organization – the AOA – is adding unproven, costly nonsense to the already high cost of maintenance of board certification.

    Osteopathic Continuous Certification (OCC) is an outrage that needs to be consigned to the trash hill of history. It is expensive in both time and treasure. Those DO’s who voted for this travesty while at the same time exempting themselves from it should hang their heads in shame.

  8. A scribe? That sounds wonderful! Let me know when Dorothy clicks her ruby shoes and we can make it happen.
    Seriously, what payors or patients will increase their reimbursement to PCP’s for this added overhead expense?
    Should the scribe be paid before or after I pay my IT guys, EHR license fees, document scanners/linkers etc. (overhead expenses all necessary for me to have the privilege of using an EHR which adds 1-2 hours a day of uncompensated work time per FTE doc.)
    Lets get real and talk about how EHR’s require more time to document a visit, easily bury significant data and substantially increase the volume of pages forwarded (multiple copies at the click of a button/”auto fax” set up) to PCP’s from specialists with no concise, clear consult findings and recommendations.
    Combine this with patient expectations that “preventive visits” should cover the evaluation & management of their symptom/problem !

  9. This is a fairly superficial analysis of a deeply complex issue, with oversimplified and platitudinous solutions offered. Can we get a little more substance please?

  10. OCC, Meaningful Use, PQRS, and the lists go on. If any of these measures have improved the quality of care our patients received, there value has not yet been recognized by me. Likewise, I suspect that the AOA membership benefits a small percentage of the members, while the rest of us are paying a ransom to remain in our specialty college. The strength of this organization will always be determined by the care and compassion that the members provide to their patients. All this bureaucratic nonsense will ultimately result in the opposite intention. More time spent on regulatory requirements would logically mean less time for patients, but since caring less for our patients is not in our nature, and most of us are not robotic, burn out is potentially one day ahead. AOA needs to focus on objectives that make medicine a desirable and rewarding profession.

  11. One of the biggest reasons for physician burnout is that the D.O.’s member organization, the AOA, makes medical practice more and more difficult. The AOA goes far beyond the federal government’s requirements. Support of Maintenance of Licensure, needs assessment and recertification are several of the areas
    where the AOA has worked to the detriment
    of its members and has made the practice
    of medicine more difficult.

  12. Exhausted. Tired. Changed jobs to avoid a commute. Paid loans off at 42 yrs. 2 kids. 6 yrs post loan pay off. Surviving marriage. 10-12hr days including computer work. I sit at home gracing the kitchen while doing charts. What pleasant family time. I currently work 3 full and two half days. This is after I cut back.

    Scribe? Did try. No real help. It’s clearing Rx tasks and labs that even on a high speed network is slow. Tried 2 screens at once. Bifocals. Multifocal contacts. Large monitor. Then one day my new unannounced for gift, the twelve inch screen even an ant could not read and pity someone with arthritis or a hand tremor to toggle and cram onto a key board. IT forgot to ask whether I needed a new computer? And, I just love those Allscripts upgrades that scramble the screen and rename sections. I was dropped off prescribe and radiology order for two weeks two years ago. Well, there was a ticket created to fix this…. I tried scheduling vacations during upgrades and then the upgrades were delayed. Anyone who has lived this can chuckle and groan.

    Meditating myself into a green meadow with a closed door and music works at lunch. Wait, I have to run and pick up a kid from school! Quick, get all the telephone calls and Rx’s done.

    Delegate? Yes, we do. Imagine though most of us now work with medical assistants, no nurses, and a telephone pool. Imagine phonetically spelling messages until you can figure out the mispelled Rx or question.

    Physical therapy for thoracic outlet. Sitting with warmed buckwheat pillows so I can turn my head after typing. I am trying out Dragon Speak (again) with my Flamingo buddy mic now to spare an arm.

    ABFM -must do more modules on computer! Because we must do computer simulated learning and patient modules. Some academic thought this brillant idea up. When to find time? On my vacation of course! Gee, can’t wait.

    The one nice moment. Treatment with OMT. Will take microwaveable buckwheat pillow on vacation. This is because we finished all the charts the night before the trip.

    IT took money for medical assistant pay raise. IT dept could not be bothered to tell physicians in group about mobile hot spit for when kids had sports tournaments and I tried to use a hotel WiFi. But, IT depts are helpful? They certainly get paid well.

    Will work until 60 yrs and not sure if I can stand the thought of full time primary care. Has all the stress been worth it? I used to think so. I liked medicine at one time.

    Our AOA and ABFM ought to be thinking about how to help us. We deal with a constant barrage of oversight from our academies, the insurers, P4P, the patients on the portals., our medical groups…Maybe the answer is to answer to one entity once. The computer generated modules are not the answer nor is any more regulation. We need to roll back and push back on some of the Obamacare regulations that are more similar to “needless use” parameters.

  13. The best thing a young physician can do is save his or her money and get to the point of financial independence. This is the only way to true freedom. Complaining about the system and allowing burnout to happen will not help. Save yourself. Your own good health is everything.

  14. I agree with all the above comments. If our organizations don’t represent us, then how we stand up for ourselves as physicians to unite and protect our profession.

    Now with upcoming 2019 Medicare mandates that all physician will be reimbursed either through merit based or an ACK model payment, which backed up by AOA and AMA. Until we physicians do something, everyone will continue to take advantage and make our daily jobs increasingly difficult.

    This is really sad because I love my profession and my dear patients.

  15. I agree with all the above comments. If our organizations don’t represent us, then how do we stand up for ourselves as physicians to unite and protect our profession.

    Now with upcoming 2019 Medicare mandates that all physician will be reimbursed either through merit based or an ACO model payment, which backed up by AOA and AMA. Until we physicians do something, everyone will continue to take advantage and make our daily jobs increasingly difficult.

    This is really sad because I love my profession and my dear patients.

  16. Medicine today reminds me of the Titanic.
    A lovely chaos after the Iceberg struck which we now call the affordable care act.
    Like the Titanic if you like the ship you could keep the ship. Aw such glamour in meaningless promises crafted by those to whom deception is an art form.
    As we are told there are infinite ways to reduce our stress and distress practicing medicine today remember the souls of the titanic were likewise appraised of the infinite portals and ramps they too could use to disembark…..Straight into the frozen death of the North Atlantic and that without remedy.
    See the Titanic and American health care system aren’t really so different after all…..

  17. I love practicing insurance plans instead of practicing medicine. I also got a great deal on a bridge in New York. I agree with all the above. Sad day for healthcare.

  18. Starts with college debts. Then medical school debts. Then we do residency training and as primary care providers we are given minimal pain and the deluge of the dumping syndrome from every other specialty.

    Dream of a union where we all walk off the job for two weeks and see what the world does.

    Insurance companies have created an environment where there is no competition. Government action supports the wasteful system we live in rather than look at options that will provide adequate insurance.

    How about $511,000,000.00 B-25 bombers that will when in the air be a $800,000,000.00 if that (29 years military, I know of what I speak), but do they care there is no psychiatry support for most Americans unless court ordered or pay-for-service?

    The problem is not the AOA. It is the government insuring we struggle as indentured servants to education/medicine and security in old age.

  19. Yes, the above suggestions all rest on the physician changing, and not the causes changing. That won’t help!!! If you want better ideas, I would suggest checking out Pamela Wible’s site, she has good ideas on how to make life better (direct patient care, low overheads), and also the HappyMD website, and his book – Stop Physician Burnout. They both have wonderful ideas, and tell us that it is not ALL OUR FAULT! Because it isn’t all our fault. It’s not all because we can’t say no. What about the requirements we have to participate in some of these meetings in order to stay on med staffs? What about all the meaningful use boxes we have to check in order to make the system happy and let them get paid? What about IT not caring about what would help our system flow better for patient care and just labeling all of the providers whiners and ignoring our requests? None of which has anything to do with actually providing the quality patient care we want to provide. I honestly feel I give worse patient care because of how much my hands are tied by the EHR, by the government, by the ever changing formularies for insurance companies telling me what I can and cannot prescribe. It never ends. I cut down to 3 longer hour days from 4 shorter ones, and it has allowed me to survive. Barely. I take a handful of supplements every day just to try to keep going. Don’t tell me I need to fix me. I’m doing that, who’s going to fix the main problems is my question?

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