When Burnout Strikes, Light Your Own Fire

Nearly half of EPs in the US suffer from burnout during their careers. Most don’t realize that they are in a unique position to push back against the tide.

“I woke up with the power out,
Not really something to shout about.
Ice has covered up my parents hands
Don’t have any dreams don’t have any plans.”

The 2004 Arcade Fire Song Neighborhood #3 tells the story of kids who wake up to a power outage, only to find their city covered in snow and parents nowhere to be found. Inspired by a 1998 blizzard that kept Montreal without power for several days, the song speaks to the cynicism and hopelessness of youth in a world we feel powerless to change. As an American physician in 2016, I can relate. We seemingly awoke one day to find physician’s power in medicine gone – the light out – with insurance companies, bureaucrats, and businessmen’s hands on the switch.

It’s unsurprising, then, that we find physician burnout at an all time high. 45.8% of emergency physicians experience signs of burnout, and over 60% of EPs burnout over their careers (the highest of all specialties) [1]. About half of the doctors we work with experience signs of feeling emotionally drained, depersonalization, and a reduced sense of personal accomplishment. We stand at a crisis, with no light in sight.

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A common refrain heard is “this is not what I signed up for,” and you’re right—life rarely is. We entered medicine because we thought it held intrinsic value—we could help people, save lives, make a difference. Not one of our Medical School Application Essays spoke to the virtues of “being in the top 90th percentile of Patient Satisfaction”, “maximizing patient throughput in less than 120 minutes”, or “hitting 100% core measures for the quarter.” As residents, we all were aware of EMTALA, but none of us expected insurance companies to pull the rug from under us and threaten to cut physician reimbursement 20-30% by using (or buying) their influence in the legislature. But alas, here we stand—the power has been cut out on physicians, our forefather’s hands frozen (probably from all the typing they had to do from learning the new EHRs), and we stand in a city without lights, no hope and blackness everywhere.

Except we all know, when the power goes out, eventually it will come back on. Someone has to fix the wires, find the problem area, flip the switch, and turn the lights back on in the city. But who controls the switch? We can say we’ve lost control and will never get it back, that the insurance companies are too strong, that corporate America and C-suites now hold all the cards. But they’re not the ones who can diagnose appendicitis, or know when to intubate an asthmatic, or when a febrile infant needs a lumbar puncture. As far as I know, not one insurance lobbyist has ever lanced an abscess (though I’ll happily let them try), cracked a chest, or walked into a room and told a room full of strangers that their father has died. And until they figure out how to replace us with robots able to perform shoulder reductions, reassure patients that it’s just a virus, or differentiate between a worried-well patient and a sick patient (though I’d welcome a dis-impacting robot—get on it Google), I’m pretty confident we’ll always hold a source of power that no one can ever take away. In the end, we are the one who lay hands on the patients— we realize providing medicine is not the same as building Fords, making burritos, or moving I-phones. There is no RVU or bundled payment which can properly value holding a scared patient’s hand, of giving pain medicine to an elderly woman with a broken hip, or of having a difficult conversation with a family about how their loved one has a terminal disease which exceeds the limits of medical capabilities. That is our power and our power alone, and maybe it’s about time we as physicians (and I’ll include nurses, techs, paramedics, advanced providers and the rest of the medical team in this) start to take back that ownership that no one can or ever will take from us.

We practice in a time when things look bleak. Medicine is at a cross-roads, and there is a power struggle going on for the heart of medicine. We face two options. On the one hand, we can yield to cynicism and anger, and take that anger out on patients, administrators, politicians, and even our loved ones. Such a downward spiral can only lead to more burnout, more disenchantment, and eventually we can all be medical widget providers in a dystopian medical wasteland. Or, we can harness some of our righteous indignation and channel that, to take back control over the power switch.

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I won’t lie—I’ve at times fallen into the aforementioned 45.8% of emergency physicians who have experienced burnout. This was not what I signed up for—this wasn’t even what I trained in during Residency. The only recourse I’ve found in combatting it (since I didn’t win the Powerball) is deciding that if other powers are going to try to take us down, I’m going down swinging. It’s amazing how taking steps to empower myself have helped combat my burnout—if you currently have a problem with medicine (i.e. if you practice medicine in the United States), then do something about it.

Believe it or not, you can actually make change happen. On a hospital level, start attending some of the hospital committees, volunteer to make protocols for your department, or run for medical executive committee. On a local level, join a local medical association and meet with your local representative/senator. You’d be amazed how much easier it is to get legislature to listen to you once they actually know you personally. On a state level, get involved with state ACEP/AAEM, or your state AMA. On a national level, email ACEP, AAEM, and/or AMA and ask to be on a committee  and contribute to the dialogue that national leaders are fighting on your behalf. And for God’s sake, don’t be one of those who bash medical organizations while you sit in the corner with your arms folded tight—they are all you have, pick one.

Lastly, and this is a hard American truth, you are going to have to give money to lobbying efforts to make change. Last year, the insurance lobby raised $118,603,460 [2] compared to $73,698,376 by Health Professionals (which includes non-physicians). Since 1998, the insurance industry has given over $2 trillion (over 2.8 trillion if you include HMOs) in lobbying efforts, second only to the pharmaceutical industry. Since 1998, healthcare professionals rank #13 in lobbying money given, ranking just behind real-estate agents and far below hospitals and insurances on the list. If you want to know why the healthcare laws favor the aforementioned, you can start there. Even teachers and civil servants, who make far less than physicians, appear much more savvy than us in realizing the importance of building a political war-chest (to the tune of $200 million dollars smarter. The old adage is true—doctors really have no clue what to do with their money.) To paraphrase another cliché, if you want to make a difference, give your time; if you really want to make a difference, give your money; if you want to change the world, give both.

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The power is out in American healthcare. The power is also out in the heart of 11,000 emergency physicians in the United States. It’s time we took that power back into our hands.

REFERENCES

1. http://www.medpagetoday.com/MedPageTodayat10/Burnout/54916
2. https://www.opensecrets.org/lobby/indusclient.php?id=F09