Depressed doctor: “I’m angry and frustrated and lost.”

DepressedDoctor

This is an email subject line from a doctor. Letter published with permission.

Hello Pamela

I have become so disillusioned with medicine. I do not know who to talk to any more or what to do with my life. 

I work one week a month in the ICU. I spend the other three weeks of the month in an outpatient clinic. This is a nightmare. The Electronic Health Record they have in place makes me so slow and inefficient I want to scream when I come to work everyday. They want me to see new complex pulmonary consult patients on the hour every hour. Frequently, just to review their imaging, labs and special studies takes 15 minutes before I even walk in the door to meet the patient. Today I saw 8 new patients in eight hours. I need at least 60 minutes per new patient and a buffer of at least 15 minutes between patients to complete my EHR charting. I am so frustrated and just want to walk away but where does one go. It is the same everywhere now in the USA. EHR’s and conveyer belt, output-driven medicine. I feel trapped and betrayed. I did not go to medical school to sit on my butt for four to six hours a day doing data entry in a computer.

I feel so deflated and trapped. Have to work to pay for the kid’s college and have health insurance for them and yet there is no joy in the work anymore. I find the hospital and the ICU more stimulating but the pace and the hours are brutal. Therefore, I decided to give this more lifestyle friendly version a try. My hours are meant to be 8am to 5pm but I arrive at 7am and leave at 7pm to try and keep up with the EHR communication method and clinical charting. I get every Monday off but it does not make up for the frustration of the four days I do spend in the office.

I know I am being extremely negative and I can not seem to see the forest from the trees. I have lost my joy and my soul is sad. I never used to feel this way about medicine. 

Any suggestions Wise One ??

Wise One to Sad Soul:

1) You are not alone! You’re having a normal reaction to an inhumane health care system—a sad soul.

2) People don’t complain about things they can’t fix (like gravity). You complain about EHRs and assembly-line medicine precisely because you know there’s a better way.

3) The real problem is—us. Yes. Doctors are to blame. We’ve relinquished control of our profession to those with divergent ethics. We’ve allowed ourselves to be abused en masse. You can’t be a victim and a healer. Choose one.

4) YOU can free yourself from the paper chains. 

5) A dysfunctional medical system can only exist on the backs of disempowered physicians—the precursor of which is abused medical students. 

6) Medicine is an apprenticeship profession. Liberate yourself and you liberate the next generation of doctors. 

7) If you do not know who to talk to any more or what to do with your life, start hanging with happy docs. Can’t find happy doctors? Click here to meet some.

~ Pamela

P.S. Anyone else with advice for sad doctor? Please leave your comments below.

Pamela Wible, M.D., is a pioneer in the Ideal Medical Care Movement. She has helped hundreds of physicians reclaim their happiness and their careers at her physician teleseminars & retreats. Dr. Wible has been awarded the 2015 Women Leader in Medicine.

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97 comments on “Depressed doctor: “I’m angry and frustrated and lost.”
  1. Dawn says:

    My heart breaks for every medical provider who is feeling this way and I’m afraid it may be more of the norm than any of us can imagine. Who could possibly be happy working in conventional medicine today with all the disconnect from true patient care and all the pressure for production, EHR, and the dreaded ICD 10.

    I’ve been a family nurse practitioner for 15 years. I left family practice after 10 1/2 years and spent 3 months crying. My soul felt crushed and I had no idea what to do next.

    I’ve mostly been doing locums assignments since then. I live very frugally and work as little as possible. Doing locums work has given me the chance to travel and meet a lot of wonderful people. It has also made it clear to me that conventional medicine is in crisis. There is a huge need for primary care providers and the providers are very unhappy every where I have been.

    Just last week I began an assignment that I think I will love (loving what I’m doing is something I haven’t felt in a long time). I’m working at school based clinics in Tribal schools on the Fort Peck Rez in NE Montana. I’ve had tears of gratitude several times this week to be doing what feels like meaningful work without all the crap. There is still an EHR to deal with but the focus here is to be here for the children.

    Meanwhile, I’m studying functional medicine and hope to someday open my own little practice in my hometown in Northern Wisconsin.

    To all the providers out there who are in pain. Don’t ignore what you’re feeling. Your feelings are your guide. Listen. It’s very hard to figure out what’s next and I know you may feel trapped in so many ways including financial responsibilities.

    Focusing on compassion for others helped me to survive in conventional medicine until I found a way out. Go to Pamela’s retreat if you can (I haven’t but would love too!).

    Take care everyone,

    Dawn – a surviving nurse practitioner

    • Romina says:

      That’s great Dawn! I think this poor doc needs to quit and start his own. He is certainly not alone.

    • Michelle says:

      Hi, Pamela.

      Since I started my work with you, I have never felt more positive. Now, granted, I still work 12 hour days at minimum, and I recently worked 14 days in a row just to be certain I could be off to celebrate my son’s 16th birthday…

      What has made me positive is the following: realizing I am smart and worthwhile. Realizing I do not have to make money for the CEO in my company (do you know he took home $8 million last year, by the sweat of my brow and others)? I imagine those who built the pyramids, the slaves in the cotton fields, the kids in the sweat shops. We MDs do not have to be the slave forces in the US medical system. WE CAN CHOOSE!

      I would love to connect with this subspecialist, because he or she is in the same boat I am in, only they at least get Monday off.

      1. First step- Realize you are running the train. As you are developing your plan, draw your boundaries, and let your partners/administration know you will be taking a lunch break in the middle of the day, you will leave by a certain time, and start at a certain time. THEN STICK TO YOUR BOUNDARIES

      2. Next step- visualize your practice of medicine as you have always wanted to run it. (And of course, connect with your patients and ask…)

      3. Sketch it out on paper and build, just the way you have told us, Pamela.

      I lost my phone after 14 days of call. My new one should be coming in soon. PLEASE feel free to give this person my contact information. I am glad to actually talk them through, although they may not be ready.

      PS
      I started “running” (if you wanna call it that) with my 12 year old son’s track team. I am finally alive again. I have not run in over 10 years (I have prosthetic hips, thanks to the rheumatoid arthritis, thanks to the poor diet I ate…)

      Hope this helps. I so much want to help my colleagues.

      Michelle

    • Suzanne, retired RN says:

      Realize you have options. If you are in an impossible situation, then change it or get out. Change requires a lot of communication with people in administration. You have to tell them what you can handle and are willing to do. Believe me, they do want doctors to stick around.

      If you need help with attitude change, then consult with Tony Robbins. He isn’t a therapist but has helped so many people realize the choices they have to make to improve their lives. If you have depression, then get help with antidepressants and/or therapy. There are national confidentiality laws for therapy that apply to doctors as well. Don’t be paralyzed by fear, what if, what if…. So what if someone finds out you are in therapy. Just tell them to “get a life.”: Do you think it is such a bad thing that you can’t get therapy because you are a doctor and someone else might find out? They don’t have that kind of power over you. If an administrator finds out, then start a law suit because it is none of their business.

      As far as addictions, I know you have to comply with state requirements, but many doctors have done so well in recovery and then have a life better than they ever knew. I know, I have been in 12-step programs with doctors.

      These days, when someone tries to put their kids through college, with the cost of that, it is impossible. They just have to get student loans or scholarships – they would rather do that than lose you.

      Realize you deserve to live and don’t give your power away. We all have to do it as individuals. Health care has always been busy and demanding and it won’t change but you can.

    • Anita says:

      A Christian Nurse for a suffering Doctor’s Soul?
      I work in Internal Medicine. I see the plight of all that you say. The doc’s in my hallway are having to cut back their hours to cope. This is one of the top rated large medical centers in the Seattle area. Answers come, often in small steps, to those who seek, if you believe. Dr Wible is one of those answers. Check out Mercy Me lyrics on line to “word of God speak”…”would you pour down like rain” If you’re not Christian, it still helps to look for the answers in your heart, then take one step at a time in the direction that seems right. Dr Wible seems right…and you might find other answers as well. Believe in yourself and what your heart says.

    • Dr. Wibble’s response is comprehensive; all salient points are addressed. The letter writer is doing many things right and will continue to do what is right because of Dr. Wibble’s courage to speak up about what is really happening to many doctors, especially physicians, in healthcare currently. In my opinion, a good support system or group does three (3) things: 1) reduces isolation 2) removes any ‘stigma’ associated with concern and 3) provides solutions available locally and/or nationally. Thanks for this forum.
      Dr. P. Edwards-Conrad.

  2. Pamela Wible MD says:

    Per Cheryl Thomas-Nduati

    You have hit center mass of the problem, with point numbers 3 & 4 okay all of them. Just last week as we seat in the weekly meeting. Instead of focusing our attention on the most complex and problematic patient(s), we focused our attention on the most overworked and worn down doctors and the team in need of the most help, in our large clinic.

    Our clinic and building are closed over the weekend, staff had been instructed to clear out the building one hour after the clinic closed for the day. The Chief of Medical Staff, anawesome woman, popped up on a Saturday. What she found was almost a full house of medical providers, dept. heads and nurses. Why? they had come in to catch up on “paperwork” for exactly the reason your depressed doctor wrote, slow technology.

    Our Chief of found that our providers and their teams are so underwater in paperwork, backed up in returning T-Con’s to patients, and just overall totally over worked. It made her mad.
    She gathered a few critics of the doc’s and made them along some of those who have the power to change things sit down and go through the paperwork process from start to finish. These people suddenly saw the light. We have a few meetings this month on process improvements.
    A few people have been told that new personal will be coming in to help off load the work from the doctors. There are a couple of doc’s for whom, we are working to off load and balance their total patient loads already.

    Totally awesome is, that the chief of staff allowed us to put off our work for better serving some patients for a bit to instead she has asked our team to see how we can reduce the load on all docs. She said “ whatever we can do to off load their work she is behind it, just tell her what she needs to do to make it happen”. In fact this Tuesday morning, we will meet and we have been ordered to each have at least 3 ways that we will strive to improve our processes. The total plan will be completed by this time next month and then put in stone. We will be held accountable to achieve these goals. Did I say I like a person of action!

    What we need are more folks who are willing to take back control and fight for themselves and their co-workers.

    Cheryl
    Thanks for all you do

  3. Terri Bowland, DO says:

    To Sad Soul Doctor –

    You are not alone. The responses above are so true. Take a step back from all of this. Take a deep breath. This is not what you or me or any of us signed up for. I cannot believe that this is where we are at but it is and we can do better. Get the help that you need to make healthy decisions for yourself. This group is a tremendous jump start to get you pointed in a totally different direction and to provide much needed HOPE and help.

    Physician mental health (and physical and spiritual) is in crisis. There are a few paths out from docs and healers who have already figured it out. Listen to what they have to say and then implement what works for you. You don’t have to stay in this spot. You are NOT trapped. There are options for you and some good ones. Get help now.

    Make a decision to take charge to be “your own best friend” if you will. It may sound corny but I know there is something better for you than what you are suffering through. The system is broken and now it’s trying to break you. Don’t let it!

    Reach out to this group – we would love to have you!

  4. Cheryl T says:

    Pamela,
    I do agree with you and the points you made. I would also say to the depressed doctor, consider moving into public health in the area of policy. Why Public health? it’s awesome. Allows one to find that “thing” that makes one want to wake up and get going in the morning. The years of medical work and training are used in new ways. Policy – working to making the change that is so badly needed.

    Consider research, teaching at a college, or another area in the medical field. When going to work makes your soul sad. It’s time to make a change. Things come and go in our life for seasons, we shouldn’t be locked into anything that makes our soul sad. Sometimes off loading some of the many things we think we need is very freeing.

    Hope that helps.

  5. Ralph Smith, M.D. says:

    Many physicians have experienced what you describe. Solutions are out there and the comments above direct you to some. Another tack is to look for opportunities to do concierge medicine and a practice without having to bill insurances and having to deal with electronic health records. Stressed out physicians can use this helpful site and can also consider individual executive coaching by someone knowledgeable and sensitive about these problems. Such a person can help you develop strategies and tactics to solve your issues. Pamela has a contact for this.

  6. Regina Puratich says:

    My heart truly goes out to you in your suffering and search again to connect with your integrity. When I found myself in the position I sought to understand what was happening to me. My journey started with reading whatever I could to understand burnout and stress in relation to being a medical provider. The facts helped me move from a reactive stance to my situation to a thought out response. I could not change the situation immediately; I did not know how to leave the situation so I learned how to change my reaction to the situation. Through this process I managed to come to what I call “an understanding with medicine and health care”. Would be happy to share bibliography, stories etc.

    • Tshepang Darlene Mothibi says:

      Hi to Regina. please share as I need to do more reading on burnout and am currently going for therapy to reduce the stress levels. It seems that when you opt to take your time and listen to patients the factory churning MO’s keep barking at you all day and it gets stresful to work with such stalwarts. crossing my T’s and dotting my i’s was not what I thought medicine would turn out to be like but even in third world countries we suffer the same queues and the pt/Dr ratio’s are a nightmare. I need to read a bit more on burnout and I realize it fits the bill to a T.

  7. Pamela Wible MD says:

    Anonymous psychiatrist, age 54, still loving his job writes:

    I might go practical. First I would suggest an outside hobby that must never be missed and is totally outside of medicine. Second he should meet with his employer and strongly suggest one simple change…..one less patient a day so he can have an hour to catch up. If that doesn’t work, maybe 2 less patients a day. Third, really focus in on what the patient wants and spend less time with records and more time with the patients. He is seeing very sick people who probably want someone to just slightly improve their quality of life. I saw a guy today in my office with COPD and severe chronic pain. He was thrilled by how much better he felt when his pulminologist turned his oxygen to 3 liters because he could go for longer scenic walks in this area. Get to know the patients and enjoy their personifies and histories. Patients love to tell stories and he might learn from them. For me going to work is like going to a movie but I get to be one of the actresses and that analogy is fun. Ask him about other symptoms of depression or substance use and if they are there suggest private evaluation and treatment. I see depression in that letter but that may simply be my bias. Ask about suicidal ideation of course he is reaching out to you so be cautious and thorough. That is what comes to mind hope it helps!

    • Pamela Wible MD says:

      I tried to post the following reply, but I’m not sure if it “took”. This was in response to “Anonymous Psychiatrist”, and I wanted to use the pseudonym “Anonymous Non-Psychiatrist Physician”:

      While I agree with “Anonymous Psychiatrist” that a physician struggling with substance abuse, depression, or other mental illness may (like any other person) benefit from professional medical and psychological assistance, I would strongly caution any physician who seeks out such assistance to do so in another town (preferably another state), using a false name, and paying in cash. This is the only way that physicians can truly receive confidential assistance for these irrationally stigmatized personal and private health conditions. Most states require all licensed healthcare professionals to report physicians with suspected substance abuse or mental illness (including depression) to their medical licensing boards for investigation of potential “impairment” (statutorily defined as simply HAVING a diagnosis of a substance use disorder or a mental health disorder as described in the current DSM). Ironically, investigation for potential health “impairment” generally creates permanent career impairment — often culminating in license restrictions, loss of malpractice insurance, loss of employment, loss of hospital privileges, adverse public state medical board orders, adverse reports to the National Practitioner Data Bank, and eventually unemployment and financial ruin. Now THAT’s depressing.

      Would you mind posting this for me?

  8. Anease Brooken MD says:

    A common thread in all the answers is that the state of you soul matters. I couldn’t be more in agreement.
    From a spiritual, personal perspective- you have invested a great deal to be able to do what makes you happy, what gives you life, and what establishes your purpose….and at the end of your life that will matter more than all the other benefits of your profession.
    From a practical aspect- if you ignore your sadness and frustration it is NOT going to just go away. My story is that it actually culminated in a crisis earlier this year, which was brief, but caused more damage than I could ever imagine. I was getting the “work” done, and no one suspected a thing, but inside the inadequate time allowance forcing trite and terse interactions with my patients and the stress of safety issues created by policies largely generated by the managed care system were eating at my soul and making me more unhappy than even I realized. Though not working now due the issues created my crisis, I am happier and much more optimistic, though facing significant, but different issues.
    So my advice is NOT necessarily to abandon ship. I am saying that the issue you bring up is important enough for adequate attention. I agree with not wasting your time and energy trying to get them to change the unchangeable, but perhaps you could identify one thing that would make your situation more fulfilling and benefit patient care significantly. Then plan and develop strategy regarding the best way to gain it like maybe 1) Generate shorter but adequate documentation strategies ( I recall doing this by taking cues from the notes of physicians that predated me) or maybe try and 2) Compel the hospital to make better happen. If you need the assistance of a PA or ARNP, perhaps demonstrating in writing to the correct individuals how such additions could improve the quality of care and efficiency will cause them to consider the wisdom of such a step.
    I also suggest finding some venue to discus “life” with folks that will likely understand. I have found the “stranger-friend” (old friend from undergrad who also went into medicine for instance) to be beneficial because they are far enough from the actual situation not to cause unwanted ripples, but close enough to you to be comforting.
    Most of all- don’t give up on better. It is out there. Your soul is not meant for torment!

  9. Neena says:

    Physicians need to demand rights as have mid level providers. Why can we not unionize? malpractice, other litigation, politics of hospital privileges and physician monitoring programs ( without) due process I America. iInefficient and cumbersome medical charting, terrible reimbursements seemingly price fixing. The explosion of healthcare knowledge and struggle to keep up even studying 10 hours a week.

    • Alicia says:

      Neena, I believe you have hit the nail on the head. We as physicians belong to a professional managerial class of workers, which like most other workers are being systematically disempowered and forced to accept dehumanizing work conditions that benefit the bottom line but not our patients. As individual workers, unless we offer some extraordinary skill set not easily replaced, we typically have 2 choices: suck it up or leave. If you are an ICU intensivist, well, it isn’t easy to start up your own ICU is it? We need to unionize because fact is they cannot fire all of us. I’m in Canada and our antiquated medical associations also need to be replaced with unions. It’s not much different here.

      Short term, this doctor needs to safeguard his or her mental health because it’s a long way back from depression, burn out and being very suicidal, which I know from personal experience. Know this, you are not alone and your colleagues feel for you.

    • annette says:

      I hear about byzantine federal prohibitions against our unionizing. I don’t know exactly what the laws state or what laws they are, but I’ve read on another blog that we could find ourselves in federal court if we tried unionizing. Does anyone else know about this?

  10. Maggie Genius- view as a patient says:

    I agree there are many stressed out frustrated doctors. I pray for a solution to this system wide problem. But, I encountered an ER physician who seemed to have found his own solution. His records are completed based on observation. Questions are few. The diagnosis is obtained by using the few bits of data (some incorrect when I read my chart) he pulled from the air. He was probably anxious to return to the hole he was hiding in while I waited over an hour in the empty ER. My chart said I came in for jaundice and not severe pain. He never asked about my meds or possible cause of pain. I’m a 64 year old female on limited funds. If I had known the doctor was going to be useless, I could have used the over $500 bill to get a bottle of vodka to knock out the pain.

    • Anease Brooken MD says:

      I hear you, Maggie. Unfortunately your experience is not at all uncommon. I am so sorry you were stuck with a high bill and no solution. Many times the hospital will work with you on unaffordable ER bills. Also, sometimes calling you physician’s on-call service can help you know whether reporting to the ER is the right decision.

  11. Jed says:

    Advice… I wish I had some…
    I am in the same boat, I have been an emergency Medicine PA for 24 years. I used to LOVE what I did, it was the only thing I ever wanted to do, or be, it defined me. For the last year, it has become a nightmare, with no end in sight, and nobody to talk or vent to. I have a director who is largely absent, and is only concerned with patient complaints and keeping the contract with the hospital system we contract with. I feel like an emotionally neglected child in a dysfunctional abusive family…
    J

  12. Pamela Wible MD says:

    A few comments via email:

    well, Pamela, my response is below, my initial thoughts on the subject. in the schema of it all we are replaceable cogs in the fucking system. but I am out. smile.

    Medical school, residency training, practice is a long arduous process of (basically) prolonged adolescence. A lot, a ton of information is learned, used, not used, disused atrophied, and the routine (basically) is hazing on a major scale. i.e. the shit always flows down; those before and above got dumped on and could not wait, were so very anxious, to do their ‘fair share’ of dumping. It is narrow. It is cloned conservatism. It does not like ‘different’. Key to get through it is the escape mechanism, i.e. what do we all do to allay the constant continuous inevitable stressors? In Colorado, most take advantage of the outdoor lifestyle. Wherever you go, there you are, practice is the same, the office clinic hospital etc is the same. What is different and what matters is what to do on that off time apart from physical exercise ‘burning’ away those inevitable stressors clearing the
    mind and body of the irritation and cob webs and hell of it all. Practice et al can be, is, hell on a relationship, primary being the relationship we have with ourselves then whoever is in our lives hopeful enough to want to share it. I know of 1 company only that specializes in the investigation of alternatives for those who do leave, as so many do want to leave but are phobic and have no idea to function without practice. Each of us gets to figure out the situation for work, generic, and for the off time in the city/town/rural we live. There is no secret to it to find to make the time/place/setting/companionship we can achieve that peaceful easy feeling. In life there are only 2 question to ask and to answer, all others come at the expense of one the other or both, and those 2 questions are what do you want to do with your life and with whom do you want to share your life. The only stupid question is the unasked question. As for changing the system, a Gorgon knot, Sisyphus pushing the boulder uphill, it is entrenched with a pole up its arse, so learn to live and to deal with you at an apart place to maintain peace at work and more importantly at home.

  13. Pamela Wible MD says:

    Another one:

    Not to mention that sitting on thy butt 4-6 or 8 hours a day is terrible for things like ischial bursitis, arthritis, DJD, etc. sigh.

    Opting out or reforming the system both seem valid options!

    In the meantime, some other things that could help are looking for ways to streamline the documentation. Some docs over document, meander aimlessly and repetitively, and say the same things over and over. Solutions for this can be to:

    Chat with their dept heads and documentation experts on what are the main essentials requiring documentation, Review documentation of a seasoned doc with a rep for awesome documentation to pattern thyself after. Develop an outline for dictating or charting to reduce wandering and repetition.Develop templates of their repetitive text that they can insert or request be inserted (such as risks include but are not limited to x, y, z; routine procedures that only require some minimal insertion of patient specific information (hardware components, implants, etc). Finding someone to document for you like a NP or PA is helpful, unless you are the NP or PA! Consulting with process improvement gurus can help find ways to streamline work, eliminate redundancies in the rest of office procedures, free up more time…

    Feed the soul at work as much as possible, music, nature, food, fun! 🙂

    Best wishes!

    Darlene

  14. Pamela Wible MD says:

    Yet another idea:

    have him hire a data entry clerk who can enter
    the data off of a dictation or worksheet.

  15. Pamela Wible MD says:

    Yet more advice:

    All too common in unfortunately. He (I’m guessing, sounded like a guy’s writing)can either change his internal attitude, change the job, or find a better job (or create his own). The first and last are “easiest” because they don’t require changing others minds. I would make the clinic get me a scribe to do my charting :).
    Jeff

    PS: nobody has to work to pay for kids college…that’s a stupid reason to work. That’s what summer jobs and scholarships are for! Kids these days…soft, sheesh!

    Why cannot physicians revolt can there be a chance of forming a union of some sort? physicians have so many stressors, hospital privileging and those politics, malpractice, defensive medicine, study and updating medical knowledge/learning what is perhaps on new frontier of medical innovation, documenting, loans, reimbursements, patient disdain. now physicians are to be paid based upon patient compliance and biometrics!

    Hey Pamela!

    Excellent advice for him to hang out with happy doctors. It is abundantly clear to a medical student which doctors are happy and which are playing the game (and losing). There is stark contrast between those that take control of their lives and career, and those that are controlled by it.

    I don’t think I, as a 4th medical student, can offer him much advice. I will throw in a couple of things though. If he can change the system from within from where he is at, I would encourage him to try until he is able to move on to a healthier place, if he thinks that is feasible.

    The most important advice I think I can offer anyone in this, and other similar situations is to begin to work on yourself. Make sure you are healthy. Eating the right foods, getting your daily physical exercise, and most importantly feeding your soul. Once you begin that process other good choices will follow, including career choices. It can be difficult and even dangerous to make life altering choices, especially those in your career, when there is such negativity surrounding ones life. He might benefit from asking himself the question, is his career part of his life or his life part of his career?

    I think he made the right choice by writing this email and reaching out. That is a difficult thing for doctors to do, simply ask for help.

    The last thing to mention is that he’s not alone. We are ALL in this together. Just let him know that we’re rooting for him, and that he has come to the right place for support.

    I don’t know why I am assuming this person is a male but I am.

    Sincerely,
    Marcus Carty, OMSIV

    I do agree. And wholeheartedly! Years ago, long before I became a physician, I wrote and published an article entitled, “Restoring the Sanctity of the Doctor-Patient Relationship.” It talked about all of the groups, industries, and individuals trying to drive an alienating wedge between the Doctor and his or her patient. At that time, managed care was largely to blame, followed by an overly litigious public, ready to sue those “damn greedy doctors” in a heartbeat. Now, the “heroes” of medicine are the doctors who can crank out/process patients like hamburgers
    at McDonalds, accepting their fate as short-order cooks in an increasingly demoralized (and demoralizing) health care delivery system. We are not practicing medicine anymore — we are practicing wanton butchery of our profession. It is high time we as physicians took a stand against the prevailing systemic insanity. We need to eliminate all of the middlemen in the system who take their profits from the hide of physicians and from the blood of patients. Decreasing reimbursrments to physicians while increasing premiums to health care consumers is a game that the health insurance industry knows how to play very well to fatten their corporate coffers. It’s high time that doctors took back their power, if not for their own professional integrity than for the sake of their patients, who are being robbed blind and don’t even know it. I say see fewer patients, forget about profits, and start really helping people again instead of hiding behind useless billing codes and equally useless EMRs.
    Be a doctor again, and tell those who are putting you under tremendous pressure to be more “productive” to shut up and go take a chill pill with soda!
    Best,
    Board Certified Family Physician

    I understand this so well, and the direct answer is to speak up–not to complain but to suggest improvements. Often times the things which are rote and frustrating can be streamlined. Whether it is working with the local Infornation Systems folks to tweak the software, reports, and data entry so that it does not take as much time. Ask! You would be surprised at how many times I did this in residency and the IS folks had no idea there were problems. There is a lot of inefficiency in medicine. Get a group of docs together, for a weekly practice management seminar breakfast (catered–work covered by alternate staff for an hour or so), add the administrators, computer support and CEO, even. Add the head nurses and a pharmacy staff member. During this meeting discuss agenda items, the frustrations, the new enhancements, make your voice heard. Change happens when people speak up. Slavery happens when they don’t speak up. Hospitals lose money when docs and patients are unhappy. Learn the language of business and request changes thoughtfully in a context that makes it hard to resist. Use positive but firm language. Look at tasks which can be delegated or automated in ways that nay not have been considered, like having a new patient’s reports with all the data gathered (electronically or on paper) ready to review by the doc in one place. Ask to hire a consultant to assist in designing a vetter work flow. Perhaps even get the Information Systems folks to have a staff member follow the doc around to see where things are taking too long. These folks are bright and smart and innovative. Instead of keeping them bored playing computer games, use them to design the system you want.

    Silence = submission = despair.

    And if you don’t find someone who will listen (remember it really is a team when you deescalate), it is time to go somewhere else where you are appreciated.

    The first step is believing that you have control over your work and your life. You are an asset, not a liability, to yourself, your family, and your workplace. Do not ever settle for slavery. It is only an illusion.

    Click your heels together three times. Your heart’s desire may just be in your own back yard, if you have the courage to see it.

    Kind Regards,

    Dr. Beatrice Taylor

  16. Sad Soul: My heartfelt compassion.
    Step one: Change the system: This can only be done by top management. Do not try and fix it piecemeal, at the day-to-day level.
    Step two: If management is not co-operative you must quit.
    Step three: If you quit: Your problem is essentially a financial one: you are constrained by the costs of bringing up your children plus all the add-ons. This economic vise is common in US, because others are making money out of you.Whether you can re-adjust your economics I cannot (of course) say.
    Step four: When I speak to prospective doctors, who ask me how I have enjoyed my career, I say that I could not have wished for better. “But if you want to be a doctor now, you must think of being a missionary”. A truism is that if you want to be financially successful, live in a poor neighbourhood/area/country. Therefor try being (initially) a mission volunteer, for a few weeks (in you vacation, so you are not prejudicing your current life-line) [I might be able to help you]
    That might provide accommodation, schooling and the adventure of a new country.
    Best Wishes….

  17. fran-LPN says:

    From this nurses point of view (namely mine), for this Dr who has in a sense lost his way-i did not work in a hospital setting because i did it for one year and hated it.! i didnt feel like i was nursing-i felt like i was pushing drugs and had no time for the Pt-to find out what that Pt needed or didnt need. It was like heres your meds, dont talk becuase i dont have time and onto the next.
    it was scary when i left. But i knew if i didn’t get out, it would not be good.
    I went to work in an Urgent care setting. We saw a lot of Pts (125+ in 14 hours), however, the Drs relied on the nurses (all LPNs-no RNs)-we were a team which meant as Nurses we did what we could in prepping the Pt to see the Dr because we were a team and the Pt became a part of that team. Sometimes a new Pt would be seen in 2 visits, because you cannot address everything in one visit- it doesnt work.
    In my honest opinion Dr I think you should get out-Run! as fast as you can. once your out you need to take time for you-to decompress and catch your breath. then you have to decide what you want to achieve in the next chapter of your life.
    You state you are feeling Trapped. well feeling Trapped-thats a choice that is run by fear-the fear of the unknown & that is a pretty scary place.
    You know that feelings of depression, being trapped etc will all lead from feeling them to physical ailments.
    someone once said to me Life is to long to hold on to the negative.
    Find someone to talk to. Evaluate your self worth and your life and those in it. rely on your nurses, but most of all believe in yourself & remember WHY you became a Dr. (then run! decompress and relax).
    I wish you well.
    Fran M-NYS LPN

  18. Sunny says:

    A phenomenal post and I like the statement “people don’t complain about things they can’t change.” Very empowering and liberating. My turning point came when I met with my advisor and set some new goals, unrelated to prestige or AOA. Then I happened to read the book Don Quixote and something clicked. The mission to be a KIND, loving, happy doctor does seem nearly impossible at times, but just having that goal has helped keep me afloat. I don’t have kiddos or a family to think of, so I am not sure what you should do practically speaking. Maybe you could be an advocate to the administration. I know a surgery resident who is very involved with hospital administration and he finds it empowering and good use of his time.

    Just remember you aren’t the only one who is sad. Maybe it will be the sad ones of us who turn the tide for everyone!

  19. Gail Hirschfield M.D says:

    I loved your site! Will visit it and make it a favorite. For this fellow, first-I do believe he is clinically depressed, an off the cuff diagnosis, but you asked-in that case, please see a doc, doesn’t have to be a psychiatrist, and consider a helpful medication-at least a trial. Second, there are problems with both his job, which is dehumanizing, and his beliefs about his job—both can change. For instance, what has helped me is the Serenity Prayer! and any other prayer, meditation, and other calming practices-like music—can he have music at his desk? and telling himself messages that are helpful, like—“I have to show up to work 8 hr, that is given, so what does it really matter about the details in those 8 hrs? (it does, but just saying that helps me!)…Like, I have to show up at 8 and leave at 5, so I will just do my best in those 8 hrs…Third, I think he can look for ways to streamline his work, Fourth, all those suggestions made by
    other providers are certainly worth considering—go with locum tenens assignments and look for a better home to work in permanently, try concierge medicine—many sites to show you how, and those physicians seem content, look into your plans and ideal medicine strategies. I like the idea of his getting a great hobby, too. Or an avocation. Please feel free to submit this to your site.

    I have a plaque on my wall which reads—-“In the midst of difficulty lies opportunity” . and I believe that, and I have been in lots of difficult circumstances over the years.

    Thanks for asking me, My prayers and best wishes for this suffering doctor…Gail

  20. Tim Schmidt says:

    If it’s workflow that is dragging you down, especially EMR I can help. I’ve created a documentation workflow that works based on each providers needs.

    I’m not going to go on and on about how sweet the EMR I made is, but if you want other options I’m open to discuss how we can customize a workflow solution for you and your practice.

    Tim Schmidt
    President
    Health Systems Technology

    cc: cwinters@hstcentral.com

  21. Char Glenn MD says:

    Consider
    1. hire your own scribe (some bright pre-med or science students can do it) for temporary trial to see if that helps
    2. step back (decrease all expenses, decrease workload to get respite for 6 months or a year)
    3. listen to happy doc lectures at the AAPSonline website about their cash-based practices (don’t listen to the ‘ain’t it awful’ lectures) Some of these people are specialists, not just primary care
    4. college is over-rated, especially for the future flexibility that will be needed; (see ideas such as Singularity University) and Would your recommend that your child sacrifice their life and happiness to put your grandchildren through college?

  22. Char Glenn MD says:

    Help your own state medical board look at this statement from Oregon’s medical board:

    “Electronic Health Records

    The passage of the federal Health Insurance Portability and Accountability Act (HIPAA) in 1996 spurred further federal regulation[1] mandating electronic medical record keeping in an effort to standardize insurance claims, make medical records more portable, and eliminate medical errors. Electronic health records (EHR) were expected to facilitate the availability of test and diagnostic information, reduce space requirements and transcription costs, and ideally increase the number of patients served each day. Charged with protecting the health, safety, and wellbeing of Oregon citizens, the Oregon Medical Board shares in these goals.

    To the extent that EHR and “meaningful use”[2] has become the standard of care, it is the responsibility of the Medical Board to ensure that the standard of care is met and to assist licensees wherever possible. The Board recognizes that licensees will need to hone computer skills, become proficient in billing and coding, and in some cases utilize voice recognition software in order to generate EHR. As with other areas in the evolving field of health care, it will be incumbent on providers to build these skill sets and adapt to the new standard.

    EHR has the potential to improve health care quality and patient satisfaction. However, the Board also understands that the documentation can seem limitless, and the patient care provider, the most expensive and time stressed link in health care, may become subject to the role of data entry.

    In order to not interfere with the establishment of therapeutic and compassionate communication between provider and patient, it is imperative that software developers, health care organizations, and providers work to optimize EHR as a tool for providing efficient, patient-centered care while minimizing interference in traditional provider-patient interaction.

    As electronic health records progress, the Oregon Medical Board is mindful of the need to balance the goals of health care efficiency, safety, and portability with those of an informative and readable record that can be created without undue complexity or burden on the increasingly stressed healthcare professionals.

    – Adopted August 6, 2015

    [1] The Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009.

    [2] http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives.​

  23. In answer to your question “What would you tell him?” I’d tell him to quit: Tell his employer to go to hell and quit.
    Somewhere along the line, this doctor made a mistake by getting himself into his current situation without a go-to-hell fund. Current terminology calls this “Plan B” but my father called it the Go To Hell Fund.

    My father was a physician, an industrial physician before there was such an animal. He put himself through college and medical school by playing trombone in dance bands. He paid for my piano lessons and was surprised when I told him I’d like to see if I could be a doctor. “Why, sure, if you want, give it a try. But I thought you’d go into music,” he said. I agreed, for so did I. I’d always thought of myself as a concert pianist when I grew up. Eventually, I asked why he’d spent so much money on my piano lessons—I mean, I felt a little guilty having wasted all his money on something I wasn’t going to become after all!. His reply was “That’s your Go To Hell Fund.” Huh? He explained that no matter what I did, Doctor, Lawyer or Indian Chief, I could always fall back on music. “You can play piano in some strip joint for $50 a week and survive. You won’t drive a Mercedes, or live on the Pacific Ocean in Hawaii, but you’ll survive.”

    He also told me that if I did go into medicine, I should remember to have a balance in life: a balance between work and play, and never get myself trapped in any situation. Always look for a path out, identify it early and remember where it is.

    I would also tell your doctor to read Atlas Shrugged by Ayn Rand. I did, in 1957, when it first came out. Several key principles that relate specifically to this doctor’s problem are identified therein and he would probably learn enough in a short time to get him over the helpless stage of his dilemma. In Atlas Shrugged, your doctor can find the intellectual ammunition he needs to figure things out. I gave my copy to my father, whose comment after reading it was “I always thought it was like that.” No kidding, Dad!

    About ICD-10: It’s a data base. That’s all—a data base. So was med school neuroanatomy—a data base. We learned it, learned how to use it, and didn’t require a Coder to do it for us. There is a direct correspondence between the diagnosis and a code—even though it may not be the one you have in mind (remember there is NEC).

    About using an EHR: Folks who sell them speak of ‘templates’ yet their systems are template-unfriendly. Even though we can create coded text listings for 85% of an outpatient pediatric practice, there is no way in the current EHR’s offered to connect them to a billing system in a single stroke that is controlled by the physician at the point of entry of his PLAN. None that I’ve looked at have it. Some are close, but all the EHR’s out there are derived from billing systems backwards to the doctor—with the exception of Practice Fusion, which does not have it’s own billing system, but which is connectable to several.

    Finally, I would tell your doctor that if he has identified the problem(s) as well as he has in his letter, and identified his emotional responses with the degree of self-actualization he has shown, then he has the ability to make changes. He should see that there is hope for him, within his own being, to prevail. If I were to write to my father a letter such as this doctor’s, my father would kick my butt and say “Stop bitching and start changing!”

    Hmm. Well, that’s a summary of my thoughts before a cup of coffee—which is on its way! I hope there is some sense in what I’ve written; it’s worked for me. Oh, and I know that none of this is politically correct. But I also heard a great definition of “political correctness”: that condition in which one tries to pick up a dog terd by the clean end.” My father would have loved that one!

  24. Jerimy B says:

    Ideally, I would love to meet with this doc. I empathize, even though I am not immersed in medicine in the same way that a physician is, I see how strenuous the process is. And this IS a process. When you used the term conveyor-belt medicine, that completely struck a cord with me. Healthcare is quickly descending into machine-status. As we all know, run a machine tool long without proper maintenance and care only leads to breakdown. Unfortunately, the powers-that-be seem to think that this breakdown is acceptable; that the machine can still function without critical parts. When one parts wears down, replace this with another…and another…and another. When will healthcare realize that the machine is not broken, but that the whole system is flawed.

    The greatest tragedy here is that human being are not machines and this is not some factory churning out health. These are real people with real feelings, aspirations and a passion for healing. Instead of fostering this passion, the health establishment seeks to replace this creativity and excitement with a flat blueprint of how the parts should fit to together. It’s not time to think out of the box, but to create a new box. Better yet, throw out any notion of a box and all and allow health practitioners do what they do best…help people.

    Now that I am off my soap box..

    Honestly, Dr. W., I am very concerned about this person. If he was sitting with me right now, I would explore a few issues right away in that first meeting. I would ant to know his purpose for engaging in medicine: the force that drives him to keep going despite all of the negativity that he describes. This would help me gauge how much is left in the proverbial tank. He already describes that “there is no joy in work anymore…” I am also concerned about his anger here as well and feeling “betrayed.” This combination of stress, void of purpose and overwork raises a red flag for me. If there is anything I can do to help, I most certainly will. I sincerely feel that he is a candidate for your program and retreats!

    Jerimy

  25. Julia says:

    Doctors and medical professions have to fight to get our profession back from the government. It will never be fixed as long as they run it.
    We are a huge group of people, we should have a huge voice in Washington. Elect people you know will change the ways things are going and get medical care back in the hands of medical professionals where it belongs. Know who you are voting for and don’t fall for the empty lies and promises. Get organized with other doctors, scream if you have to until they see the problem we are all facing. Write your congressmen and elected officials and demand our profession back. Because everyone is hurting the way it is now. The staff and the patients. the time to sit back and watch what happens is over. Now is the time for action.

  26. Thom Ruley MD says:

    Pamela,

    I agree with most of what you have to say. I would recommend extreme caution in seeking treatment for depression. We both know how easily that could come back to haunt him (not assuming that depression=female).

    Sounds like a lot of Sad Soul’s frustrations are not with medicine itself. The EHR was mentioned repeatedly in the letter. Not sure which EHR Sad Soul is using, but most EHR systems are horribly designed (for the doctors at least). Mention of an ICU implies a hospital, which also implies a “help desk” or one or two physician “super users.” I had an attending once who was actually involved in building new features into EPIC. They may have some tricks that improve computer productivity. This alone could give Sad Soul some “breathing room.”

    The comment about going to medical school to do data entry catches me as very ironic, as I did go to medical school and am currently working on A+ certification and teaching myself Linux.

    Hope that helps

  27. Eric L. Thomas, MD says:

    Good morning, Pamela.

    I agree with your response. I would also suggest that he start talking to someone (ie ask for help). Emails and tweets are fine, but siting with another human being is invaluable. The strength and hope that comes from an empathetic “yeah, me too” is incredible. I love the fact that he did reach out.

    Eric L. Thomas, M.D.

  28. Pamela Wible MD says:

    Another anonymous psychiatrist:

    I have read his letter…and also some of the comments that are posted on your forum. I would like to say something, but I prefer that you post it similar to how you posted the response from another psychiatrist (for my anonymity and privacy, if you don’t mind).

    First, please have him check with a psychiatrist to assess for any mental disorder – ex. depression, adjustment d/o, mood d/o, etc. that could be brought on by stress.

    Second, I empathize and sympathize with what he is going through. He is not alone as there are many doctors out there facing similar situations especially in this day and age where managed care and the health insurance corporations have taken over. The Obama Care is making it worst. I find that the Obama Care is anti physicians and it is ruining physician-patient therapeutic relationships. Unless our future president takes the stance of autonomy for the doctors to practice medicine the way it should be, then even myself would not advise any student to become a doctor….I would even find another career to pursue.

    Third, I agree with others’ suggestions of taking on a hobby, and pursue some recreational activity that he always been wanting to do, to remove himself from his daily job (ergo, separate his job from his personal life). I separate my job from my personal life. I take an objective stance when I go to work, I remove my personal feelings when I’m dealing with work issues. I don’t bring my work home with me. I don’t talk about work with my family, unless it is related to a career move – advancement or changes in what I want to do. I like to travel, walk my dogs to the beach and to the park, etc….I tend to them as my kids, I cook for them healthy foods which also motivates me to cook for my family more (I used to eat out more often than I should). By cooking at home, I save on every aspect…especially I feel healthier.

    Keep in mind if he is having trouble separating work from personal, (as most of the time, when one does not have a healthy personal life, one does not feel happy, healthy inside, anything from work would be viewed as negative and eventually crippling to one’s life), then again, he should seek professional help – have his health check-ups as well as seek out personal or family counseling and/or psychiatrist if needed.

  29. Hi Pam,

    I could have written this pulmonologist’s email. First of all, he can call or write me. Anytime.

    “This transformation of pulmonary has been going on for decades now. This speciality has been transformed into “Uber-hospitalists” by corporate chains. ICU’s are a cost-center is hospitals and only insofar as they make the hospital seem like a safer place for a surgeon to do his high-risk cases do they make economic sense. All sorts of hospital employees and functionaries glom onto ICU multidisciplinary rounds primarily in efforts to keep the ICU cash burn rate as low as possible. The intensivist is on these rounds to fulfill a contract with the hospital and to sign things.

    The problem is that if you do a week at a time on hospital call, you may be too impaired from sleep deprivation to function in the office after your week on the ICU service. Also, a new patient every hour in pulmonary clinicis a lot of work unless they are straightforward uncomplicated emphysema patients. Usually however, these patients are some of the sickest and most complicated patients that your community has to offer.

    If you have no control over your work environment in terms of setting your schedule, use of ancillary resources, and so forth then the problems you describe will only get worse. The solution is looking elsewhere.

    If you have some control, then you have options. If the EMR is a huge timewaster (and they almost always are in pulmonary cases) get a scribe to deal with it. The only value I saw to an EMR was getting better at the use of voice-to-text software. The rest of the platform was there to fabricate data and make the case seem to code at a higher charge level.

    Another approach is to turn outpatient pulmonary consultations into a mid-level service. This is what is going on in Denver. You can supervise mid-levels closely with complex cases and not spend all day in cubicle-land on a computer. Some practices will be stuffy about mid-levels doing most of the work in consults but this is what the market is paying for anyway. The resistance to making these consults a mid-level activity oftens comes from older, pre-retirement members of the group, who are dead weight for the most part anyway and living off your work. They made their money when the rules were different.

    There are a lot of potential approaches to fixing your situation if you have some degree of control. If you don’t have control, then you have to bail before you have an MI or CVA. Give me a call on my cell at 303-242-7930″

  30. I want to first extend my support and empathy. To go through all that training with a desire to help heal patients and then to feel like such a small cog in a big wheel can be heartbreaking, and exhausting. I applaud the response of Dawn, the nurse practitioner who is studying functional medicine. I completed my training last year and was certified this year. I am a psychiatrist. I can tell anyone out there that it is uplifting and heartening to be in the midst of so many like-minded physicians, attendees and faculty alike, who are all united in getting to the root causes of chronic illness. Not only do we learn new tools, but we join a community of docs who are all seekers to do medicine a different way. Some stay in the system with their new tools and others create their own path. But there is support all the way. Patients will line up to get this kind of care. We may not earn as much, but we are so enriched in countless ways. I would be happy to speak with “sad doctor” if that would be helpful.
    Pamela, so glad you are doing this. kudos, Caroline Smythe

  31. change your life or your attitude
    you decide how you feel

    focus on the people and not the disease
    from someone at the hospital i noticed was quite caring
    similar situation to your story 2 years ago so i decided to quit but had to give 2 weeks notice
    “got up every day miserable for 2 weeks”
    “last day got up happy and went to work happy and noticed everyone around me was happy. so i didn’t quit i decided to come in happy.”

    • Wayne Smith MD says:

      I started laughing with delight as I read the profound truth you revealed in this poem…..I could not agree more!

  32. Dr. SC says:

    I agree with the sentiments above that you are making yourself more miserable by continuing to practice. If that is what is making you miserable, then that is what you have to get out of your life.
    We frequently tell our patients that if their jobs are hurting them, then they should consider changing their jobs. While I am fully aware that we have invested so much time, energy, and money into our careers, the fundamental premise boils down to the same principle.
    You are absolutely not alone. I think that it is rapidly approaching the point where the majority, that is greater than 50%, of practicing physicians are burned out. And that is a conservative estimate. Therefore, the likelihood of anyone getting a doctor who is not burned out is slim. Again, the burnout is becoming the rule, not the exception.
    I also agree with Pam in that physicians, as a group, have done this to themselves. The medical education system, along with assembly line medicine, is a breeding ground for burnout and depression. Most doctors I know are at the point where they try to practice the least, and just make enough to get by. They simply do not enjoy the work any more, and wish that they did not go into medicine. They also strongly discourage their own children from going into the field.
    Opening your own ideal medical clinic might be something to also think about. I do feel your pain, and can absolutely empathize.

  33. Honestly, I’m a pharmacist and the red tape at my company was a problem for me. I couldn’t spend time with my patients so I am in the process of leaving the career I devoted 20 years to. What am I doing now? I am in the process of opening my own wellness center, providing integrative, holistic care. I will run my clinic in my vision not someone else’s and for the first time, do what I am passionate about…patient care. Good luck and don’t give up. We all went into healthcare because we wanted to make a difference. We all just to need to find a way of making that happen.

  34. Carolyn Nowosielski says:

    There are lots of ways out of this situation but it’s hard to know which way to go when you are beaten down. My suggestion is to take some leave time. You earned it. I bet you have a thousand and one weeks of paid sick time that you’ve never used. Go see your pcp and start your fmla paperwork today. Take some time, at least 6 weeks and rest. Then slowly figure out what is next. You can do this. I did it, took 8 weeks off and felt human again. It’s been Six months since I made that decision and I am
    No longer depressed, anxious or snapping at everyone. I practice in Africa now, treating Peace Corps volunteers. I am learning French, getting my finances in order, not watching TV or over drinking. I ride my bike on the beach, write long thoughtful emails to my friends and family and I am reading books again. Who knows what is next? Maybe when I return home via India, China or who knows where I will feel ready to start over in a sane way. But why worry about that now, I have some visiting to do with new friends.
    Also, this profession is not going away , we will hold down the fort while you get some rest. When you are ready to return who will be a better healer.

  35. Karen says:

    Love this!!
    You write well.
    Love the numbered list of a addressing the issues. Clear, concise and easy-to-read and assimilate under distress.

    WOW!!!! you introduced the truth that will empower him. Now he knows what he NEEDS to do.

    I’d add one thing.

    You need to invite him to your gathering of professionals: he desperately needs to “hang” and take a break from his reality. He needs an infusion of “Pamela.”
    You’ll introduce him to the reality of being the healer that he is….I’d say “if you weren’t already a healer you wouldn’t be able to *see* the inefficiency of the clinic, the inhumaness of it, and express it “out loud” to another doctor.”

    Bravo. I woulda been happy getting happy receiving this post!!

    Just back as of last night from Illinois. And, glad to be back. I’d forgotten what the midwest is like. Salt of the Earth people yet a tad oppressed by the culture. Everything is about ‘what others think.’
    At dinner on Saturday night at the VFW, [it was wild and crazy] I had to be careful not to ask Sandra, a family friend of my parents, if she thought farmers would grow hemp. Just in case, that was the right thing to do…chuckle*

    Evenutally, couldn’t contain myself as I know she’d have an answer for me. She did. Bottom line, business woman: If it’s lucrative.
    Whereas, I’m thinkin’ save the planet, fuel, new hemp pants and all. chuckle.

    Time to create some work….there is a huge need…just need see* the plug insert and plug into it. That’s the hard part…”seeing” what I can do and where I can be helpful in the medical cannabis business.

    Hugs…
    Karen

    ps. Thank you for sharing this letter and your response. It is monumentally important to me to know these truths. It has truly opened my eyes. It makes me happy, your work.

  36. Robert Talac says:

    Dear Pamela,

    I feel the pain he goes through. This is simple but not easy. What I mean there are only 3 options he has.

    1. Quit medicine – it is not a good option as I believe he invested a lot of time, effort and money getting where he is. However, it is still an option.

    2. To continue working in current arrangement, keep telling himself that he has to do this or that, keep complaining as many doctors do. This is self-destructive path. I called these doctors medical zombies.

    3. Decide to change situation. I believe this is very important that he makes conscious decision that things has to change.
    Similar to our relationships with patients, we all understand that any successful treatment plan starts with patient enrollment and
    full engagement. In other words, he needs to fully understand why, before looking how to reach his goal.

    I think the diagnosis is clear. He is getting burnt out with inefficient hospital system. It is not medicine it is a hospital system. Each hospital is becoming more and more patient mill. They are too big and inefficient. Unfortunately, the ugly truth is that a very little can be changed about it now. The only small change possible is if he is extremely valuable to the hospital. I mean money wise. If he bring a ton of money to the system and his departure would be quite painful financially, he can demand change for himself (i.e. getting scribe to do all the charting for him). Forgive me, I am a spine surgeon and we usually bring a lot of money to hospitals, so most administrators have to be “nice” to us. Even in my situation, I had to deal with lot of BS. If you are not economically vital to the system they will not listen to you. Any attempt for change is mission impossible. It is not personal it is business decision. I am afraid ICU is not money maker for any hospital, so any real change is unlikely.

    I still believe that having your own practice is best way to go. It does not matter if you are employed or you are solo practitioner, you have to be productive. If you are not productive no employment or contract will safe you. I am afraid that our colleague will soon talk to administrator anyway as his productivity is going down and they will use it against him. I have seen it many times.

    Every employer looks at bottom line. The only reason to have an employees is to make more money. Administrators are not doctors, they do not provide care they are babysitters for big corporations making sure employees are producing revenue. I know many employed physicians don’t like to think about themselves as an employee, but the ugly truth is that they are just employees. Employer is “renting” their skills to make a profit.

    I understand that he needs to work. There is a way to accomplish it. What is his specialty? He must be a very accomplished doctor if he works in ICU. There are many opportunities for him. I would be happy to help in any way with more specific ideas. I would need more information though.

    Pamela, I think we as physicians, who recovered, need to create platform where other doctors can information how to run their clinics and businesses. Our professional organizations failed us. They are complicit with the system. We are slaves in country of free. It is not unachievable goal. One has to a.) name and reject his/her fear. b)decide what we want; c) and act upon it.

    Kind regards

    Robert

  37. Chas Wreschner says:

    I would tell this doctor now after 40 years of being a family physician. I worked for two different doctors with two different philosophies. I finally had my own practice for 30 years. Unfortunately with the increase of sophistication technology personnel trying to give healthcare insurance pension plans I felt it was better to be part of the local hospital. What ever you do ,don’t make that mistake unless you want to be bullied and being treated as a wiget worker . A Term I use for piecework since I work in a mill town. I guess there are some great places to work that Still value quality work but you might not make as much and I think the trade-off is worth it.

    I would try to form a group for direct access medicine.
    1. It would cut your cost would be able to hire maybe one or two people and offload a lot of clerical work pre-certifications that would be wasting your time.

    2. But more Important than that would be other physicians to review cases and see different types of things that you might not be exposed to in solo practice.

    3.in the last four years working at the hospital doing so many chronic problems and health exams I therefore was not exposed to many acute problems they would either go to the other providers PAs nurse practitioners or the walk-in .my clinical skills of not taking care of sick people is not the same.

    I personally believe if you don’t see enough sick people you lose your skills .It was nice we had a four-man practice each of us had a special interest and for that reason became more proficient. Simply got to see more cases it was a good resource for my partners as well as our patients.

    So in the end I guess my choice would be direct access medicine in a 3-4 man practice. You just have to find the right partners,or find the organization or group that Value physicians not just as a wiget workers. Physicians now are wiget workers it’s not the quality only the quantity.

    Good luck

    As for electronic medical records I think they are a great thing but saying that we are using it just as a coding to make money. If I was in direct access medicine I would use Dragon NaturallySpeaking medical version. I used to use a EMR called text talk it cost about thousand dollars. It was great I could print my prescriptions my labs my x-rays have a continuity note that I could send with my snowbirds included everything you would want to know in 2 pages. It was never 26 pages of bullshit nobody ever reads. most people who read it had all the information that they needed at their fingertips without looking through lots of garbage.

  38. Myth of Electronic Medical Records,

    I would like to share few thoughts on electronic medical records (EMR). EMR as they are sold to medical providers today are not designed to help patients’ care. This is a simple transfer of data entry into physician office. The standard EMR today is nothing else as a.) Calendar b.) Depository of Medical Notes (i.e. Word processor) , and c. ) Accounting software allowing to submit bills to insurance companies.

    Insurance industry convinced people in Washington that this will improve the care. However, the only reason it exists is that insurance companies are using physician office staff to entry all the data that are transferred to their system. It not only saves them a lot of money, it is also make audits and statistical analysis much easier for them.

    In addition, it also keeps eye on us providers. If you don’t follow guidelines and other PQRI systems you are labeled and quickly penalized.

    It is a myth that EMR are here to help us care for patients. There are here to get better handle on us.

    I don’t suggest that we boycott the system. I think we need to demand data showing that EMR improve the care. I asked my previous administrator (it drove him crazy) to show me data proving that EMR improve the care and data about return on investment. I argued that I can’t prescribe any medicine without some evidence that it works. It would be irresponsible to use tools without any validation. They have no answer for this.

  39. Hi Pamela,

    You make some good points. But the problem is not an EHR. We have to do progress notes – not because of any law or rule, but because they protect us, and they protect our patients (when properly used…). If an EHR takes longer than a written or even a dictated note, something is wrong with the EHR system, granted. But that doesn’t sound like the root of the problem here. He sees 8 new patients in 8 hours? The average American doc sees 38 patients a day. Frankly it sounds to me like what this man needs is a change in perspective. It’s not his workload or his EHR that’s getting him down. I think there’s something else going on for him that prevents him from feeling the rewards of helping people. Your third point is your best. And I think that he really needs to find a mentor himself so that he can find the joy in medicine again (your points 6 and 7). I wish him luck.

  40. Matthew says:

    Take a break and/or vacation and re evaluate your goals of a career. What is important and most importantly what do you enjoy about medicine? Is teaching students or residents appealing? Do you want to make as much money as you can for as long as you can? Do you want to get into the administration side and help other doctors frustrated with the current environment and what might be done to make things better. Then write these down and see if you can meet your goals in your present situation and job. If not, start researching and consider a job change. Life is too short to hate what you do. Doctors are by definition rule followers(most of us) and highly intelligent people. Jobs are like dating, you may have to date a few to find “the one”. Changing jobs is not an admission of failure but a failure of the job to achieve your personal goals and more importantly happiness.

  41. Pamela Wible MD says:

    A few other responses flying in by email:

    Good response.

    He might also benefit from psychotherapy with a wise psychiatrist.

    ***

    dear Pamela——-I feel so sorry for the doc….I am worried about him….I am worried that he will start taking psych meds or drugs….I am worried that he will kill himself…he needs to keep talking about everything…. with someone he trusts outside the system..the system can be very abusive as you know….from harry with love

    ***

    This honestly doesn’t seem as bad as FP schedules. We only get the wkd off and see 3 pts per hour meaning 20-22 patients per day 5 days a week. And it is all different things people come in with so you should send him the schedule of a “treadmill Family practitioner” and he should feel better. I guess it is a matter of perspective. Maybe he just doesn’t feel like he can ask for what he wants or hasn’t. It sounds like a reasonable schedule and maybe he just has to ask for the 15 minutes between each patient and get someone to help with the EHR.

    ***

    Hi Pam,
    Please tell him to contact me or one of the physicians working in Ideal Medical Clinics.
    There is a way out, but people have to be willing to make that first step; maybe the first step starts with talking to other physicians running smaller practices.
    I may put in long hours in my practice, but its still my practice. This physician is a specialist, but can still practice Internal Medicine, and there is a shortage of primary care doctors.
    Should we create a dialogue where we start discussing higher pay for primary care physicians?
    You should tell him about overseas medicine/mission trips. I do that twice a year, and love it. Nourishing for the soul.
    Tell him to call me ……..

    Love you for what you do.
    ~ Anandhi

    ***

    Good morning, Pamela.

    I agree with your response. I would also suggest that he start talking to someone (ie ask for help). Emails and tweets are fine, but siting with another human being is invaluable. The strength and hope that comes from an empathetic “yeah, me too” is incredible. I love the fact that he did reach out.

    ***

    I’d say he should try doing a locums spot in New Zealand just for a change of pace. Kids are always expensive, people underestimate how much time and money they really are. Own it or move to an area that has a better free public school system (they do exist). You can always earn more money as a locums than permanent. Kid should stay with mom or grandparents or someone stationary and he can pay while traveling around and when he gets a vacation he can see his kid while having a more flexible lifestyle. Sometimes life isn’t always about achieving the house and white picket fence with the wife and kids and is about being flexible and figuring out the economic options.

    ***

    Pam

    You are the wise one!!

    I completely agree with what you wrote 101%!

    My thoughts/reactions (similar to yours):

    1. You are NOT alone. The sentiments, grief, disillusionment that you express is so common amongst your colleagues. So many of us suffer in silence and consign ourselves to a life of misery….

    Just trying to hang in there till the next weekend or vacation, the next temporary reprieve or parole of a couples of days off is not the answer.

    2. I congratulate you on having the courage to contact Pam and to reach out for help. That is a huge first step along the path to recovery. The real question is where do you go from here? At times like these, it is almost inconceivable to contemplate major life changes but that is likely what is going to take for you to rediscover your joy and passion for medicine. You need to look at making these changes and comitt to them. You, your family and the patients that you treat will be the better for it.

    I went on a similar journey with Pam last year and made these changes and I am a better man, doctor, husband and father because of my work with her.

    ***

    Hahaha, God alone is the wise one. Well suffering has some benefits until we fall smack idown n to despair. Suffering is the price we pay for caring but we need to make sure we care for ourselves. Certainly having some self care to get out in the woods and feel normal is good. That was your advice to me Pamela.

    One hard pill to swallow is that we chose this lifestyle. A gratitude journal is god medicine. Having some gratitude that he only works 4 days, what an an unusual treat these days and having an hour to work up complex patients is also a blessing because unfortunately in the outpatient setting the system tries to squeeze water out of a stone and most docs don’t even get 30 min.

    I have quit many many bad jobs so ask yourself is this a bad job for me. If it is bad, move on. It might seem bad because the brain is so depleted. Getting help to jumpstart the brain pathways is good medicine. Dr. William Walsh in Chicago is the worlds leading researcher in nutrient therapy and it is amazing how a little B6 can perk up the brain so at least you have some aliveness. I recommend getting testing. It may not all be psychological stress.

    Paula

  42. Tom Murphy says:

    1. You are NOT alone. The sentiments, grief, disillusionment that you express is so common amongst your colleagues. So many of us suffer in silence and consign ourselves to a life of misery….

    Just trying to hang in there till the next weekend or vacation, the next temporary reprieve or parole of a couples of days off is not the answer.

    2. I congratulate you on having the courage to contact Pam and to reach out for help. That is a huge first step along the path to recovery. The real question is where do you go from here? At times like these, it is almost inconceivable to contemplate major life changes but that is likely what is going to take for you to rediscover your joy and passion for medicine. You need to look at making these changes and commit to them. You, your family and the patients that you treat will be the better for it.

    I went on a similar journey with Pam last year and made these changes and I am a better man, doctor, husband and father because of my work with her.

  43. Paula says:

    Response to “Wise One”
    Hahaha, God alone is the wise one. Well, suffering has some benefits… until we fall smack down in to despair. Suffering is the price we pay for caring but we need to make sure we care for ourselves. Certainly having some self-compassion and self care to get out in the woods and feel normal is good. That was Pamela’s advice to me (smart Pamela).

    One hard pill to swallow is that we chose this lifestyle. Own it. To counter negativity, a gratitude journal is good medicine. Having some gratitude that you only works 4 days, what an an unusual treat these days and having an hour to work up complex patients is also a blessing because unfortunately in the outpatient setting the system tries to squeeze water out of a stone and most docs don’t even get 30 min.

    I have quit many many bad jobs so ask yourself is this a bad job for me. If it is bad, move on. It might seem bad because the brain is so depleted. Getting help to jumpstart the brain pathways is good medicine. Dr. William Walsh in Chicago is the world’s leading researcher in nutrient therapy and it is amazing how a little B6 can perk up the brain so at least you have some aliveness. I recommend getting testing. It may not all be psychological stress.

    When I finally got tested I had a host of things like chronic infection. Healing the healer is the name of the game.

  44. Paul says:

    Pam, thanks for asking. I know in your work sometimes you run into these hard working and resposible guys. He will keep working until the big blow up.

    First of all, the EMR dysfuntion is what is ruining his life. His employeers embraced this and they should get him a scribe, Dragon, or data key board entry person IF they want him to see the same volume of patients.
    Second, he is working too long and his bosses love it. They do not care his personal and emotional life is suffering. His administrators are no good.
    He has to work 8-5 right now, today. He will need to see fewer patients until they can help him with the computer nightmare.

    A lot of physicians are stable introverts(Eysenck’ model) and have traits that are dedication to hard work, neglect of personal enjoyment, reliable, timely, perfectionistic and dedicated. These guys are an administrators dream come true. Eventually it ends poorly when a medical, personal, substance use, or psychiatric problem in the physician. The psychiatric term is “Demoralization”(not really depression, more like your discription of “burnout”
    These guys do well running there own practice but must be held accountable for overwork and taking on too much financial, work and personal responsibility.

    I hope this help our fine friend. It takes courage to stand up for yourself when your administrator has manipulated your fine personality traits for a long time.

  45. Dear Sad Doctor,
    I really feel your pain. I’ ve been in your shoes. It’s so sad to accept that the healer is the wounded. The healer can’t fix himself. You try so much to convince yourself to love what you’re doing but you can’t. I did all that but it did not work. I lost myself in the twisted system. I was disillusioned. I was devastated. I did not study that long to subject myself to the twisted system. Right now I resigned. I am now a non- practicing anesthesiologist. I am trying to move on. Making a happy life for me and my family.
    I am not an authority to give a sound advice but here is what I have to say…
    Try to take a breather. If you miss what you are doing then go back with a new mindset and perspective. But if you don’t miss what you have been doing, then get out and start a new career where you can live a life that you envisioned.
    Life is short, live your life with perspective and significance.
    Don’t mind what others will say.
    Maybe you can go to Pam’s live meet ups where you can meet the happy doctors. I myself have not attended but I know this advocacy of Pam can do wonders for you.

  46. Jeff says:

    Dear Pulmonology doc,

    You have three options:
    1. Change your mindset
    2. Try and change your current job
    3. Get a new job (or create one)

    That’s it. Try then in any order or mix and match!

    Benefits of option 1 is nobody is required to change but you. This makes it relatively easy. Realize that your are awesome, your life is awesome and pretend you are a superhero when you go into see a patient. Read Man’s Search For Meaning and don’t let them take your last freedom. You would be surprised the power of your own mind.

    Option 2 is harder because you have to convince people that don’t care about you to change. Sounds hard huh? I would at least get a scribe to do my charting…or I would become an EMR ninja!

    Option 3 may be the best of all. Think about what you want in a job, write it down, visualize it and then find it or create it. Life is way to short to be unhappy.

    Good luck!
    Love,
    Jeff

    PS: Working for money to put your kids through college is the stupidest reason to work. Your kids are tough. They can work, get scholarships or take out loans. It will make them tougher and appreciate what they have more. Loving, happy and present parents are much more valuable than a big 529 account.

    • Pamela Wible MD says:

      I love how you wrote love Jeff! That’s the spirit. We need more doctors to be loving with one another 🙂

    • Gail Hirschfield M.D says:

      You have a way with cutting to the core of it…succinct and compassionate! as the British say–
      “brilliant”.

  47. Mark Mc Ginley says:

    Thanks Pam

    I sat down to read this thinking I would like to help a burnt out physician and realized it was my post !!!

    I do appreciate the feedback and I have found several of the suggestions very helpful.

    Things have improved and I now have more time with my patients.

    I have recently completed a fellowship in Integrative Medicine and I think that was adding to the frustration of where I am and what I really want to do.

    Suffice to say that I will be working in the soon-to-be-opened Wellness Center in the summer of next year. I want to inspire and empower people to regain their health and I sat down with the CEO and explained what my vision was and what I needed. The CEO listened and I have my “mojo” back.

    Thank you to all my colleagues for taking the time to write and showing your concern and compassion.

    Mark

  48. Locums MD says:

    I’d say try doing a locums spot in New Zealand just for a change of pace. Kids are always expensive, people underestimate how much time and money they really are. Own it or move to an area that has a better free public school system (they do exist). You can always earn more money as a locums than permanent. Kid should stay with mom or grandparents or someone stationary and you can pay while traveling around and when you get a vacation you can see your kid while having a more flexible lifestyle. Sometimes life isn’t always about achieving the house and white picket fence with the wife and kids and is about being flexible and figuring out the economic options.

  49. Wayne Smith MD says:

    Hello Depressed Doctor,
    You have spent a lot of time and emotional energy to correctly name the source of your current, though possibly only temporary misery. You use the words trapped, sad, negative, betrayed, deflated and frustrated. You are a soul in horrific pain. You are grieving the loss your personal and professional autonomy, which has been usurped by the requirements of the medical/governmental establishment. The comments from so many others are not only full of helpful advice, but also show that you are not alone in this. My advice, for what it’s worth, is to keep in contact with trusted peers, family, or colleagues. A professional therapist may be of some help. Share your pain with them and lean on them.Take care of yourself…you know, diet, exercise, meditation, adequate rest. You are a valued, talented, worthwhile, and competent healer attempting to function in a system that depersonalizes not only you, but your patients. You have some difficult days and decisions ahead of you as you seek to establish the kind of life, professionally and personally, that your soul longs for. Continue to listen to that soul’s voice. The letter you wrote to Pamela is ample evidence that you have started the process. May you find the strength you need to continue to walk your path to wholeness, health, and contentment. My thoughts, and those of the many who have written here, are with you.

  50. Dr. T says:

    I understand this so well, and the direct answer is to speak up–not to complain but to suggest improvements. Often times the things which are rote and frustrating can be streamlined. Whether it is working with the local Infornation Systems folks to tweak the software, reports, and data entry so that it does not take as much time. Ask! You would be surprised at how many times I did this in residency and the IS folks had no idea there were problems. There is a lot of inefficiency in medicine. Get a group of docs together, for a weekly practice management seminar breakfast (catered–work covered by alternate staff for an hour or so), add the administrators, computer support and CEO, even. Add the head nurses and a pharmacy staff member. During this meeting discuss agenda items, the frustrations, the new enhancements, make your voice heard. Change happens when people speak up. Slavery happens when they don’t speak up. Hospitals lose money when docs and patients are unhappy. Learn the language of business and request changes thoughtfully in a context that makes it hard to resist. Use positive but firm language. Look at tasks which can be delegated or automated in ways that nay not have been considered, like having a new patient’s reports with all the data gathered (electronically or on paper) ready to review by the doc in one place. Ask to hire a consultant to assist in designing a better work flow. Perhaps even get the Information Systems folks to have a staff member follow a doc around to see where things are taking too long. These folks are bright and smart and innovative. Instead of keeping them bored playing computer games, use them to design the system you want.

    Silence = submission = despair.

    And if you don’t find someone who will listen (remember it really is a team when you deescalate), it is time to go somewhere else where you are appreciated.

    The first step is believing that you have control over your work and your life. You are an asset, not a liability, to yourself, your family, and your workplace. Do not ever settle for slavery. It is only an illusion.

    Click your heels together three times. Your heart’s desire may just be in your own back yard, if you have the courage to see it.

  51. Pamela Wible MD says:

    Another comment:

    I think I would echo what everyone else has said first. He/She is not alone. I think that was the biggest thing for me was that I felt like I must be weird and no one else feels this way. By being part of our group, I realize that is the farthest thing from the truth. I think they want us to feel alone. We are not good at sharing our feelings because we are afraid of being chastised. You are valuable. In case you missed it, Sad Soul, I will say it again. You are valuable. Don’t let them make you feel like you are not. You are good, talented and your patients appreciate you even when administration does not. On days when I feel overwhelmed, it is the patients that keep me going. I had a patient tell me I was “so awesome” just yesterday. They need you to listen to them. That goes a long way. I can’t tell you how many times I have been told I was the first doctor to really listen and explain things. And patients love me for it. The other thing that has made me happy is learning to say no. I have one hour new patient appointments and 30 minutes follow ups. Managment has tried on several occasions to get me to shorten visits or double book and I just refuse. It is scary the first time you say no but it gets easier. I do have the benefit of being a pretty rare specialist so it is not like they can just replace me so that does give me some significant power in this struggle. But again, I will remind you that you, too, are valuable. That just don’t want to admit it. So, embrace your power and value and tell them no. I need more time for administration. Maybe it is one less patient a day as someone else suggested, but I will admit that an hour would not be enough time for me. It takes several hours of charting to keep up a day. maybe the answer is an afternoon of admin time where you don’t see patients but work on papework. I know several docs that do that.
    Above all, remember you are not alone. We are all here and you are a commodity. God bless and hang in there.

    How is that for a response? 🙂
    Alison

  52. Alison says:

    I think I would echo what everyone else has said first. He/She is not alone. I think that was the biggest thing for me was that I felt like I must be weird and no one else feels this way. By being part of our group, I realize that is the farthest thing from the truth. I think they want us to feel alone. We are not good at sharing our feelings because we are afraid of being chastised. You are valuable. In case you missed it, Sad Soul, I will say it again. You are valuable. Don’t let them make you feel like you are not. You are good, talented and your patients appreciate you even when administration does not. On days when I feel overwhelmed, it is the patients that keep me going. I had a patient tell me I was “so awesome” just yesterday. They need you to listen to them. That goes a long way. I can’t tell you how many times I have been told I was the first doctor to really listen and explain things. And patients love me for it. The other thing that has made me happy is learning to say no. I have one hour new patient appointments and 30 minutes follow ups. Management has tried on several occasions to get me to shorten visits or double book and I just refuse. It is scary the first time you say no but it gets easier. I do have the benefit of being a pretty rare specialist so it is not like they can just replace me so that does give me some significant power in this struggle. But again, I will remind you that you, too, are valuable. That just don’t want to admit it. So, embrace your power and value and tell them no. I need more time for administration. Maybe it is one less patient a day as someone else suggested, but I will admit that an hour would not be enough time for me. It takes several hours of charting to keep up a day. maybe the answer is an afternoon of admin time where you don’t see patients but work on papework. I know several docs that do that.

    Above all, remember you are not alone. We are all here and you are a commodity. God bless and hang in there.

  53. Amanda says:

    Hi Pamela. Reading this letter just motivates me more to act. The time is now. The lives of both physicians and patients are at stake here. We all need to do our part to say enough is enough. Depending on your particular situation, the way in which you approach this problem may vary. For those of us here in my situation, we have decided to go to hospital management and the hospital board of directors to enter a vote of “no confidence” for the company contracted to provide services at our facility.

    I have been through trials so difficult that I should be dead right now. It is literally a miracle I am alive. I am thankful for those trials because they have forged my strength to persevere as well as my integrity into something much stronger than I could have ever imagined having. I work for my patients’ interests, not corporate interests. In the corporate world, everything has a price…even human life. And everything including life is expendable for the right price.

    My patients depend on me. As our program has been progressively mismanaged, our workload and work hours have progressively gotten worse until we have reached the breaking point. Our particular situation may be a little worse than average, but it is still just an indicator of the ethical and moral depravity that is progressively ruining our healthcare system. It is a nightmare. If the public were aware of how bad is really was they would be outraged. Each physician is now rounding on at least 25 patients per shift in a high acuity facility, many of which are in the ICU and most of which have multiple and highly complex medical problems. In fact, the complexity of the patients here is far greater than what I have encountered at any other facility in the past.

    At this point our core, top performing full-time providers have been working on average 14 to 15 hours per day just to keep up. That is 14 to 15 hours of nonstop backbreaking work. There is no down time. The shift is supposed to be 12 hours. We are having to double check each other to avoid making mistakes in an attempt to keep both us and the patients out of harm’s way.

    But I have realized that we are indeed in harm’s way and if we do not act there will inevitably be catastrophic consequences. That is simply unacceptable. This situation has now become a public safety issue. Once winter hits the situation will become unmanageable. Using last year’s data and predicting a 20% surge in the inpatient census, that will give each provider an average of 35 patients to round on each day. And again, these are 35 sick, complicated patients. The burden of the workload will simply become too heavy to bear. We cannot work from 7:00 AM to midnight or 1:00 AM each day in order to get the work done. That type of situation is completely unsustainable and it will surely result in bad outcomes (including patient deaths), lawsuits, physician burnout and illness, and physician attrition. And when these bad outcomes occur I assure you corporate brass will not stand by us. They will insulate themselves in their offices and cubicles as the physician potentially loses his or her livelihood and reputation and the family of the victim mourns the loss of their loved one.

    This represents a true state of emergency for our facility and our community. What is happening here, in my opinion, is criminal. It is a crime with two victims: the patients and the providers. Every unnecessary death that occurs is tantamount to negligent homicide. When the bad outcomes are serious but not fatal, then it is battery. And I am including the physicians here as victims of this ongoing violence. This is motivated by money just like many other murders and other forms of violence. Corporate interests can no longer insulate themselves from the damage they have caused. Many lives have been lost, and many have suffered. We have identified that a serious threat to patient safety is imminent. We are ethically and morally compelled to act.

    • Pamela Wible MD says:

      So what do you intend to do?

      • Amanda says:

        We intend to go to the highest levels of hospital management and explain the situation in terms they can understand so they can really grasp what the implications are. That should be enough to motivate them to do something for several reasons:

        1. The hospital board of directors and members of top management are part of the community here. They care about the community. Both themselves and their loved ones may be patients here on a regular basis, or at some point in the future. They do not want bad outcomes caused by mismanagement or any other reason for that matter.
        2. Many members of the hospital board and top management are prominent members in the community. If the implications of this problem became public it would be bad enough, but if it continues past the breaking point it will be downright catastrophic. They do not want or need a public relations nightmare.
        3. Finally, like with anything, money plays a role. Once they realize they will be losing money in the end if this is not dealt with (and a lot of it), even those who are reluctant to act will be persuaded to do so. We have the data to show the deterioration in revenue that has occurred already, as well as data to predict what will occur if this continues on past failure. All means of revenue and measures of performance have suffered. Yes, sheer patient volume has gone up but that doesn’t even make a dent in the damage that has been done. And referencing back to #2, a PR nightmare would be very costly for the hospital.

        It is time for them to see the big picture. We will request that they emergently demand the contractor to staff the facility adequately. If they refuse or are unable to do so, then we are willing to step in and manage the program, at least temporarily, in collaboration with hospital management.

        None of us want things to get to this point. Hopefully, this will shake up corporate management enough to start managing their contract with the hospital properly. If they do not then we will do what we must to save lives.

  54. Pamela Wible MD says:

    Dear disillusioned:

    You’re not alone, that’s for sure. From my more independent perspective, it has not seemed like any of the EHRs are ready for prime time. They all seem like the tail wagging the dog, so I have as yet resisted. We do just fine with our old paper charts, but are connected online, and with faxing and texting, though I prefer face-to-face contact and still make house calls.

    But with every choice comes other realities, limitations, inadequacies. I still don’t regret my decisions over the last several years to forgo EHR, but looming ahead, yes overwhelming, is the prospect of losing access and dollars etc. because of not meeting criteria for meaningful use, or being excluded from the hospital campus on some flimsy excuse. On the upside, I limit the number of days per week I work, and the number of patients I see per day, and have a much more tolerable lifestyle/workstyle, even look forward to going to work. My income has hovered between 45 to 50,000 a year for the last 16 years. I can live with this. The divorce, and the parenting schedule, and loneliness are frequently overwhelming. The medical practice has literally been a lifesaver for me, so I just keep it the way it is, as this model is durable. There are always plenty of appreciative patients who want what I do.

    Disillusioned, it looks like you’re stuck a bit, especially if you would be condemned by your kids and partner if you weren’t to provide what they expected in the way of college money.

    My patients had me buy a little house for the practice a few years ago, instead of renting office space––smart retired realtors! ––So I plan to sell the house I’m living in, for college money for the kids, and move into the basement apartment under the office if money is needed, as I expect it will be.

    Look for the win win wherever possible. I hope you feel safe enough to express to your employer at the ICU how unrealistic they are being, or how they might be able to attract more business and gain a better reputation with quality rather than quantity, but if they are anything like the managers at our community hospital here they will be blinded by the dollar signs or their management style, and you could very well be punished for speaking out. I have been, but I continue to do it anyway, partly because I can! It helps to be a small single mom seeing poor old people: it wouldn’t look very good if they were to attack me.

    Seek to leverage your strengths. Don’t give into despair. You are completely right of course. You are also are a smart person who probably could’ve made changes long ago, or taken a different course. See where you now can take a different course for the future you, and as an leader to your kids and others.

    Have courage!

    Dotty

  55. Good morning and I read your response….while I agree with what you wrote, I also think that the physician doesn’t seem to also realize that the “system” of care that he works for needs him just as much as he needs that health insurance and other employee benefits.

    So, I think that the doc should also sit down with the administrative staff (and Medical Director) and lay out his concerns, and the options that he sees are available to solve them. For instance, has the clinic realized that a Physician’s Assistant can reduce physician burnout by “sharing” the work load in an efficient and cost efficient manner? Also, has the doc talked with his colleagues – and are they equally dis-satisfied ? If so, there is power in numbers and they should (as a group) talk with the “powers that be” about changes and concerns.

    Ultimately, this doctor may need to change work activities – but before that he needs to be assertive and present solutions as best as he can. Otherwise, he will (sadly) always feel like a victim.

  56. Laurel Methot, MD says:

    Hi Dr. Wible,

    You have (somehow) maintained the humanist perspective through your training. I respect this very much. I could not, that is why I left. I still answer people with the same response, when they ask how I could go through that kind of intense training and then leave. My response is: “First, it had nothing to do with the patients. They were my joy. Second, it had everything to do with the ‘system’, that was my despair.”

    This is my thought about one of your statements in this article. You said: “You can’t be a victim and a healer.”

    Please allow me to disagree. Providers have to be both healers and victims, or else we lose ourselves. I think part of the problem with the medical profession is we don’t allow ourselves to feel bad, sad, shamed, disgraced, and we don’t allow ourselves to seek help because that is weakness; so how does that translate to our view and care for patients?

    This perspective is what leads to the lack of self-care, self-healing, and the elevated physician suicide rates we see. We need to heal ourselves too. And my argument is that we need to be ‘trained’ (if it’s not already inherent, as it was for me) to see ourselves on both sides of ‘the table’. I accept myself as healer and patient. There should be no bad, sad, or shame in acknowledging that.

    ~~~~~~~~~~~~~

    Laurel M. Méthot, M.D.
    UCLA BRITE Center, Postdoctoral Research Scholar
    Minority Health & Health Disparities
    UCLA Department of Psychology
    e: lmethot@ucla.edu

  57. Stev says:

    try this: https://www.youtube.com/watch?v=khOaAHK7efc and this one to refresh ones perspective: https://www.youtube.com/watch?v=0jHsq36_NTU
    ‘ would also benefit from hearing this doctor: https://www.youtube.com/watch?v=YqsdCqKQCLU and watching this: https://www.youtube.com/watch?v=dajBfZQXDus.

  58. Robin Deethardt says:

    I am completely sympathetic to the “systems,” breakdown for overworked and disheartened physicians working in healthcare at this time. Is it plausible, the “frustrated and sad,” physician could take a brief sabbatical/vacation from practicing (1-2 months) and step away from the situation in order to regain mental aptitude to review his/her options with rested clarity? “First things first,” allow the brain to step away and refocus after a period of rest, in order to allow some comprehensive personal problem solving to take place. Reasonable decisions cannot be made under extreme stress and fatigue. Some thoughts.

  59. Victoria says:

    I know there is an ongoing battle between NPS and MDs, but I’m in the midst of closing my practice, and job hunting. Tried to practice with dedication, the way it should be. I saw complex, under served patients, with no one to refer them to for problems outside my scope. Now, deciding what is next, do not want cattle call practice, as disillusioned as you. We have to find a way to make it better, we have a common goal! Your situation is so common, mine is one level worse, layers of mismatched red tape. The patients needs help, we want to help, it’s all aboutmoney, not healthcare. We can fix this together. We’ve been purposely divided by those who can benefit from our division. We need to create a better solution, all healthcare providers together!

  60. Charley Johnson says:

    Advice, wow! I read the comments and yours too Pamela. All good. Becoming a locum might help; change of scenery, change of people. I realize running away from problems is said to not be the right answer but a change and not getting caught up in the daily B.S. can be refreshing. Also socializing with others in the same boat to talk things out is of help. As a nurse I never talked with one patient who said they should have worked more it was always they wished they would have worked less, traveled more or spent more time with friends and family. As for helping kids through college, chasing a big mortgage or any of the myriad of life’s expenses I would add: at what cost? If you are struggling physically and emotionally from providing is it really worth it? I worked at 25 different places in my 50 year career. I didn’t build up much longevity or retirement but it kept me sane. I was never afraid to try something new or experience a new environment. It worked for me and kept me sane and happy! Pamela’s retreat seems like a great idea. Good luck!!

  61. Steven Claus, DO says:

    Hi Pamela

    Feel free to give this lost soul my contact email.

    I too was like him. I worked for Ascension Health at one of their Florida hospitals. They are the largest Catholic health system in the country, unlimited money, pay poorly (except to overpaid non revenue administration), and Doctors are considered to be scum of the earth by them.

    Felt like your writer every day. Hated to go to work, worked 70 to 80 hours every week.

    After 7.5 years I said enough is enough. I quit to become a Hospitalist. Because of non-compete couldn’t work near my home for 2 years. Took a traveling position with a Hospitalist Management Company.

    Through trial and error eventually became a Full-time Locum Hospitalist and work for myself now. Work 18 to 22 weeks a year, vacation with wife frequently, make more than 2.5X my average pay when was an employee. Self-fund my retirement and the ACA allows me to get affordable health-insurance both for me and wife, despite my many spine surgeries.

    Never more happy in my professional career. Wife sees me more than she ever did when I was and employed doctor.

    There are options for your writer.

    I never had to move, we kept same home and friends, make so much now home and house are all paid off, cars too. Licensed in 7 states which gives me unlimited work opportunities. Extra benefit, we travel basically for free all the time with all my airline miles, hotel points, and rental car points.

  62. arney benson says:

    With a Telehealth platform & the right emr, you should have an wasier life. The key is to coordinate clinical & operational protocols that are effective. Arney Benson, Pharm. D., MBA

  63. Life has a way of convincing us that things should be a certain way, a standard I suppose. frustration is created when we feel we can’t meet that standard. Contentment is created when we create our very own standard for ourselves and our families. One should do what works better for his or her situation and this will likely alleviate any disappointment and frustration. Why stay in a situation that steals your joy? This is no qualify of life. This doc should not be afraid of change – either proposing a system that would work better, meeting with his clinical director and advising on a more manageable clinic schedule, considering working in the hospital which may be the lesser of the two evils, employment with other group, PRIVATE PRACTICE!

  64. yes I can relate, we are all in the same boat. Health Care documentation is becoming a nightmare and excessive regulations are stealing the pleasure of doctor-patient relationship
    I am glad I took a coaching course the last nine months and learned some skills to deal with the stress and to prevent Burnout
    I am happy to help I any way
    Check my website and call me

  65. J. says:

    Your story is familiar. I suggest you diversify your interest, occupation and source of income as soon as possible. Re-train! Do say MBA or law(JD) or both to give you an edge or an exit route. You can do either or both while you remain a practising doctor. Good luck.

  66. Roderick T. Beaman says:

    We began our sacrifice of integrity decades ago when the very first physician signed the very first claim form to accept payment for services from an insurance company, probably Blue Shield. It’s taken quantum jumps since, most notably with Medicare & Medicaid. The Affordable Care Act will likely give it another quantum jump; I think we’re already seeing it.

    Physicians have abused this system as much as patients have, leading to what we have today. I remember from the 1970s, physicians who were griping the most about the system were the very ones who were bilking it the most.

    EMRs are children of this. They’ve been promoted, partly, to deal with the regulations, etc. Every time we adjust to the new demands, they’ll just increase them.

    There’s no way out unless everyone withdraws which is about as likely as the sun coming up in the west.

  67. Paul McClintock MD says:

    Don’t despair!!! You can fix this. You are having a normal reaction to a very abnormal/abusive situation. No reason to tolerate it! You have two choices: 1. Attempt to fix the issues within your current employment setting, or 2. Give them the Raider Salute (Middle Finger) and change your job setting. How?
    Quitting is easy and finding other employment is easier. Just be sure your new situation suits your needs.
    Attempting to fix within will be harder, but possible. Hospitals need physicians to survive. You have power! Use it! The hospital CEO, chief of staff and IT dept. etc. need to hear you. Their job is make your life easier, not harder. Their job is to make you more efficient, not less. Their job is to support you by all means possible, so you can spend the large majority of your time doing what you do best. Treating, caring for patients, and developing the doctor-patient relationship.
    Here are a few ways the hospital/medical group can support and help you:
    A. They can hire a full time scribe to enter in all the data
    B. They can fix their EHR so it is phenomenally efficient and easy to use. Why physicians don’t demand this is beyond me.
    C. They can use mid-levels to take some of the patient load off.
    Bottom line: every medical task that is demanded of you should be easily and efficiently accomplished within the medical system for which you work. Being a doctor is difficult enough. Adding the burdensome EHR, coding, checking boxes, etc. is ridiculous, and should not be tolerated. Speak up and demand change. You are not alone.
    If the “powers that be” refuse to help you and make significant changes, then the raider salute is the answer.

  68. karyn aldridge says:

    It saddens me that the system has beaten up those in what I consider the noblest of all professions. Having said that #3 above really hits the nail on the head! My bit of advice would be to vote for Ben Carson, MD as a 1st step …

  69. If you are able , take a leave of absence . Then look into the type of practice Pam is advocating . You deserve much better and this medical abuse must stop . You are not alone so take heart . Many , like many of us have been abused and screwed . WE are going to fight back
    Robert

  70. Although it may not be much consolation, my organization specializes in a 24/7 EMR support call center for clinicians and hospitals working on the EPIC emr. I’m sure we could provide you with some tips to at least make things easier. Depending on the system, there are usually a lot of ways to customize the EMR to get through your day faster. Feel free to e-mail me at info@northstaritsupport.com. I would love to see if I can give you a quick few tips on making which ever system you work on more customized for your specialty.

  71. Cheryl says:

    Update.. Recap our chief of staff stoodup to offload task for our doctors. Along with making process improvements. Well this caused everything to hit the fan.

    So we’ve made 15 process improvements over the past year. We have now from a larger group to make more improvments for all staff and patients. Our extremely over worked doc. Is now on a paid 12 day vac. On an island. Upon return there will be an additional doctor in that department.many of her complex patients will be off loaded to the doc. We also hired more doctors in other departments. Additional staff will also have additional workers join them.

    We also found that many docs needed to employe all of the resource’s available to them
    no resource had more than a 30% usage rate. One provider used all responses. He arrives 15 minutes before his first PT and leaves on time daily.

    More improvments to come.

  72. chelsi says:

    Feel the same. I’m from Canada but working in a rural community. It has been frustrating. People are very demanding and complicated, also they don’t take a good care of themselves. People are either alcoholic, on opioids or on disability. I have to constantly fill in the disability or insurance papers.
    Hospital work is not even easier. Family’s are very demanding as they get free hospital privileges.
    I completely understand what you’re going through.
    Just stay calm and don’t be a victim to people’s demand. you can always ask patients to come back to complete their charts or for a follow up visit.
    I heard it’s harder in states.
    Stay strong.

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