More than half of emergency physicians are burned out, a rate that puts the specialty near the top among doctors who’ve lost their passion for medicine, according to a recent survey.
The Medscape Physician Lifestyle Report, released earlier this year, found that 52% of emergency medicine physicians reported that they were burned out, second only to critical care physicians at 53%. Specialties that reported the lowest burnout levels included dermatology at 37%, and psychiatry/mental health at 38%.
Overall, the survey found that 46% of all physicians were burned out, up substantially from 40% in 2013. Burnout was defined as “loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment.”
According to the study, multiple factors are contributing to growing disillusionment in medicine, including longer hours, lower income, excessive paperwork and increased computerization.
The Affordable Care Act effect
John Stimler, DO, a McKesson consultant and board-certified emergency medicine physician, said emergency medicine faces the added burden of an expanding gatekeeper role triggered by a surge in non-emergent cases coming through the emergency department.
“We get every type of case and quite frankly, many of them don’t belong in the emergency department,” he said. “The problem is that a lot of people still have nowhere else to go in the healthcare system. It creates a lot of frustration, particularly when patients are treated multiple times for a non-emergent illness or conditions often related to the use of pain medication or other drugs.”
The Patient Protection and Affordable Care Act (ACA) was expected to reduce emergency department volume through its emphasis on improved access to primary care physicians. But the opposite has occurred: A survey released recently by the American College of Emergency Physicians found that 75% of 2,098 physicians surveyed in March reported that volume had increased since January 2014. That’s up sharply from 50% of physicians seeing an increase in the year-earlier period.1
Experts suggest that difficulty in arranging primary care coverage and appointments for the newly insured is contributing to the increased volume. Stimler noted that not only is the emergency department providing a greater amount of primary care, but it is also facing more mental health cases due to the reduction of insurance coverage for both short and long-term psychiatric care.
Compounding the problems of overcrowding and non-emergent care, Stimler said, are lower reimbursement rates from many payers and growing difficulties collecting from self-pay patients due to the much higher co-pays and deductibles associated with the ACA.
The range of challenges that all physicians face has led many emergency physicians to contemplate leaving the field. “The burden is increasing to the point that some are just fed up, so they’re saying, `I’m done. I’ve had it,’” Stimler said, adding that emergency physicians are turning to less stressful occupations, such as occupational health or urgent care.
The growing burden imposed by both federal and state regulatory agencies is especially problematic for many physicians. Stimler noted that recent revisions in the Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System are confusing and extremely difficult to understand. The program imposes progressively higher financial penalties on physicians that fail to sufficiently report quality measures.
“The penalties are far more egregious than they need to be, and may lead to a 6% reduction in reimbursement for legitimate services provided to the Medicare patients,” Stimler said.
Also disheartening, he said, are CMS audit processes that often result in incorrect code choices made by auditors with little knowledge of emergency medicine coding, billing practices or standards of care. Resolving these audit disputes, he said, typically requires multiple steps that are extremely time-consuming and expensive.
In search of solutions
Stimler suspects the difficult landscape in medicine will likely worsen before it gets better. Increased payments that appropriately reimburse the physician for legitimate services provided, coupled with reform in the regulatory environment, are essential to improving physician morale and reducing burnout, he said.
“There is an assumption that physicians are trying to game the system, but we’re really just trying to survive,” he said. “We want to be able to take care of our patients, and we want to be paid fairly for the work we do. But it seems like the entire process is just becoming more and more untenable and burdensome.”