Being a physician is more than just challenging work; it is often outright grueling. The stakes are high and the rewards are tremendous. More and more, however, these rewards are overshadowed by the stress and strain that plague the practice of medicine today. Almost every day I hear a colleague complain about the loss of control over medical decision making, obscene amounts of paperwork/red tape and a growing lack of appreciation for what has historically been seen as the noblest of all professions.
Doctors as now referred to as “providers” by a corporate system that seeks to increase profit margins by making physicians employees and squeeze independent, self employed groups and solo practitioners out. The hours are longer and the mental strain unprecedented, especially when the standard is perfection. “To err is human”, but apparently not for doctors. Even absent any error, a poor outcome can result in the stress of a lawsuit, subpoenas, depositions, and obscene legal bills. Even if the case settles, there is potential further scrutiny from state medical boards, increased malpractice premiums and the threat to one’s livelihood and one’s sanity at times.
The emotional toll of these things pale in comparison to carrying the weight of having done anything that possibly contributed to harming a patient. How many surgeons have ever had to postpone their grief over the loss of a patient so that they could attend to the next patient in need? A good doctor must be able to handle all of this and more because for a physician to do their best work, they need to be alert and healthy, both physically and mentally.
Unfortunately, there is little-to-no regulation on how many hours a physician can work. Think about this in comparison to pilots for a minute. Since pilots are responsible for safely transporting people through the air, there are strict requirements for how many hours they can work and how often they have to rest. Physicians also play an essential role in keeping people safe, however, their working hours and rest are not monitored at all after training is over. The current restrictions for residents limits shifts to 28 hours or 80 hours/week. Imagine that. What other job works more than 28 consecutive hours? These conditions can lead to serious issues for physicians and in turn, their patients.
Physicians often face a variety of mental health issues. Without the proper rest and care, they are at risk for burnout, substance abuse, and even suicide. Working 24-hour shifts and getting only a few hours of sleep each night can take a tremendous toll on even the best and brightest.
Many hospitals are ill-equipped to handle their physicians’ issues. They are inexperienced at best, and unaware at worst. Many hospitals still do not even have wellness committees; groups that help care for physicians. Many hospitals do have such a group, however they often lack any real impact or understanding on how to help without trampling on the physicians rights and further damaging a physician’s career and compounding the problem.
Physician’s Health Programs, or PHPs, were created with the intention of combating these issues, but they often fail physicians for a multitude of reasons including an obvious conflict if interest. The Recovery/Rehabilitation industry is a 35 billion dollar business, much of which is based on “junk science.” As a result, PHPs will often have a detrimental effect on physicians. A physician may enter the program to improve their health and to seek help to fight personal issues, but they are often misdiagnosed with nonexistent disorders or strong armed into unnecessary treatment.
If a PHP receives an anonymous tip about a physician, the physician in question lacks any method of appealing or disputing the claim. Then, they are forced to go to a preferred treatment center. If they disagree, they are at risk of losing their medical license, thus losing their career and livelihood. Medical professionals are also required to pay for treatment out of their own pockets, which could cost thousands of dollars, and there is no limit on how much treatment could be.
The PHP system is deeply flawed, and physicians need help, but they have nowhere that they can safely turn to. Most states have a PHP, however a handful of states such as California do not have a PHP, but instead have Medical Boards who in many cases have taken a more punitive approach over addressing the real crisis facing medicine and doctors today. Physicians deserve to be cared for so that they are equipped to care for the public properly. Action needs to be taken to improve the overall well being of physicians across the country.
“Employed Physicians Outnumber Self-Employed.” American Medical Association, May 6, 2019. https://www.ama-assn.org/press-center/press-releases/employed-physicians-outnumber-self-employed
Gever, John. “ACGME Raises Ceiling on Residents’ Duty Hours.” MedPage Today, March 10, 2017. https://www.medpagetoday.com/hospitalbasedmedicine/graduatemedicaleducation/63752
Munro, Dan. “Inside The $35 Billion Addiction Treatment Industry.” Forbes, April 27, 2015. https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#459113bd17dc
“Doctors Fear Controversial Program Made to Help Them.” Disrupted Physician, February 15, 2019. https://disruptedphysician.com/2019/02/15/__trashed/Miller MD, Dinah. “Physician Health Programs: Diagnosing for Dollars?” MD Edge, December 5, 2017. https://www.mdedge.com/psychiatry/article/153573/depression/physician-health-programs-diagnosing-dollars