qotd: Since enactment of ACA more than half of physicians experiencing burnout

Mayo Clinic Proceedings
December 2015
Changes in Burnout and Satisfaction With Work-Life Balance in Physicians
and the General US Working Population Between 2011 and 2014
By Tait D. Shanafelt, MD; Omar Hasan, MBBS, MPH; Lotte N. Dyrbye, MD,
MHPE; Christine Sinsky, MD; Daniel Satele, MS; Jeff Sloan, PhD; and
Colin P. West, MD, PhD

Conclusion

Burnout and satisfaction with WLB (work-life balance) among US
physicians are getting worse. American medicine appears to be at a
tipping point with more than half of US physicians experiencing
professional burnout. Given the extensive evidence that burnout among
physicians has effects on quality of care, patient satisfaction,
turnover, and patient safety, these findings have important implications
for society at large. There is an urgent need for systematic application
of evidence-based interventions addressing the drivers of burnout among
physicians. These interventions must address contributing factors in the
practice environment rather than focusing exclusively on helping
physicians care for themselves and training them to be more resilient.

http://www.mayoclinicproceedings.org/article/S0025-6196(15)00716-8/pdf

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JAMA
December 8, 2015
Prevalence of Depression and Depressive Symptoms Among Resident Physicians
A Systematic Review and Meta-analysis
By Douglas A. Mata, MD, MPH; Marco A. Ramos, MPhil, MSEd; Narinder
Bansal, PhD; Rida Khan, BS; Constance Guille, MD, MS; Emanuele Di
Angelantonio, MD, PhD; Srijan Sen, MD, PhD

Conclusions and Relevance

In this systematic review, the summary estimate of the prevalence of
depression or depressive symptoms among resident physicians was 28.8%,
ranging from 20.9% to 43.2% depending on the instrument used, and
increased with calendar year. Further research is needed to identify
effective strategies for preventing and treating depression among
physicians in training.

http://jama.jamanetwork.com/article.aspx?articleid=2474424

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RAND Corporation
March 19, 2015
Effects of Health Care Payment Models on Physician Practice in the
United States
By Mark W. Friedberg, Peggy G. Chen, Chapin White, Olivia Jung, Laura
Raaen, Samuel Hirshman, Emily Hoch, Clare Stevens, Paul B. Ginsburg,
Lawrence P. Casalino, Michael Tutty, Carol Vargo, Lisa Lipinski

The project reported here, sponsored by the American Medical Association
(AMA), aimed to describe the effects that alternative health care
payment models (i.e., models other than fee-for-service payment) have on
physicians and physician practices in the United States. These payment
models included capitation, episode-based and bundled payment, shared
savings, pay for performance, and retainer-based practice. Accountable
care organizations and medical homes, which are two recently expanding
practice and organization models that feature combinations of these
alternative payment models, were also included.

Within our sample, alternative payment models had not substantially
changed how physicians delivered face-to-face patient care. However, the
overall quantity and intensity of physician work had increased because
of growing patient volume expectations and ongoing pressure for
physicians to practice at the "top of license" (e.g., by delegating less
intense patient encounters to allied health professionals), which was
described as a potential contributor to burnout because lower-intensity
patients could be an important source of respite for busy physicians.

Increased Stress and Time Pressure

New nonclinical work for physicians was almost universally disliked,
especially when there was no clear link to better patient care. For
example, frustration was common when physicians believed they were being
asked to spend more time on documentation solely to get credit for care
they had provided already. Overall, increased stress on physicians might
directly harm the quality of patient care and might also serve as a
marker that physicians are concerned about the quality of care they are
able to provide.

http://www.rand.org/content/dam/rand/pubs/research_reports/RR800/RR869/RAND_RR869.pdf

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Comment by Don McCanne

Since enactment of the Affordable Care Act (ACA), physician burnout and
dissatisfaction with work-life balance have increased and now are
experienced by over half of US physicians. The prevalence of depression
or depressive symptoms amongst physicians in training is 29 percent and
increasing. Health care payment models, which have increased under ACA,
are contributing to physician burnout.

Do we really need to say it? ACA was the wrong model for reform.

We need to switch to a well designed single payer national health
program which will then free us up to reform the health care delivery
system so that we have contented health care professionals dedicated to
providing optimal patient care. It would work for everyone.