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Primary care docs on the front lines of medicine are burning out

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It’s no secret that med students, with their demanding workload and punishing schedule, have it rough. Witness a study from the Annals of Internal medicine — entitled “Burnout and Suicidal Ideation among U.S. Medical Students” — that found that 50 percent of medical students report burnout and 11 percent experience suicidal thoughts.

Unfortunately, it doesn’t get much better once these students become full-fledged docs. Almost half of all physicians (46 percent) report burnout, according to a JAMA Internal Medicine study of more than 7,000 doctors.

Burnout happens across the board, the report found, but is highest among doctors who are on the front lines of medicine — namely, primary care physicians and emergency room docs.

The upshot? “Burnout can lead to misdiagnosis,” Paul Griner, MD told Power Your Practice, a medical-practice-management website for physicians. “Doctors need to be in tune with their patients, asking, listening and connecting the dots. They can’t do that effectively if they’re burned out.”

Shortage of primary care docs

Burned-out doctors are also "more likely than other doctors to leave medicine," Mark Linzer, who has been studying physician wellness for more than 20 years, recently told the Chicago Tribune.

That’s bad news because the U.S. is already facing a deficit of primary care doctors. In short, KevinMD.com explains, primary care doctors “are becoming extinct.”

Fifty years ago, about 70 percent of all physicians practiced primary care — that is still the current rate in most developed countries — but today, according to KevinMD.com, only about 30 percent of U.S. docs opt into primary care.

And, although primary care doctors — which includes family physicians, general pediatricians, general practitioners and geriatricians — make up less than one-third of all doctors, they account for about half of all doctor’s office visits, The Atlantic reported.

Adding to the burden, the Chicago Tribune reports, millions of new patients who are becoming insured through the Affordable Care Act will be looking for a primary care doctor, as will the “10,000 baby boomers turning 65 and becoming eligible for Medicare every day.”

The shortage of primary care docs directly undercuts patient well-being, David Blumenthal, president of the Commonwealth Fund, a health care research foundation, recently told The Washington Post: “The lack of an adequate primary care infrastructure in the U.S. is a huge obstacle to creating a high-performing health care system.”

Surveys by many organizations, including the RAND Corp., show that rising numbers of patients, increased interaction with insurance companies and odious clerical duties (including filling out electronic forms) all contribute to physician dissatisfaction.

Primary care doctors are also among the lowest paid of all doctors even though, KevinMD.com explains, “there is good data to support the notion that a primary care-based delivery system increases quality of care and decreases costs compared to our current specialist-based delivery system.”

Medical Lexus lanes?

Frustrated with the inability to offer personalized care to their patients, many doctors are opting out of of the traditional model and joining the growing field of concierge medicine.

Concierge-medicine docs see about 300-500 patients annually — compared to the typical 2,000-3,000 patients that traditional doctors treat every year. Fewer patients means more time spent with each patient and, concierge-medicine doctors say, a higher degree of job satisfaction.

So, how do docs with fewer patients make ends meet? They charge an annual fee — patients pay them between $1,500 and $2,000 — which buys perks like same-day appointments, 24/7 access to the doctor and, of course, more face time with the doctor. Health insurance, though, will still pay for much of their care, The Atlantic reported in a recent piece on the trend.

Although the number of concierge doctors is relatively small — in 2012, there were about 4,400 of these so-called “private” docs, MarketWatch reports — it is growing rapidly.

Critics of the trend point out that most people cannot afford this new boutique-model of health care. Worse, they say, concierge medicine siphons away much-needed primary care docs.

One silver lining: There are many initiatives afoot at places like Stanford and Harvard that are trying to tackle the topic of physician burnout. Internist and anesthesiologist Bryant Bohman, co-chair of the Stanford Committee on Professional Satisfaction and Support, told the Chicago Tribune that Stanford is hoping to build a medical center focused entirely on physician wellness.

“We are completely aware," he said, "that one of the greatest obstacles to improving patient care is burnout by doctors who practice on the front lines of medicine."

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