Simons, Sandra Scott MD
Emergency Medicine News: July 2019 - Volume 41 - Issue 7 - p 9
Rebekah Bernard, MD, said, “We created our physician wellness program to provide free and confidential counseling to suffering doctors because of the suicide of several of our medical society members.” Follow her on Twitter@ERGoddessMD, and read her past columns athttp://bit.ly/EMN-ERGoddess.
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July 10th, 2018 - Minnesota Physician-Patient Alliance
This well written article by Rebekah Bernard MD highlights a perplexing dilemma for physicians and patients today. Doctors and other professionals who are denoted as “providers” within a clinic, insurance plan, or government program are graded and paid based on lab tests or questionnaires aggregated as scores for their performance derived from a population of patients who’ve been (arbitrarily) paired with that physician or “provider.”
Yet, we know that in most outpatient settings physicians have little control over what their patients will actually do. The terms “patient adherence” or “patient compliance” attempt to quantify discrepancies between the recommendations of the physician and the actual result of the patient in following his or her advice. Ironically, given the narrow (and narrowing) time crunch for allowable doctor-patient interactions, current P4P methodologies are likely to discourage patients from taking responsibility for their health care.
That’s where motivational interviewing comes in. Motivational interviewing enhances (realistic) patient and doctor decision-making. It helps put “skin in the game” for patients and doctors, especially when both patient and doctor can readily compare real, consequential prices of health care services, medications, and insurance benefits.
Physician Martyrdom Contributes to Burnout
Andrea Downing Peck
Rebekah Bernard, MD, a primary care physician in Fort Myers, Fla., describes what she calls the medical profession’s “martyrdom” problem, which ultimately can lead to burnout and disillusionment.
“Since physicians tend to be highly motivated, intelligent, and resilient, we get away with burning the candle at both ends for a very long time,” she said in a Medical Economics (MedEc) article “Unfortunately, at some point, we burn so brightly that we burn ourselves out. And when doctors burn out, patients lose.”
Rebekah Bernard, MD, a primary care physician from Fort Myers, Fla., believes the medical profession’s “martyrdom” problem causes physicians to do a poor job caring for themselves. She argues physician self-care is important for patient care, not because burned out doctors do a worse job caring for patients, but because unsatisfied doctors are two to three times as likely to leave clinical practice.
While Bernard found no evidence in medical literature indicating burned out doctors do a poor job caring for patients, she says patients do suffer. She notes physician self-care is important for patient care because unsatisfied physicians are two to three times as likely to leave clinical practice.
“Patients suffer when doctors don’t care for themselves: Because burned-out doctors are doing something that hurts patients more than anything else,” she said in the MedEc article. “We are leaving the practice of medicine, either by leaving medicine entirely, or more heart-wrenchingly, by taking their own lives, with physician suicide claiming the lives of approximately 400 doctors—an entire medical school class—each year.”
This is not the first time physician burnout and dissatisfaction has made headlines. A 2016 studypublished in Mayo Clinic Proceedings found that high levels of burnout and low professional satisfactions scores led to a reduction in physician work hours. Each one-point increase on a seven-point emotional exhaustion scale correlated to a 43% higher likelihood a physician would reduce their working hours.
Because pathologists do not see patients, they experience a different range of pressures and challenges than most office-based physicians. It would be timely for one of the national pathology associations to conduct a well-designed study of how pathologists view their career prospects in medicine.
ROCK-STAR WRITER AND DIRECT PRIMARY CARE PIONEER: MEET DR. REBEKAH BERNARD
Describe your traditional path in medicine:
I graduated from the University of Miami School of Medicine in 1999 and completed my residency in Family Medicine at Florida Hospital in Orlando in 2002. To fulfill my National Health Service Corp Scholarship obligation, I served in a Federally Qualified Health Center in the rural town of Immokalee, Florida for four years, and spent another two years there because I was passionate about working with the underserved.
After six years, the administrative and bureaucratic demands began to cause compassion fatigue, and I decided to transition to an alternate career path working with a more typically insured patient model, joining a hospital out-patient practice. I learned after five years that corporate medicine offered the same challenges to creative thinking and problem solving that I had faced in a government setting, and decided that my best option was to open my own practice, which I converted to Direct Primary Care in 2016.
What was the turning point or inspiration for you to make a major shift or start a big new project? What are you doing differently now?
When my company announced that they would be changing to a new electronic health record with no automated data migration, I realized that I had reached my limit. I had volunteered hours of my time working on a committee to make the EHR system better, only to hear that "corporate" had made a change without seeming to consider the impact that it would have on the physicians or patient care. I knew at that moment that I had to do something different, or I wouldn't be able to continue practicing medicine with any sense of joy or satisfaction.
I opened my own practice, which I transitioned to Direct Primary Care, eliminating third-party payers like insurance companies and Medicare. Now I work directly for my patients. I have more time to give them, and I spend far less time on meaningless computer work or unnecessary documentation. I love being a doctor again.
This also allows me more time to follow one of my biggest passions - writing. I wrote "How to Be a Rock Star Doctor" in 2015, and just published "Physician Wellness: The Rock Star Doctor's Guide," which I co-wrote with a psychologist. I also write blogs for KevinMD and Medical Economics. My ultimate goal is to help empower physicians, and I have shared this message through invitations to speak to more than twenty local and national organizations about how physicians can take back control of their lives and professions.
Did you have doubts or hurdles along the way? What was the biggest challenge? How did you overcome it?
I never thought that I could open my own practice - it just seemed too daunting to manage all of the moving parts of getting paid and staying out of trouble with the ever-changing Medicare rules. The way I overcame this challenge was to convert to Direct Primary Care, which eliminated one of the most stressful parts of medical practice, and allows me to focus on my patients.
Imagine you could travel back in time and give yourself an important piece of advice. What would it be, and when would have been the most important time in life to receive it?
One of the biggest hurdles that I faced in my life was 10 years of an unsupportive marriage. I would not have settled for marriage just because of societal or self-induced pressure ("you're 30, why aren't you married yet?") and I definitely would have insisted that I get a prenuptial agreement (something that I recommend to all women physicians!). Now that I have a supportive life partner, I have more freedom and joy than I could have ever imagined.
Female Physicians May Be Especially at Risk of Burnout
by Physicians Weekly | Oct 17, 2017 |
TUESDAY, Oct. 17, 2017 (HealthDay News) — Female physicians are more burned out than their male colleagues, but there are steps they can take to reduce the stress associated with burnout, according to a blog post published in Medical Economics.
Rebekah Bernard, M.D., a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida, notes that female physicians have twice the level of burnout as their male colleagues. In addition, the rates of depression and suicide among female physicians are 2.4 to four times higher than in the general population. Female doctors usually spend more time with patients during office visits, focusing on preventive care, education, and counseling as well as the psychosocial aspects of patient care. As a result, they tend to attract more female patients, who are more likely to have psychosocial issues in addition to physical ones. Also, male and female patients tend to talk more and demand more in office visit with female physicians versus male physicians.
However, female physicians can take steps to reduce the stress that leads to burnout. First, they can adjust their schedules to avoid running behind while ensuring adequate time with patients. They can also schedule frequent follow-up visits for emotionally challenging patients who can’t be dealt with in one visit, and they should refer patients with many psychosocial issues to psychologists. They can minimize documentation by finishing notes after each visit and keeping notes short. Last, they can renegotiate salaries by requesting fair compensation and adequate support.
“When women physicians feel treated fairly, and are given the resources that we need, our burnout levels will decrease,” Bernard writes. “And less burned-out doctors means better health care for everyone.”