Friday, June 24, 2016

Tough Life

Just read an article on "Medscape" about burnout among general surgery residents. (I'd link to it, but it requires "membership.") It says, in part:
More than two thirds of general surgery residents in a national survey meet the criteria for burnout, and many of them have considered leaving their residency program because of it, a study shows. 
... The study adds to a growing body of research suggesting that burnout among physicians in training has reached epidemic proportions, they write. 
In a 2015 study reported by Medscape Medical News looking at burnout rates among medical residents by specialty, general surgery residents had the highest burnout rates ...
I find this interesting, puzzling, and worrisome. (Also, the fact that second on the list was radiology, one of the least demanding/best-paid specialties there is.)

Okay, here's the part where I point out that in my day, we worked literally twice as hard in training as they do now. My "easy" rotations were the ones where I (in theory) got to leave for 12 hours out of every 48 (more like 8, in practice). Otherwise it was 12 out of 14 days in the hospital except, when chief resident on trauma, it was 60 days out of 60. I suppose that means it's more than just the work hours.

In a way it's like teacher shortages: years of being demonized by right-wing screamers and leaders (Wisconsin, Kansas, et al) has led -- who could have seen it coming? -- to people looking away from teaching as a profession.

Yes, most docs make more than most teachers. But there's been a similar stupidity in approaching budgetary issues: people don't want to pay teachers what they're worth; R governors, unwilling to raise taxes on anyone, would rather see public education die. And the only way, so far, people have addressed rising health care costs has been to cut payments to docs and hospitals, along with producing more and more onerous (and, often, meaningless) rules requiring more and more paperwork and useless documentation of compliance with criteria having little to do with quality of care.

I'd have thought that residents, i.e., docs not yet fully subject to the rules and regs and stresses of practice, would have been relatively insulated. But I guess not.

I don't know where it'll all end up. I loved being a general surgeon, and it also burned me out after about 25 years of practice, causing me to bail at what some might agree was the height of my skills and knowledge. Residents, evidently, are bailing before getting into it at all. This doesn't bode well for the future. Meanwhile, because of the shortened work hours for residents, it's becoming clear that people finishing training are less well-prepared than we of the iron age were. One wonders, at this point, what sort of people finish training without burnout, and why? And, given the less preparation, who is it that decides to foist themselves on the public? Are those who didn't burn out ones who don't care as much about commitment? I have no idea.

Fortunately, I've worked out how to deal with it, were I ever to need the services of a general surgeon: stay home and die.

[Image source]


  1. I think it would be telling to also know what kind of people burn out prior to completing training. A comparison of the two groups would probably shed some light. Are the best and brightest sticking with it? Or are the smart(er) ones bailing? Probably there are other factors or characteristics that might predict the outcome to a better degree.

    The documentation requirements are easy to understand. We changed to Group Health a few years ago and the first thing that we noticed was the computerization of records and processes. My former GP would walk in with my thick file folder and, in the course of the visit and examination, talk to me and look at me. He'd pause at the end to jot down a few notes and that was it. My current GP talks to me and examines me, but he also spends a healthy portion of the visit at a terminal screen entering data while engaging me.

    I'm fine with that. He hardly gives any indication of how he feels about being tied to a computer network. But one day he briefly grumbled when the system wouldn't work the way he expected it to. I asked him what kind of person bridges medicine and IT. He gave me a cynical smile and replied, "I don't think there is anyone who bridges medicine and IT."

    Another thing I wonder about is possible generational differences. When I was working and involved in hiring later in my career, I was increasingly dissatisfied with many candidates. I saw lot of resumes of young people with employment history where their average employment with any company was less than 3 years and sometimes less than two. Many of them left impressions of people unwilling to commit as they hopped, skipped, and jumped to their next career challenge. Not willing to put in the work? An instant gratification/quickly tired or bored generation? I don't know. Those resumes always went to the bottom of the pile.

  2. I read and participate in this discussion while actively not completing documentation because goddmn I hate the doc system that doesn't even let you copy patient medical history from previous admits. Bastards.
    Sorry that was a bit of a rant, but I can at least testify to a certain general malaise ( there's actually an ICD-10-CM code for malaise R53.81) in current practice.
    Insurance certainly at top of list. Kind of funny that ACA critics haven't noticed this never stopped being an issue. .
    The facilityI work at has been bought and sold 3 times in the last 6 years. New owner's, different priorities, frequent
    turn over- you get the idea. Not sure about surgical residency, but part of me wonders if part of is about wealth. Medical school is affordable for few humans and I wonder about the fortitude of children of the wealthy.
    (Not meant to be a dig at Sid at all-hell serving in Vietnam is proof positive about commitment)
    But I did spend a couple of years at a school I couldn't really afford watching the prodigy of the elite drink and party their way to barely graduating. Still can't understand having that opportunity in life and throwing it away.

  3. For the record, I was lucky: finished college and med school with no debt, thanks to my parents who, I'm pretty sure, took out a second mortgage to finance their three kids in various states of college/post grad education. And residency was a paying job, if only at a rate of about ten cents an hour.

    I was at what some would call an elite college, and I know of damn few classmates who did anything but work hard, if partying hard, too. In my case, planning on med school, meant no way to slack off. Same as when in med school.

    I don't know what's different nowadays, if the data in my post are reflective of reality. But I've thought for a long time that the trend toward cutting reimbursement, having to prove one's worth in a guilty-til-proven-innocent atmosphere, increasing and increasingly onerous and ineffective paperwork requirements, etc, add to disincentivising the best and brightest, the most committed to high quality product, from going into medicine. And it's not about the money, really. I think people willing to work hard, to sacrifice, to commit to excellence expect some sort of recognition; ie, a sense that their quality is appreciated. Instead, insurers (at least in my time) considered a "preferred provider" one who'd accept the latest round of cuts in pay. Quality had nothing to do with it. Which gets depressing.

    Whether people in training can recognize it in a non-practice environment, I'm not sure. But it may well be that they go into it with higher purpose, only to find that results matter less than they thought.

  4. I'll chime in I guess...

    Y'all are over thinking it and Sids' "guilty-til-proven-innocent atmosphere" is a big reason for the demise of just about every profession we hold dear. Like Teachers for example. They raise our kids and get nothing but lower pay and benefits and parents that berate them while the 'haves' refuse to pay it forward. After a couple of generations surrendering pay, vacation, retirements, collective bargaining that the boomers parents fought for. At every turn the boomers sold their kids down the river. From wages to social security. These people were told "You are not going to see a cut in pay, social security and bennies, it's only the people who come after you that takes a cut." Everyone votes yes...Boeing gets 9 billion for doing nothing except threatening usual, and *poof* goes any chance the people who come after you will ever carve out a secure existence.

    Then fire/layoff etc. the folks that negotiated it all away and listen to the tears fall when they are 55 and can't find a job. When everyones resume looks like Swiss cheese. Staying with one company is gone. The companies took care of that with the full cooperation of labor. "Work hard to get ahead" is total bullshit. "Trickle down" is bullshit. "Give me your money and I might hire you, maybe, so you can make more money for me." How effing stupid is that? Well...30 year olds in 1981 thought it was the answer to all our problems. Union busting was all the rage. Then forced labor via the DSHS offices during the Clinton administration. In 2016 we got the results and they ain't good.

    If you are not "flexible" these days (AKA no life) you got no job. There's so many shady employment gimmicks that are not in favor of the worker, and it's gotten from the point of ridiculous to the point of embarrassing.


    Technology happened. Yesterdays medical students are software engineers, computer science etc. Anything that is "people oriented" is a dead end. My kids are pursuing educations in technology. As kids they wanted to be a teacher, artist etc. Now they'd rather work at Google or something like that.

    If anyone is looking for the one generation of "kids" that lack balls...It's the boomers, born every ten seconds. They were practically handed everything and then gave it away. From the early 70's to this day, wages have flat lined. Kids today actually make less money and live shorter lives than the boomers before them. Todays' kids are the first generation to have shittier lives than their parents. Are the unborn children responsible for that? Our kids fought (and are fighting) two wars simultaneously that are nearly as long as Americas involvement in WW2, Korea and Vietnam combined. Only to come home to divorce, foreclosed homes and sick, unemployed parents with medical bills they can't pay.

    There's alot more going on than a simple "kids these days". Oh...and "kids these days" are one helluva lot smarter than we were at that age. We had to compete with Chip down the block. The kids are competing with the world. While we fight eachother for the right to work for less.

    Seems pretty obvious to me anyway...

  5. Nicely said Smoothtooperate. The good news is that a lot of kids have seen the apocalypse coming and are demanding change. Hopefully the spark that Bernie and those that believe in what he preaches have ignited, will continue to grow until one day there is meaningful change. I won't see the end result, but I'm going to stoke the fire while I'm here.


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