By Roni Caryn Rabin and Kaiser Health News
March 31, 2014 – Martin Kanovsky, an internist in Chevy Chase, used to see patients every 15 minutes and worry at times about what he might be missing by moving so fast. In December, the 61-year-old doctor reduced his practice to a small pool of people who pay a premium for longer visits and round-the-clock access to him. “There’s no such thing as double-booking,” he said.
Janis Finer, 57, a primary-care physician in Tulsa, Okla., gave up her busy practice two years ago to care full time for hospitalized patients. The lure? Regular shifts, every other week off and a 10 percent increase in pay.
Tim Devitt, a family physician in rural Wisconsin, took calls on nights and weekends, delivered babies and visited his patients in the hospital. The stress took a toll, though: He retired six years ago, at 62.
Physician stress has always been a fact of life. But anecdotal reports and studies suggest a significant and rising level of discontent in recent years, especially among primary-care doctors who serve at the front lines of medicine and play a critical role in coordinating patient care.
Just as millions of Americans are obtaining insurance coverage through the federal health law, doctors like Finer, Kanovsky and Devitt are voting with their feet. Tired of working longer and harder because of discounted insurance payments and frustrated by stagnating pay and increasing oversight, many are going to work for large groups or hospitals, curtailing their practices, or in some cases, abandoning primary care or retiring early, experts say.
The timing couldn’t be worse. “The lack of an adequate primary-care infrastructure in the U.S. is a huge obstacle to creating a high-performing health-care system,” said David Blumenthal, president of the Commonwealth Fund, a health-care research foundation.
A 2012 Urban Institute study of 500 primary-care doctors found that 30 percent of those aged 35 to 49 planned to leave their practices within five years. The rate jumped to 52 percent for those over 50.
Stressed doctors, meanwhile, often mean anxious, dissatisfied patients. Many consumers report feeling shortchanged after waiting weeks or even months for an appointment, only to get a quick once-over and be told there isn’t time to address all their complaints in one visit.
“Your actual one-on-one with the doctor is getting to be less and less,” said Christine Miserandino, 36, of Valley Stream, N.Y., who sees many doctors to manage her lupus.
Worrying about mistakes
“I always felt I was cutting my patients off,” acknowledged Lawrence Gassner, a Phoenix internist who recently switched from seeing patients every 15 minutes to a “concierge” model where he sees a third of his previous caseload. “I went to bed many nights lying awake, worrying that I missed something.”
There are no hard national data on physician burnout. But nearly half of more than 7,200 doctors responding to a survey published in 2012 by the Mayo Clinic reported at least one symptom of burnout. That’s up from 10 years ago, when a quarter of doctors reported burnout symptoms in another survey.
A RAND study for the American Medical Association last year found that nearly half of surveyed physicians called their jobs “extremely stressful” and more than a quarter said they were either “burning out,” experiencing burnout symptoms “that won’t go away” or “completely burned out” and wondering if they “can go on.” Nonetheless, many still described themselves as satisfied with medicine as a profession.
Should the happiness of physicians — a fairly privileged lot — be of concern to their patients? Experts answer “yes,’” saying that unhappy doctors can make for unhappy patients.
Indeed, one of the drivers of physician dissatisfaction is their sense that they are shortchanging patients: that they are too rushed, don’t have time to listen and aren’t always providing good care.
Kanovsky said he used to worry about what might have eluded him because of his relentless pace. Now that he sees fewer patients, he said, he is more relaxed — and his patients are happier, too. Working with a consultant called MDVIP, which helps doctors switch to a concierge model, he went from 1,200 patients to 400.
“Being a doctor is a bit like being a parent,” he said. “At the end of the day, if you have one patient who’s unhappy, you’re unhappy.”
Patients of satisfied doctors are more likely to show up for their appointments and adhere to treatment for diabetes and high blood pressure, studies show. Another survey found dissatisfied physicians reporting more difficulty than other doctors in caring for patients.
And in another study, burned-out surgeons were more likely to report having made a major medical error in the past three months.