Physician burnout is a complicated issue, as reflected by the recent Pulse report written by Markian Hawryluk. Yet there is much more to the story. Physician burnout reflects the dysfunction of our healthcare system and should be understood in the broader context of the perverse incentives, loss of autonomy, greed, abdication of responsibility and fear of change that defines what is wrong with our current system. The public needs to understand the parallels between physician burnout and the substandard care they receive at exorbitant costs. We can fix only what is known to be wrong.

To state the obvious, the system has many intelligent, competent and compassionate people who make the system work despite its flaws. They provide care to the best of their abilities on a daily basis, yet the system is increasingly working against them.

My purpose for interviewing for the article was not to complain for the sake of complaining or to garner sympathy, but to open up and communicate about the issues that adversely affect both patients and physicians. There isn’t much to be gained from blaming others in the system, including insurance companies and corporate entities. I hope to show that patients and physicians, while shortchanged in seemingly different ways, are essentially experiencing the same underlying issues.

Physicians are continually burdened with the fear of mistreating patients as a consequence of seeing too many patients too quickly and simultaneously overburdened by computerized documentation. We are held responsible for outcomes over which we have little to no control over. In using the tiny-carrot, big-stick method, insurance carriers, healthcare system corporations and Medicare apparently believe that physicians are lazy, uncaring and ignorant. With this oversight, the patient-physician relationship is toxic to both parties. Physician culture shuns admitting mistakes or limitations; thus we never push back against those who wish to control us.

It is well-established we have the world’s most expensive health care system spending: As a percentage of our sizable gross domestic product, it is two to three times more than other industrialized nations. This extraordinary fact suggests expenditures could be cut roughly in half. The reasons for this waste are numerous and interwoven. Physician burnout is a fundamental reason and needs to be acknowledged and effectively addressed — virtually all dollars that move through the system have an associated physician order. Health care reform that ignores or views physician burnout as a necessary price is doomed to fail or, worse, mediocrity.

Being a physician provides benefits beyond the obvious extrinsic financial rewards, but the adverse environment has critically reduced those intrinsic rewards. Those intrinsic benefits are what motivate us to peak performance of maximizing patient health and, secondarily, cost reduction. To turn an intrinsically gratifying and economically supportive profession into one in which more than half of physicians are experiencing burnout should clearly indicate how unbalanced our health care system is. Although the public is aware things are quite bad, many don’t fully appreciate how bad things are behind the scenes — or how good things could be if healthcare was reformed intelligently. Physicians are just realizing how bad the situation is.

The phrase “burned out” subtly implies that the etiology and fault resides within that person. More accurately, physicians experience burnout as a result of the medical system, not individual shortcomings. More micromanagement and punishment exacerbates the consequences of burnout: Patients suffer and die. I successfully developed multiple effective coping skills, but this only superficially addressed the symptoms and not the unethical and overall substandard system — health care is more about business than “health care”.

The solution to our healthcare crisis is a process, not an off-the-shelf law or economic premise. Patients and physicians must work together to positively change the system. It may be easier and falsely reassuring to continue the current course, but we must actively trust each other and figure out where to start. The first step is for physicians to reject self-defeating fear and open up about burnout.

— Dr. Mike Henderson is an internal medicine physician and lives in Bend.