The "Physician Misery Index" was released earlier this month by Geneia, a health care solutions company. The results not only rang true to me but also cast a harsh light on the reality of being a physician in the American health care system. Over half (51 percent) of physicians surveyed said they had considered leaving medical practice, but more startling is that this number increases to 62 percent for young physicians with less than 10 years of practice. These figures are worrying given our aging population, and the predicted shortage of physicians, estimated to be between 46,000 and 90,000 by the year 2025.
What is happening to our health care system that is leading to such widespread job dissatisfaction?
Some of the other findings in the survey shed a little light on the causes: 78 percent of physicians said that they feel "rushed" when seeing patients, and 87 percent said that the "business and regulation of healthcare" have changed the practice of medicine for the worse. I can attest to having had conversations on these very topics with some very frustrated younger physicians just recently. In fact, the top three reasons given by physicians for their unhappiness were (1) lack of time to create meaningful patient relationships, (2) fear that quality time with patients might be a thing of the past, and (3) increasing regulation of health care.
Clearly, doctors feel that the pressure to see more patients in less time, and the increasing paperwork or "keyboard time," is making it impossible for them to fully utilize the skills they spent ten years acquiring. Sometimes I ask myself, did I go to medical school to do manual data entry for the majority of my day? Saddled with student debt and working long hours, many of my physician colleagues are simply burned out. Physicians have the highest suicide rate of all the professions, with nearly 400 physicians committing suicide each year. Male physicians are up to three times as likely to commit suicide as the general population, and female physicians are up to five times as likely. Additionally, almost 1 in 10 medical students in the U.S. has contemplated suicide.
What can be done to improve the situation? Can social media and social networking sites help?
There are many factors involved in physician burnout, but it seems that professional contacts and peer relationships are important. Research suggests that fostering a sense of community, providing mentoring, and having positive professional-professional interaction may all be of importance in addressing burnout.
Social networking sites for physicians may be a useful medium to provide such supports, although only a handful exist. These sites are proving very popular among physicians. The largest network, Doximity, claims over 50 percent of doctors as being registered on the site, and the newest, Medstro, reports rapid user growth and partnerships, including Google and the NEJM Group, which publishes the New England Journal of Medicine. Interestingly, both Doximity and Medstro have physician founders. Doximity was founded by Harvard and Emory University alumni Dr. Nate Gross, who also founded Rock Health, while Medstro was started last year by Dr. Jennifer Joe, a Harvard trained nephrologist who saw an opportunity to make an impact on medical students and early career physicians.
Catching up with Dr. Joe, I heard her recount her story. She knew she had to do something creative when she arrived on the job market after completing four years of college, four years of medical school, three years of residency and two years of fellowship in nephrology. She was 33 years old, saddled with debt and looking for her first job. "I had 13 years of training, yet no one ever taught me how to start my career, to find a job that's right for me. I struggled." By the end of her first year in professional life, Dr. Joe had worked at five employers, everything from a large community hospital, to a small "concierge" practice, to a start-up giving second medical opinions.
"I was one year out of training, and already I was burned out." Dr. Joe
It was at that point that Dr. Joe started the physician networking site Medstro, with the aim of helping young physicians and medical students to support each other, find mentors, and navigate their careers. "We all know millennials in general have different expectations of technology and connectivity, and millennial doctors are no different." Dr. Joe surmised that the frustration of young, millennial physicians uncovered by the Geneia survey was a result of the clash between the highly networked, efficient modes of social communication that her generation takes for granted and the often antiquated, and often bureaucratically hindered state of technology and communication in the American healthcare system today.
"When I walk into the hospital to start a shift today, I put away my iPad, sit down in front of a Windows XP machine and boot up an electronic health record designed over a decade ago." Dr. Joe
Hospitals today use multiple overlapping systems that don't talk to each other, many of which were designed in-house and haven't changed much since they were originally deployed 10 to 15 years ago. Dr. Joe's words resonated with me; it felt like she had plucked the thoughts from my very own mind. What's worse is that physicians have no idea about the backgrounds, interests and specialties of the colleagues they work with every day. "I can join a Meetup group, read everyone's profiles and then attend a real-life event and it's as if I already know everyone because we've already interacted online," says Dr Joe. For millennial physicians, this disconnect between the hyper-connected world of their personal lives and the fragmented world of medicine has given rise to frustration. "I know what my former middle school classmate had for dinner last night but I had no idea that the attending I'm rotating with just got back from volunteering to treat Ebola in Africa."
So is it time for doctors to login?
Can engaging physicians socially through this unique type of online community really help? That answer is still not clear, but the indicators are that there is huge demand. Social media networks for physicians appear to have been successful for a number of reasons. They have also drawn the attention of organizations like the NEJM group, and Google, both of which have secured partnerships with Medstro. These social media platforms are providing physicians with robust, interactive, and engaging social networks that are helping to virtually breaking down the silos of institution and geography, and allowing physicians to collaborate, get advice, or just chat, crucially allowing them to draw on a broad network of support. So it seems that for the time being, logging in, might be a useful way to avoid burning out.
P.S. Medstro is currently running an online competition called the "Joy of Medicine Challenge" which asks physicians for ideas to restore the joy of medicine, you can find more information on their website.