Hospitals across the state are undertaking a united initiative to audit their credentialing practices and forms and to remove any questions that are overly intrusive or stigmatizing regarding a clinician’s mental health history. This first-in-the-nation effort is being championed by the Massachusetts Health and Hospital Association Board of Trustees.
Dr. Jesse M. Ehrenfeld’s July 14 op-ed was an important encapsulation of how burnout is affecting our caregivers each day and the solutions that are within our reach ( “Burnout is causing doctors to leave medicine. Here’s how to help them stay.” ). We are encouraged to report that one such solution is already in motion here in Massachusetts.
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As Ehrenfeld suggests, we believe this change in practice can make clinicians less hesitant to seek the mental health care they need and, ultimately, improve patient care.
This is just one element in the comprehensive approach that the MHA and its members are taking, in close coordination with the association’s partner organizations across health care, to meaningfully address burnout for all caregivers. We remain committed to working with the Massachusetts Medical Society, leading nursing organizations, and state leaders to make the Commonwealth a place where clinicians can thrive and be their best selves.
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Dr. Steven M. Defossez
Vice president of clinical integration
Massachusetts Health and Hospital Association
Burlington
National single-payer plan is the only solution
Dr. Jesse M. Ehrenfeld, president of the American Medical Association, eloquently describes the crisis in US medicine as physicians increasingly suffer burnout. He writes that doctors “can’t ignore the increasingly bureaucratic and impersonal health care system and the toxic environment that surrounds it.”
The remedies Ehrenfeld proposes, however, fall far short of what is needed. He wants, quite rightly, to reduce common burdens such as lengthy prior-authorization procedures and to make it easier for physicians to obtain mental health care. He neglects, however, two more fundamental problems: first, the multiplicity of insurers, which makes it impossible to eliminate the unneeded expense, time, and hassle involved in providing care; and, second, the increasing corporatization of medical care that disempowers physicians and the role of for-profit entities, including private equity, that need physicians to generate profits.
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The only solution is to establish a single-payer system. It would hugely simplify the process of delivering health care, thereby reducing costs, frustration, and physician burnout. Moreover, health care would cease to attract corporations and investors intent on making profits. With single payer, physicians would be able to focus on what is most important to them: interacting with and improving the health of their patients.
Dr. Gordon Schiff
Jamaica Plain
Dr. Paul Sorum
Jamaica Plain
Schiff is an associate professor of medicine at Harvard Medical School and general internist and quality and safety director at Harvard Medical School Center for Primary Care. He is also former president of Physicians for a National Health Program, and Sorum is cofounder and former chair of the organization’s Albany, N.Y., chapter. Sorum is also a professor emeritus in the departments of medicine and pediatrics at Albany Medical College.
It’s a stressful profession, but many stressors should be curbed
I felt Dr. Jesse M. Ehrenfeld missed some key factors in his recent op-ed on addressing physician burnout. Yes, mental health is important. Prior authorizations, though, are a minor inconvenience.
Physician burnout is because of stress, plain and simple. There is always the background stress in medicine of just being a good doctor and striving for the best possible patient outcomes — that’s fine. Burnout, however, comes from the stress of mandatory, uncompensated call responsibilities; malpractice concerns; reimbursements lagging well behind increasing practice expenses; arcane documentation requirements subject to audit; and Draconian regulations at both the state and federal level.
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Until those problems are addressed, physician burnout will escalate, doctors will retire early, and the quality of health care will suffer.
Dr. Crawford C. Campbell
Moultonborough, N.H.
The writer, who retired in January, is an emeritus fellow with the American Academy of Orthopedic Surgeons.
All-consuming profit motive gets in the way of patient care
I would underscore the following as the main reasons for physician burnout:
Overbearing administration compels physicians to maximize revenues by seeing more patients faster. This aggressive and all-consuming profit motive kills caregiver attention to patients.
Insurance companies deny treatment options that are necessary for patient care. Physicians routinely spend countless hours with nonmedical insurance personnel trying to explain why a patient needs an MRI or a referral.
Cumbersome electronic medical records rarely are built by medical personnel, and they do not help providers treat patients. Their only true purpose seems to be to allow for the greatest amount of billing. What’s more, the various systems don’t communicate well with one another.
The fear of seeking mental health care treatment is a relatively minor cause of physician burnout. Physicians and other caregivers burn out because they have lost control of their practices. They cannot give patients the time and individual care they need.
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Dr. Paul Miles-Matthias
Seekonk
The writer is a retired physician.
No simple diagnosis for physician burnout
