*The patient’s name has been changed
Hospitals and health systems around the country are launching initiatives and programs aimed at combatting healthcare worker burnout. This isn’t just in the interest of keeping their doctors and nurses happy — it’s about keeping patients healthy.
Let’s look at a scenario that has become increasingly common amid worsening doctor shortages. Maria* was receiving her cancer treatment from Dr. Smith, who then left the medical center last year due to burnout. Dr. Hong assumed her care, but she also left a few months later; Maria’s care is now in the hands of Dr. Patel. Maria is grateful for the great care she has received, but she can no longer remember her doctor’s name, and wonders if the doctor remembers hers.
Academic medical centers are especially prone to the turnover Maria experienced, as physicians in these settings are more susceptible to burnout. Patients are becoming hot potatoes, handed off from one provider to another.
The situation is especially troublesome in advanced care situations, such as cancer care. Under such circumstances, patients seek to form deep relationships with their physicians and expect their doctors to know the in’s and out’s of their disease so they can receive personalized care. Patients feel scared when, in the midst of this deeply intertwined patient-doctor relationship, they are suddenly told their doctor is leaving the practice, and they must seek care with someone new.
The architecture behind unprecedented physician turnover, which increased by 43% between 2010 to 2018, is likely multifactorial. According to a report last year, 35% of physicians experiencing burnout said those feelings significantly increased in 2022, and more than half said they considered leaving their current employer for another. This was a 46% increase from the year before. A separate poll found that 40% of medical groups reported that a doctor left due to burnout in the past year. And this is despite physicians being significantly more resilient than the general population.
The COVID pandemic may be at least partially responsible for these eye-opening numbers, with the crisis placing immense stress on our medical infrastructure. Physicians and nurses on the front lines worked long and stressful hours, provided care for more sick and dying patients than they could handle, tried to comfort stressed-out family members, and risked their own health and well-being and that of their families. However, at academic medical centers, other factors may also be playing a role in the high rate of physician turnover.
A primary factor could be related to the very structure of academic medicine. In academic medicine, there is a culture of graduated responsibility, which follows from the structure of clinical training. In training, as a student, resident, or fellow gains greater medical knowledge and skills, they move up the ladder toward more supervisory roles. There is a “see one,” “do one,” “teach one” philosophy in medical training.
In practice for an attending physician, this gets translated to greater supervisory roles with increased seniority. And for more junior-level physicians, they see greater patient loads than more senior clinicians who typically will have more administrative responsibilities. In extreme cases, this can translate to department chairs and deans not having seen a patient in years, or sometimes decades, and in extreme cases, abrogating their ability to practice medicine altogether. Moreover, ironically, some of these more administrative roles in academic medicine may be associated with substantially increased pay, much more than their boots-on-the-ground clinical colleagues who are seeing the actual patients and bringing revenue into the medical center.
During the COVID pandemic, this translated to junior-level physicians reporting a greater level of burnout than their more senior-level colleagues. Thus, we witnessed junior-level clinicians leaving academic practices for other opportunities, whether in private practice or industry, or employment breaks to spend more time with family. Clinicians, like the rest of us, have also begun to seek more remote work opportunities, such as through telehealth or pharmaceutical industry roles with geographical flexibility. While clinicians, like the rest of us, should have agency regarding their livelihoods, this becomes potentially problematic when their patients are handed off continuously to the point that the new physician barely recalls what the original treatment and indication were, and the patient no longer remembers the name of their new doctor. Forget about having a meaningful patient-doctor relationship.
While the public health crisis associated with the COVID pandemic is by-and-large in the rearview mirror in this country, it nonetheless hearkened a new normal regarding how and where we work. Physicians experienced burnout at levels not seen before, and their suicide risk increased. Ultimately, we owe it to our patients to address these issues head-on. Because if physician turnover continues to rise at this rate, then the deep patient-doctor relationship that we grew up learning about, and which we expect for ourselves and our own family members, will become a thing of the past.
Aadel Chaudhuri, MD, PhD, is a board-certified radiation oncologist, a Paul and Daisy Soros Fellow, and a Public Voices Fellow of The OpEd Project.
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