The pipes in Rome were slowly killing the people.  No one knew lead in the pipes was actually poisonous.

Today, it’s quite easy to scoff at their ignorance.  Yet, each of us have our own lead pipes, those modern “marvels” that future generations will shake their heads at.  We have at our fingertips inventions and practices later proven to be catastrophic to our health and well-being.

It’s one thing to learn about these blind spots after the fact.  What if you knew in REAL-TIME what was happening?

What if you had secret knowledge about your OWN lead pipes . . . ?

What if you were among a small group who knew which of our modern inventions and practices were slowly killing our health and vitality . . . would you still turn a blind eye?

Or, would you make the simple change that set you free?

After reading the following two articles, I now understand why I must spend 17-18 hours a day working to keep up.

I thought that maybe it was just me.  However, this study published in the Annals of Internal Medicine found that during a typical office day, just a quarter (27 percent) of a physician’s day is spent having direct face time with patients – while nearly half (49.2 percent) of a physician’s day is spent on EHRs and other administrative work. This roughly translates into two hours of additional time spent on EHRs and desk work for every hour physicians spend face-to-face with patients.

Over the years, we’ve hired more staff and I now have six and a half staff members to every provider. It’s taken part of the burden of time off of our shoulders, yet, in an era of rising inflation, hiring more staff isn’t affordable.  It’s not a sustainable model financially.

This second study found that with an average primary care practice responsible for roughly 2,300 patients, doctors would need to spend 21.7 hours of patient interaction per day to provide “all the recommended acute, chronic and preventive care” for a panel of this size.  The average internist has 3000-4000 patients in their panels.  There literally are not enough hours in the day to take care of all the office tasks required for a panel size of 2000 patients or more.

It has become physically impossible to do what is now required on treating acute, chronic and preventative care for the patients that we see day to day in the primary care setting. The inability to fully meet patient needs due to factors outside of their control results in frustrated patients and very frustrated physicians who lose sight of why they decided to practice medicine in the first place. This can leave physicians feeling depressed, cynical and suicidal, pushing them to contemplate early retirement, search for other practice options, quit medicine altogether – or worse, take their own life.

This has created the general feeling and perception in the mind of patients across the country that physicians just don’t care, they don’t have time for me and “they just want my copay.”

It isn’t that we don’t care.  If I didn’t care, I would have quit practicing medicine 15 years ago.  I love the practice of medicine.  It is the immense burden of documentation, the paper work, the seven page FMLA forms, and the thousands of ancillary treatment plan reviews & signatures, the providing proof of performance to Medicare and payors required every day that makes it so very hard to complete lab reviews, refills and callbacks in a timely manner.

I haven’t taken a real vacation in 15 years.  Who has time?!

Today, mounting evidence shows that the day-in-day-out pressures experienced by primary care physicians – caused by long hours, excessive fatigue and the sheer emotional toll of the work – can lead to burnout, depression and suicide. Sadly, the medical profession has among the highest risk of death by suicide compared to other occupations in countries around the globe. Recent studies reveal the concerning rate at which primary care doctors feel as though their personal lives are negatively affected by work, feel stressed at work and wish that they had more time to do more for their own health. When it comes to patient care, physician burnout is associated with higher rates of self-reported medical error, substandard patient care, longer recovery time and lower patient satisfaction. Layer on top of the burnout syndrome what some are describing as “moral injury,” the distress weighing on physicians because the business of medicine has overtaken the doctor-patient relationship. And for some, it seems that practicing medicine is literally killing physicians.

To regain control over their practice and personal lives, some primary care physicians are leaving the profession and others are taking steps to deal with work-related emotional exhaustion and chronic over-stress. Over the years, I’ve inherited a number of patients who’s doctors have left practice or moved to concierge models.

I’ve offered concierge services to my patients for years, but few patients have shown much interest up to this point.

Does one just leave medicine altogether?

Maybe.

References:

1. Sinsky C., Colligan L., Li L., Prgomet M., Reynolds S., Goeders L., et al., “Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties,” December 2016, (Accessed online June 21, 2022)
2. Altschuler, Justin et al., “Estimating a Reasonable Patient Panel Size for Primary Care Physicians with Team-Based Task Delegation,” 2012, (Accessed online June 21, 2022)