Wanted: Healthy and Engaged Primary Care Physicians
Primary care physicians across the country are facing many daunting challenges today—including navigating the Affordable Care Act that will affect who will receive care and how physicians will provide services to an increasing number of health care consumers. Our profession is simultaneously navigating the slow and unclear journey from a fee-for-service payment model to value-based reimbursement.
As we undertake these evolutions, we are constantly reminded that we are facing a growing shortage of primary care physicians, estimated to be around 45,000 physicians early in the next decade.1 Demands on the individual physician are compounded by pressure from insurance companies who are dropping physicians and groups because of profit concerns.
In addition, scrutiny from patients armed with inflated expectations and access to a diverse healthcare marketplace may result in potentially damaging and rapid, reflexive criticism of providers on web physician-rating sites. This results in an ever-increasing emphasis on subjective patient experience, which may be completely unrelated to the objective quality of healthcare received.
Meanwhile, physicians are struggling with increased documentation requirements that steal precious minutes from our patient interactions. These complex and unfortunately integrated factors provide insight into the sober statistic that primary care physicians (internal and family medicine) have the second and fourth highest rate of burnout amongst physicians in the United States— approximately 45%.2
How Do We Respond?
The challenge we face is how we, both as a profession and as individuals, respond to these difficult issues without damaging the most sacred aspect of our vocation—our unique and powerful relationships with our patients? I propose the answer lies in us embracing multiple perspectives. We must embrace the challenge of how we will provide care as a profession and individual providers in the next 5, 10, and 20 years by exploring novel models of care provision. This includes developing and advancing current concepts, such as the patient-centered medical home and team-based care. It also requires electronic health records that improve and coordinate care, instead of acting as a hindrance.
Secondarily, but perhaps most importantly, we must fight to remain “in the moment” with each individual patient for 15 to 20 minutes of empowering interaction. Integral to maintaining a sense of presence with each patient is the concept that we, as providers, place a premium on our own mental, bodily, and spiritual health.
Finally, it is essential that we are active participants in advocating for the future of primary care. There are numerous non-physician entities that are clamoring to dictate the future of our practice. We must be active participants—locally, statewide, and nationally—to ensure we protect our natural right to define our profession and our relationship with our patients.
Remember, it is the primary care physician leader who is best positioned to achieve the triple aims of healthcare reform—improved care, better patient experiences, and reduced cost3—but only if we take and active leadership stance in shaping the landscape.
The Elephant in the Room
As we face this era of transformation, our greatest danger may be the increasing risk of physician burnout. I laughed when I saw a full page ad in a state medical journal about PCCD—primary care career dissatisfaction disorder. And, yet, I recognize many of my colleagues are struggling with this issue. It is also a major reason medical students tend to look beyond primary care as a viable career option. We must combat this disturbing trend by pursuing self-care and work-life balance to maintain our sustainability in this profession.
Our individual patients and populations are hungering for health. Our patients today are seeking more than a prescription and a few minutes of uninterrupted time to discuss their ailments. We struggle to provide what we do not ourselves understand or possess. The healthier we are as individuals, the better care we will provide as physicians.
A Healthier Role Model
In the past year, I have had more patients pursue dietary changes than ever before. They are looking to us for encouragement and education on current nutritional and lifestyle recommendations. Patients increasingly want to know how they can safely and consistently address their medical conditions using nonpharmacologic, nonprocedural modifications as a weapon in their health arsenal.
In a time when our patients are inundated with infomercials and misinformation, our ability to be able to educate and empower our patients will help engender trust. Patients are yearning for positive ways to handle stress, and are looking at us for role models of busy people who can successfully find a way to make exercise a meaningful and regular part of their lives. Sadly, we as a community often miss this leadership opportunity to provide a powerful example of health to our patients: A 2008 study in Britain showed 21% of physicians surveyed meet current exercise goals, down from 29% in a Canadian study in 1992.4,5
Let’s not forget that we can also make a profound positive impact by encouraging our colleagues. Every day we are surrounded by admirable “battle buddies” trying to forge ahead and the negative connotation that our profession is becoming increasingly challenging. Nowadays, it is common for me to not see my partner during the day even though we share a common hall. This isolation is a danger we must combat. Words of encouragement, genuine collegial interest in each other’s professional and personal attributes, and development of a team culture are significant factors in addressing workplace burnout for our colleagues.
Practice What You Preach
Forget about the old adage, “physicians make the worst patients,” and make it a point to see your own physicians at least annually. The great physician William Osler expertly noted, “A physician who treats himself has a fool for a patient.”
At my 36-year-old check-up, I was surprised to learn that my hemoglobin A1c registered at prediabetic levels. However, the news served as a great motivator for me to pursue a plant-based diet and improve my exercise regimen. Thankfully, my numbers quickly dropped to normal, and most important to me as a primary care physician, my struggle became an inspiration to many of my patients, encouraging them to pursue their own best health with more vigor.
And, a final note to my fellow physicians: Schedule a vacation (or 2) this year. Time away from the practice is often a great restorer of both our energy and our attitudes. A fresh perspective, clearer mind, and energized body refuels the spirit and better prepares us for service.
When we adopt the stance of a student and practitioner of good health, we inspire our patients, our staff, and our colleagues to do the same. In the pursuit of optimal personal health, our resilience to the increased risks of burnout and stressors in our current medical climate is strengthened. We achieve the higher degree of focus and energy necessary in the current practice climate to advocate for what our profession should and will be. If we do this I believe we will enter a “golden age” of primary care. I encourage you to continue to fight the good fight. Our patients and our profession are depending on you. ■
References:
1. Association of American Medical Colleges. Physician shortages to worsen without increases in residency training. Available at: https://www.aamc.org/download/286592/data/. Accessed February 2014.
2. Shanafelt T, Boone S, Lan T, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;
172(18):1377-1385.
3. Institute for Healthcare Improvement. The IHI Triple Aim. Available at: http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx. Accessed February 2014.
4. Gupta K, Fan L. Doctors: fighting fit or couch potatoes? Br J Sports Med. 2009;
43(2):153-154.
5. Stevenson LM, McKenzie DC. Physicians’ exercise habits. Can Fam Physician. 1992;38:2014-2018.