Provider Burnout, in the Flesh

SEPTEMBER 09, 2015
Megan Weigel, DNP, ARNP-c, MSCN
Two months ago, I truly felt that if a student opened a nursing textbook to the few pages on “burnout”, my picture would be there. I am a nurse practitioner in a busy general neurology practice, with a sub-specialty in Multiple Sclerosis. I am efficient, have good time management skills, and do my best not to run late. I usually have a speaking engagement two nights per week after clinic, and once a week I teach yoga to people living with MS for my nonprofit organization, oMS Yoga. I have a busy, full life, and while these extracurricular activities certainly take away from time for rest and rejuvenation, I love to do them. Educating peers and patients comes natural to me, and teaching yoga to people living with MS is one of the best things I have ever done in my medical career. Sounds great, right? Well, a month ago, I took an unpaid leave of absence from my practice. You might ask, then, what happened?
 
Burnout Defined

  • A long-term stress reaction resulting in depersonalization, negative attitudes, emotional exhaustion, feelings of decreased personal achievement, and lack of empathy. (from the AMA module, “STEPSforward: Preventing physician burnout, http://www.stepsforward.org)
  • By the inventors of the Maslach Burnout Inventory: “an erosion of the soul caused by a deterioration of one’s values, dignity, spirit, and will.” (Christina Maslach)
  • Burnout results in decreased care and professionalism, increased errors, lower patient adherence and satisfaction, and increased rates of substance abuse/suicide/intent to leave practice.
Do Patients Cause Burnout?

Well, sure, there are certain personality types that can eat away at a health care provider: the person who refuses every option for treatment presented by you and many other providers and continually says, “No one can help me”; the “woe is me” personality, or as I call it, the “Eeyore” (think Winnie-the-Pooh), who usually does not want to dismiss the sick role; the person who comes in armed with information from Google University, looking for an argument… the list goes on and on. But, if you are armed with a healthy personality and a healthy sense of humor, these people just become little potholes in the day. You cruise over them, and forget they happened. Two months ago, I was finding it much harder to cruise over them.  I felt like I was getting whiplash every time I hit a pothole.
 
Does the System Cause Burnout?

Well, sure it does!  We don’t get reimbursed as well as we used to, and certainly not for time spent in care and concern of a patient and their family. We get monitored for checking specific boxes, documenting things that may be irrelevant to a case, and making sure we send in a prescription electronically, even if the patient doesn’t need one. We spend countless non-reimbursable hours filling out step edit forms, writing letters of prior authorization, and trying to get physicians on the phone to get appropriate studies approved for patients. Even older medications require prior authorization. Blue Cross and Blue Shield of Florida has a six-page form to get PT approved for some of its plans. We learn how to play in a sandbox that doesn’t have the right tools, that doesn’t support us, so that we can adequately care for our patients. Some days, it feels like swimming while holding a 100-pound rock.
 


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