Physician Burnout under ObamaCare

This blog has 2 purposes:

One, to weigh in and expand on Doctor Dike Drummond’s post yesterday “Physician Burnout Presents: Differences in Male and Female Doctors” (The Health Care Blog, June 1).

Two, to promote the first of my tetrology of E-books The Road to Hell is Paved with Good Intentions: The Story of ObamaCare ( Amazon, $9.99).

As indicated in Drummond’s blog, physician burnout is real. It is pervasive. It is taking its psychological toll. It is differs in men women and in younger and older doctors. It is contributing to a growing physician shortage. It is related to ObamaCare. It is deeply felt. In a 2012 Physicians Foundation survey of 20,000 doctors, 46% gave Obamacare a grade of D or F.
As Doctor Drummond observes, medical burnout manifests itself in different psychological ways : exhaustion, cynicism, reduced accomplishment, capitulation, employment, or simply withdrawing from practice.

In a recent Washington Post article “Why Doctors Quit,” Doctor Charles Krauthammer, psychiatrist, conservative commentator, and prominent health law critic, after attending his 40th Harvard Medical School reunion, quotes one of his classmates, “My colleagues who have already left practice all say they still love patient care, being a doctor. They just couldn’t stand everything else…. a never-ending attack on the profession from government, insurance companies, and lawyers . . . progressively intrusive and usually unproductive rules and regulations,” topped by an electronic health records (EHR) mandate that produces nothing more than “billing and legal documents” — and degraded medicine.

Krauthammer’s comment on electronic records leads to my promotion of my first tetraology E- book The Road to Hell is Paved with Good Intentions; The Story of ObamaCare. The book would not be possible without electronic technologies. Indeed, it is a birth child of those technologies. It covers the period leading following ObamaCare’s unilateral passage in March 2010 to disastrous launch in October 2013. It consists of 109 blogs organized into these categories:

#1, One, Prelude to implementation - Blog posts in this section deal with problems of how to sell the American public on ObamaCare’s merits.

#2, Obama, Words and Actions. Here I deal with President Obama’s underlying progressive philosophy.

#3, Uncertainties, confusions, and adverse consequences of a complex, awkwardly worded, and poorly thought-out law.

#4, Media and Messaging - This section describes the workings and attitudes of the mediapolitical complex.

#5, Physicians and Hospitals – These components of the medical industrial complex bear much of the burden of ObamaCare.

#6, Politics - A necessary evil for the conduct of public affairs is politics, which is how we keep score on the progress and setbacks of health reform.

#7, Consumers, patients, the public - The health law is designed to protect the public and provide affordable care, to accomplish the mission near-impossible goal of expanding access while lowering cost.

#8, Employers - Employers cover 149 million American workers, a fact which makes employers vulnerable to the law’s vicissitudes and retards hiring of full-time workers.

#9, Mandates - The health care law contains unprecedented authoritative federal decrees, which do not sit well with Americans.

#10, Miscellaneous and Personal - Not everything in this book follows a set pattern.

#11, Eleven, Health Plans - Someone has to carry out and execute the provisions of the health law and that task falls to health plans.

#12, Innovation and entrepreneurship are what distinguishes America.

#13, Verse - Poetry is sometimes more effective than prose in explaining and crystallizing ideas.

#14, Health System – Humankind often resists systematic thinking because of individualism and desire for freedom.

The book says five things were notable about this first phase of ObamaCare:

1. ObamaCare passed in a straight party-line vote, setting the stage for intense partisanship.

2. So far ObamaCare has failed to deliver on its promises, lower premiums, and keeping your doctor and your health plans.

3. Public opposition by double-digit margins has remained constant since day 1 of passage.

4. All attempts to replace or repeal failed or have not been brought up for Senate vote.

5. Presidential executive orders have resulted in numerous delays, waivers, or modifications of key provisions or mandates.

To these five points, if I were to rewrite what I said then, I would add that ObamaCare’s Achilles Heel has led to demoralization of the medical profession, with losses of autonomy , replacement of clinical judgment by metadata-directed algorithms, and growing doctor shortages.