Summer Bootcamp: Burned out? How membership-based primary care could be your career reset

Editor's note: The information is this story was taken from a recent Medical Economics Bootcamp session. You can find the full video of the session here.

INTRODUCTION

There are two crises in medicine that have converged in recent years, which include the aftereffects of the COVID-19 pandemic and an increase in burnout among physicians, but this overlap is not all negative. Many physicians, burned out from the administrative hassles that come with running a volume primary care practice, are using the upheaval caused by COVID-19 to reevaluate their careers and are considering a membership-based model.

A discussion about this reset opportunity was the focus of this bootcamp session, featuring a conversation with a burnout expert. The following transcript was edited for length and clarity.

LEARNING OBJECTIVES

Understand how burnout impacts physician work-life balance, mental health and medical errors.

Learn why now is the time for self-reflection and exploration of ways to improve physician career satisfaction.

Listen to an open discussion about the various strategies to alleviate burnout.

Discover why a membership-based model can help reduce burnout and enhance physician work-life balance.

MEET THE PANELISTS

Ken Nazemetz
Vice President of Physician Development
MDVIP

John Kello, Ph.D.
Professor of Industrial-Organizational Psychology
Davidson College

Burnout, COVID-19 and the ‘Great Reset’

Ken Nazemetz: Do you think the psychological impact of COVID-19 will continue to affect physicians as they learn how to live in this next normal?

John Kello, Ph.D.: Yes, the COVID-19 pandemic is not something that happened once, then went away. It is similar to the Great Depression. The Great Depression changed the people who grew up during that time, so we will not be the same people we were. We cannot just be carried along by the next fad or wait to deal with the next crisis; it’s up to us to design how we want our future to be in the remaining chapters of our lives. I’m going to sound like a psychologist here: The remaining chapters of our lives have not yet been written. Physicians should ask themselves, “What can I control? What can I do differently so I’m not, once again, dealing with all this bureaucratic work that’s impacting my autonomy?” Doctors need to take care of their body and mind, and that often requires rethinking their business model, rethinking how they do what they do.

Nazemetz: You brought up how physicians should consider recrafting their careers, but these days, physicians have been conditioned to be strong and persevere. Why is it so difficult for physicians to take care of themselves the same way they look to take care of their patients?

Kello: It’s their sacred mission to take care of others. Physicians are the best of the best, but they’re susceptible to breaking down as much as anyone else. When that happens, it’s horrible for them, and it’s hard for their patients. Physicians tend to think they can tough it out. Nearly half of all the responding physicians in a national survey said, “My strategy for managing stress is to isolate myself and not burden others with it.” They would never advise this to one of their patients.

Nazemetz: In your presentation, you talked about how a crisis can be the right time for someone to explore something new, possibly a new business model. In the midst of ongoing uncertainty in healthcare, how is this applicable to physicians?

Kello: You can experience a crisis and the aftermath of a crisis in a variety of ways. You can think, “Poor me. Life is bad. I lost two years of my life. I’m not happy.” Or you can say, “This is an opportunity.” Again, I would not have chosen this as the trigger for the Great Reset, but now physicians can be empowered to look at their own life and redefine how they want it to be. If you go back to the same version of your old normal, you’re missing a tremendous opportunity. This is your chance to take action and find a solution that allows you to have more control and autonomy over your life, in whatever form that is. Some physicians are leaving the profession. I am not recommending that, but we’re seeing a potential nurse and doctor shortage in several areas. I want physicians to recognize that they’ve been on the hamster wheel, running harder and faster, and running the risk of wearing themselves down and burning themselves out. Instead, doctors should be asking themselves, “How do I get back to providing quality care for my patients in a way that nurtures them, cares for them and allows me to have work-life balance?” It’s not out of reach.

Nazemetz: Let’s say you have a physician who’s recognizing some signs of burnout, recognizing that things need to change and recognizing that they are not practicing medicine the way they would want to because of stress. It’s human nature to avoid change. How can physicians get past barriers they set for themselves?

Kello: Think about it like this: Change has been imposed on us by the pandemic, so it might be difficult for physicians to want to make a change if they feel they’ve been successful with their current strategy and believe their life is good and they’re okay. Maybe they don’t see reasons to change. But if you’re constantly running on the hamster wheel or the pandemic has increased your stress level dramatically, you don’t have a constructive choice. You’re on the burning platform, and you have to make a change. It’s time to self-reflect: What’s your vision if you make a change? Where does that take you? What are your goals? Maybe the answer is work-life balance, taking care of your family, having enough income and making a positive difference. So, now that you know what’s driving you to change and have directional clarity, how are you going to get started? What are your first few steps?

Nazemetz: With your research, you’ve had a unique opportunity to take an objective eye and observe what’s happening in the business of medicine and what’s influencing physicians both positively and negatively. In your professional opinion, do you recommend doctors explore other practice models that might better meet their needs?

Kello: The short answer is yes. A lot of the physicians we interviewed, and some I have read opinion pieces from, have said they simply had to get out of a huge hospital practice or another gigantic system to get more control, manage their workload and be able to continue to deliver the kind of healthcare they want to provide. There are alternative business models available. Again, one of the primary culprits that impacts a lot of primary care physicians is the prevailing volume-based, fee-for-service business model. That’s not a business model anyone with a blank sheet of paper would have ever designed, but it’s now the standard for primary care, and it unfortunately keeps doctors in the cycle of having to see more patients with less time per patient to maintain their income. It is a chief underlying contributor to the stress everyone’s experiencing. So, while we’re waiting for the government to change regulations to make it easier for physicians to manage their load, physicians have to look at their own business model.