Dermatologists weigh in
Tucson, Ariz., dermatologist Ronald G. Wheeland, M.D., says there’s no doubt in his my mind that the increased burden of governmental regulations and insurance company bureaucracies are the leading causes of dissatisfaction and subsequent burnout among all physicians, not just dermatologists.
“I personally know three well-established dermatologists who retired early rather than have to implement the EHR (electronic health records) for their large and well-established practices. In addition, the added difficulties brought about by having to implement the provisions of ICD-10 were simply the straw that broke the camel's back, so they retired!” Dr. Wheeland says.
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Dr. Wheeland gave a personal example of what he called relentless regulatory intrusion faced by physicians: “Today I spent over three hours reviewing 20 detailed pages of CAQH (Council for Affordable Quality Healthcare). Proview documents to maintain my professional standing. This was totally unexpected since I had just reviewed these same documents in August.”
Among the dermatologists that Dr. Wheeland has spoken with, he says there is a prevailing feeling of dissociation or loss of contact with their patients, as they try to simultaneously document in the EHR the patient's problem, while trying to maintain eye contact so they comply with the provisions of ICD-10.
“As one friend told me: too much computer time and not enough patient face time!" Dr. Wheeland says.
Seth L. Matarasso, M.D., clinical professor of dermatology, at the University of California School of Medicine San Francisco, says that while he loves the profession and wouldn’t do anything else but dermatology, the specialty can be wearing on the most resilient doctors.
“I can see burnout for two reasons. Number one, from the patient perspective, dermatologists tend to be shock absorbers. The patient comes in and they’ve got a laundry list of ails and woes, and you’re the final frontier,” Dr. Matarasso says. “Also, I see up to 30 patients a day. That can be an exhausting pace.”
New York City dermatologist Janet H. Prystowsky, M.D., says dermatologists burn out because the overall practice of dermatology has changed significantly since the advent of managed care.
“Service payments from entities like Medicare have dwindled to the extent that doctors have to make up lost revenue by increasing the number of patients they see in a day. Now, the average patient visit lasts only nine minutes, which is, in my opinion, severely too short,” she says.
And, unlike physicians from many other specialties, dermatologists must identify and submit a multitude of diagnosis and procedural codes.
“Unless done perfectly, insurance companies and Medicare will deny claims that they feel are inconsistent, cosmetic or uncovered,” Dr. Prystowsky says.
As an academic dermatologist , Albert C. Yan, M.D., professor of pediatrics and dermatology at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, says his biggest sources of stress predisposing to potential burnout include increasing administrative responsibilities (not always with additional compensation) and increases in documentation requirements.
Dr. Elizabeth Tanzi, founder and director of Capital Laser & Skin Care, Chevy Chase, Md., says drivers of burnout are not limited to medical dermatology. Some burnout may be due to misunderstandings between the patient and doctor — especially in the field of aesthetic dermatology.
“Although the media is enormously helpful to create market awareness about the treatments and procedures we offer, it can also fuel unrealistic expectations,” Dr. Tanzi says. “We as doctors often have to re-educate patients about realistic results and the actual recovery and side effects from treatments.”