Solving the burnout problem
Dr. Prystowsky solved one of her persistent stressors by dropping providers, including Medicare.
“It took me months of analyzing payment processes and correcting my own rejected claims before fully understanding the nightmare of managed care. I gradually dropped every provider until I was only left with Medicare. It took a few more years before I opted out of Medicare as well,” Dr. Prystowsky says. “I am now able to spend a full half hour with each patient, screening for skin cancer, performing biopsies and advising about other skin problems in one comprehensive visit.”
It’s doable, she says. Dr. Prystowsky submits all claims to her patients’ insurance providers, so they may be reimbursed for out-of-network benefits. For the patients who can’t pay her customary fees, she sometimes offers steep discounts or doesn’t charge at all.
“The important part is that the decision to work for free is my choice,” Dr. Prystowsky says.
Another way in which Dr. Prystowsky says she feels the rewards of the profession is by volunteering on professional academy and society committees.
“Working with fellow dermatologists will help establish you amongst your peers, and may allow you to push for change,” Dr. Prystowsky says.
Dr. Matarasso relieves his work-day stress by focusing on the positive impacts he makes on patients’ lives, as well as with a good run or workout at the gym.
Dr. Yan taps what he says are built-in mechanisms for faculty, which help prevent burnout. These include a supportive administration that does generally protect his academic time; the chance to work with motivated and smart trainees (residents, fellows, students); and he is currently enjoying the rare privilege these days of taking a paid sabbatical.
“Which gives me time to recharge, learn new skills and gain perspective,” Dr. Yan says.
Elaine C. Siegfried, M.D., professor of pediatrics and dermatology, at the Saint Louis University, St. Louis, Mo., says she combats job-related stressors, including bureaucracy and professional politics, loss of autonomy and the increasing necessity for electronic medical record documentation, with a strong marriage, the Serenity Prayer, appreciation for personal and family health and realization that there is no perfect work (or life) environment.
“I am very lucky,” Dr. Siegfried says. “Although I generally work 60 to 70 hours a week, I do not feel unable to control work hours, and although my income is in the lowest quartile for a dermatologist, it has been more than adequate to support my needs and those of my family (including college and graduate school education for three children).”
According to Dr. Tanzi, miscommunications between physicians and their patients can lead physicians to believe their patients are difficult, which causes stress.
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“I’ve found it helpful to remember that somewhat ‘difficult’ patients are often not difficult at all, just misinformed about the reality of the procedure or treatment. If I take a little extra time to educate the patient, the stress level for patient and doctor goes way down,” Dr. Tanzi says.
Helen M. Torok, M.D., medical director of Trillium Creek Dermatology, in Medina, Ohio, says she remains passionate about dermatology after 37 years in practice. Her advice for keeping the passion is to delegate.
“You must not make yourself an island and feel that you are responsible for all facets of your practice,” she says. “Hire an excellent practice management team. And I mean team.”
Another tip from Dr. Torok: “Implement a first-class EMR (electronic medical record) system so it documents for you. But, when you finish with a patient in the exam room, ensure that you are finished with that chart. You do not want to do charting in the evening. Hire scribes. Hire physician extenders. Get help at home.”
This all might cost more, but it’s worth the cost in happiness, according to Dr. Torok.