More doctors are employed (and burnt out) than ever. Is it the lack of autonomy in employed positions or is it all just Covid?
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As healthcare continues to consolidate, more and more physicians are taking employed positions. In fact, the percentage of employed physicians grew during the pandemic, from 62% in 2019 to 74% in 2022. This is a marked growth of almost 20%.
At the same time, studies show that physician burnout rates grew by a whopping 50% during the pandemic. In 2020, the rates of physician burnout were around 38%. By 2021, the burnout rate had spiked sharply to 63%.
Is it the Covid pandemic that caused such high levels of burnout? Or did the transition of more physicians to the employed model (with the loss of their autonomy) contribute to the burnout epidemic?
Effect of the Pandemic on Healthcare
The pandemic has been awful for healthcare workers (HCWs) for so many reasons. A few of the pandemic factors that may be causing burnout include:
- The never-ending Covid-19 variants
- Healthcare worker shortages
- Increased rates of violence against HCWs
This pandemic has persisted far longer than anyone would have dreamed. While infection rates have settled down (at least in the US), Covid continues to wreak havoc around the globe as different variants cause spikes, shutdowns, and supply chain issues.
Even as a urologic surgeon, I spent a couple of weeks rounding on Covid patients during the worst of the Delta surge. Just a few months later, I remember feeling frustrated and hopeless as Omicron again shut down our ORs and clinic.
Now as I read about antibody resistant strains spreading rapidly in the US, I reflexively shudder at the thought of these strains becoming widespread in time for the winter holidays.
Healthcare worker shortages
As the chief of my department during the pandemic, I also heard the frustration of my department’s physicians because of staffing issues. It became normal to have to share nursing staff in clinic, which backed up our clinics and caused angry patients. Then it even became normal to have to cancel surgeries due to lack of nurses in the OR or recovery room. Either they were out sick themselves with Covid, or there just weren’t enough nurses to go around due to retirement or quitting.
And don’t get me started on the patient complaints. Between having their surgeries postponed and the increased wait times in clinics, it’s no wonder patients were upset. As chief, I also reviewed and responded to these complaints. Most of the time I was sympathetic, but at times I asked myself, “What do they expect? We’re doing the best we can!”
Between the stress of being an administrator during the pandemic, my full time employed job, overnight call, and my 10 hour a week commute, I absolutely struggled with burnout.
When I surveyed my department, most of my colleagues were also burnt out (some severely so).
It’s hard for doctors to quit their jobs
Despite the burnout epidemic and staffing frustrations, it’s not so easy for doctors to just quit their jobs. Aside from the very real guilt over leaving their patients behind, it’s just not financially feasible for many doctors to quit (or even take a break).
Many early career doctors are still drowning in student debt or suffering under weight of self-imposed golden handcuffs.
- How I Failed at Refinancing my Student Loans | Avoid my Mistakes!
- Physicians are trapped by golden handcuffs
My family is in a special (and admittedly lucky) position. After aggressively investing into real estate for the past few years, we’ve reached partial financial freedom. So when my wife wanted to move out of California for an exciting opportunity, I agreed to make the leap with her.
We recently moved to Memphis, Tennessee, where my wife is contributing to the cultural renewal of the arts scene. I’m interviewing with private practices and am tantalized by the increased control I’ll soon have over my schedule and practice.
Is Private Practice the Cure?
The private practice groups I’ve met seem to be thriving, and I haven’t heard the term “burnout” even once. It’s a very different picture than my experience as an employed physician in SoCal.
So I can’t help but wonder — is private practice the cure for America’s doctor burn out?
Is it all about autonomy?
One of the biggest advantages of being in private practice is autonomy. Autonomy, or freedom from external control, is one of the main differences between the lives of private practice vs. employed physicians.
In private practice, you are your own boss. You get to decide your schedule, your workload, and exactly how you want to practice medicine. There are obvious disadvantages, like having to run a business and manage overhead and insurance.
The risks that come from fixed overhead costs sunk a lot of practices in the early part of the Covid pandemic. This no doubt contributed to the increased percentage of employed physicians in our country.
But as more doctors become employees and lose their autonomy, will our burnout epidemic get even worse?
As an employed physician for the past six years, there were a lot of things I enjoyed about the model. I had less concerns over the day to day mechanics of my urologic surgery practice. I didn’t worry as much over the big picture of keeping the lights on in the hospital and keeping the clinic staffed. This changed when I became chief of the department. I started to worry about these things, but felt a frustrating lack of ability to do anything about them. I often butted up against the bureaucracy of my organization in a way that worsened my outlook.
As I transition to the private practice setting, I’m sure I’ll find that it’s not all unicorns and rainbows. But I expect to really enjoy the increased autonomy and opportunity to run another business. For most of our physician colleagues in the country, being employed is the only option, with all of the advantages and frustrations inherent to that model.
Certainly the Covid pandemic itself is to blame for a lot of the spike in physician burnout. But if being employed in itself is a contributor to the burnout epidemic, I worry about the future of our nation’s physicians.
— The Darwinian Doctor
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The is no doubt that employment has accelerated the burnout crisis for doctors. The cure is “employment lite” https://prudentplasticsurgeon.com/employment-lite/ –because it’s a blend of employment and private practice. It helps restore our autonomy while also working in the security of an employer’s safe harbor. I have an entire website and blog set up to inform and inspire about this important message at http://www.doctorincorporated.com
Interesting concept, thanks for adding to the discussion!
Great article. I could identify as a physician in Canada. We are all largely private practice in Canada. However, the freedom to shape your practice is still very dependent upon being in a strong financial position. Otherwise, you have the stresses of running your business and feeling trapped in how you do it to make sure costs are covered. I have watched different physicians adapt and grow their practices in new ways, but watched the ones on the financial treadmill just grind themselves down. Covid was hard for all of the reasons you state, but a perceived or real lack of control magnifies burn-out and makes extraction difficult.
I can imagine that the autonomy of private practice comes at a price, just as you said. Great perspective, thank you!
I think there is a lot not discussed with private practice including:
patient referrals and where do new patients come from
expanding (or shrinking) a practice
where the practice is located (ie a big city, small town, competition from others, etc)
hospitals buying out or out-competing from small practices
autonomy is nice, but not even close to what it use to be back in the 80-90s
There’s a lot to say about private practice, and I’m eager to write it as I experience it! My job was previously 100% employed, and I write what I’ve experienced. Stay tuned for adventures in private practice!