[kitkat24]

August 25, 2003
Are half of all doctors "Burned Out"? Are Cutbacks to Blame?
By Neil Seeman

Canadian newspapers have been reporting that "almost half of Canadian doctors are burned out," that they "blame medicine for putting a drain on their family life," that "12% of teaching doctors have had thoughts of suicide," and that "7% have planned a suicide attempt" (Toronto Star, Aug. 20). Don’t blame government cutbacks for these figures, as some media are tempted to do. CANSTATS looks behind the numbers.

Behind the headlines

Are 50% really burned out? The National Post (Aug. 20, 2003) does explain that, out of 55,000 members of the Canadian Medical Association, 8,000 (presumably at random) were sent questionnaires to fill out. We are not told what the questions were, but only 2,250 doctors responded, a 29% return rate. The better educated — like physicians — are much more likely, usually, to return questionnaires. Overall, over 60% is considered a reliable rate of return in an attitudinal questionnaire. Less than that means that only a small proportion of participants are responding and they may be those who are most dissatisfied. (This is especially so given that we would expect to see a high response rate considering such well-educated respondents). The questionnaires were distributed between February and June of this year. None of the media reports mentioned the fact that April-June was amidst the thick of the SARS crisis, an extraordinarily stressful time for Toronto and Vancouver doctors. The geographic locations where survey response was heaviest is not mentioned in the reports. Only the National Post actually mentions how the results were analyzed — by using a diagnostic tool that usually finds about 40 per cent of people to suffer burnout when the test is applied to other work forces. Among doctors who responded, the survey found 46 per cent suffering from burnout.

Why is medicine being blamed? Since 40% of the whole work force is reported as being stressed, emotionally exhausted, and cynical, why is medicine being blamed? Since the questions on the questionnaire are not cited, [they were part of a Physician Resource Questionnaire] it leaves the reader to suppose that there were some leading questions that made it possible to interpret the stress as arising from medicine-related conditions. "Frustrated by an inflexible, bureaucratic health system that has heaped more patients with more complex problems on fewer physicians" editorialized the Toronto Star. But maybe some other variable is driving their stress. The survey shows that shows that 47.6 per cent of female doctors and 44.6 per cent of male doctors feel burned out. Few of the media reports comment on this differential. And yet it is known that many female doctors work shorter hours, enjoy a healthier "life style" when it comes to medicine while shouldering the main responsibility at home for children. So should we then conclude that children are to blame? (Surely not. Stress is a multi-variate phenomenon).

Cause and effect. "Physicians are facing increasingly harsh realities in their daily lives, including worsening work conditions, regressive government legislation, and being shut out of government decision-making processes," said Dr. Hanson, outgoing President of the Canadian Medical Association. "The result is clear: more and more, physicians are becoming disenfranchised from key decisions, with their locus of control is reduced, and suffering from burnout." Dr. Hanson’s opinion is certainly one informed by personal experience, but this suggestion of cause and effect is not clear from the survey results.

Why blame medicine for spoiling family life? The majority of doctors who responded to the CMA’s questionnaire, 58 per cent, said their personal or family life has suffered because they chose careers in medicine. "Many of the respondents" it is said, said they felt trapped by their obligations to patients. How were these questions phrased? Would the attributions for what is felt as "trapping" have been different if the questionnaire had been sent out by a neutral third party rather than by the Canadian Medical Association? (This implies a response bias in the results).

Behind the Suicide Data. Twenty one percent of physicians report seeking help for emotional problems. This figure is actually lower than it might be and might therefore explain the disproportionate suicide rate. Only 45% of Canadian physicians report having a personal physician who provides regular care — significantly lower than pharmacists (65%) or lawyers (66%). This has always been a problem for some physicians, who tend not to trust other physicians to know anything about medicine and feel that being ill is a sign of weakness. Partly for this reason, the suicide rate has always been high among physicians. In a survey among medical teaching staff in Ottawa, 12% admitted to thoughts of suicide and 7% (about 10 physicians) had planned a suicide attempt. This survey also found that university physicians were working about 59 hours a week and that 48% reported low job satisfaction. In the three months preceding the survey, 25% were under high stress. While it may be tempting to link suicidal thoughts and attempts to heavy work loads and stress levels, it is probably more accurate to look at the young men and women who are accepted into medicine — a very competitive weeding system that rewards those who earn very high grades, i.e., obsessive studiers already prone to depression. Practising medicine is not what produces the high suicide rate. The high suicide rate is more likely associated with innate, obsessive personalities that are highly competitive. It may also be associated with the general failure of doctors to look after their own mental health.





All materials © 2002 CANSTATS and The Fraser Institute

[mattsmom81]

If inadequate access is really what is behind the abuse I see of healthcare (by patients who will not pay for services), I would support universal healthcare.

I would like to see for profit, private facilities still in existence for those who wish to use (and pay for) them. I would like to see more county/tax supported facilities too.

[pickledpepperRN]

Originally posted by kitkat24
Chart 1: Waiting Times in British Columbia—Time to Exhaust List of Patients
Waiting Reported by Ministry
Specialty Median Wait
(Weeks)
Patients
Waiting
Procedures Procedures/
Week
Expected
Wait1
Plastic Surgery 5.4 4,341 9,598 184.6 23.5
Gynaecology 4.0 6,339 23,007 442.4 14.3
Ophthalmology 9.1 17,265 31,722 610.0 28.3
Cataract Surgery 10.6 15,291 26,995 519.1 29.5
Cornea Transplant 16.5 616 406 7.8 78.9
Otolaryngology 6.0 4,755 11,279 216.9 21.9
General Surgery 3.9 12,675 38,650 743.3 17.1
Neurosurgery 4.4 1,246 3,722 71.6 17.4
Orthopaedic Surgery 7.3 15,938 26,806 515.5 30.9
Hip Replacement Surgery 18.6 2,487 2,505 48.2 51.6
Knee Replacement Surgery 26.7 4,200 2,646 50.9 82.5
Cardiac Surgery 14.9 651 1,480 28.5 22.9
Vascular Surgery 3.3 1,288 3,296 63.4 20.3
Urology 3.6 5,942 22,665 435.9 13.6
Radiation Oncology 1.1 307 9,380 196.8 1.6
Waits as at March 31, 2003. Procedures column counts the procedures performed between April 1, 2002 and March 31, 2003 except
for Radiation Oncology which measures the procedures performed between April 1, 2002 and February 28, 2003.
1Number of weeks to exhaust the list of patients waiting (patients waiting/procedures per week)
Source: British Columbia Ministry of Health Services, 2003.

I admit to not understanding what all the numbers after the procedures mean.
I do have personal experience with insurance I pay for. My hospital employer deducted $389.00 from my check each month after 20 years.

As a working registered nurse with nearly sixty thousand hours of direct patient care worked I was in an accident. I made an appointment to see my primary physician. 1 1/2 weeks later i was seen. She determined I needed an ortho consult. (Guess so, the ROM of my arm was less each day and I was in pain). Mind you I was working full time nights through this time.
After two weeks i could not move my arm at all. The insurance telephone guard told me it would take another 10 working days because the company was in the next county.

My MD gave me a copy of the paperwork and I drove a couple hours to the company and said the 10 days had already passes so I would just sit there until getting the papers that would let me get treated.

The orthopedic MD did an x-Ray and ordered an MRI. Put me on disability so the taxpayors were paying >$300.00 a week now.
2 more weeks!
The MRI took a week to read.
I had to go back to my regular MD for paperwork to let me go to the ortho guy. She prescribed pain tablets.
2 weeks!

Finally after 8 weeks PT was ordered but there was another 2 weeks to authorize the TX!

It took 10 weeks for treatment to be started.

I was fortunate in that the waiting did not kill me. I am back caring for patients.

[kitkat24]

Table 3

2003 profile:

California’s Uninsured

Average Age 30

Average Income $42,214

%Male 48%

%High School Graduates 52%

[purplemania]

I think we could combine private ins. and Fed. insurance similar to the "medicare supplements" offered now. There are different plans, various insurance companies offer the plans, collect premiums and provide benefits. However, they are restricted by law as to what the plans must offer, so if you choose Plan F you have the same benefits as your neighbor on Plan F with another co. But EVERYONE has basic coverage. To do this on a larger scale would mean that the govt. would determine what constitutes a "basic" plan. If you are working or can otherwise afford "supplements" then you have them. If you have no options other than the basic plan then you are covered by the govt. and assigned to a private co for benefits administration. THis is how Medicaid operates, with each state differing in how the plan is administered while following federal guidelines. The Ins. co that does the administration on people not paying premiums just bills the govt. for what they pay out on benefits. It could be done. For one thing, it eliminates some waste and that allows more $ for other uses. The govt. does not have to set up administrative offices across the country and people working at the ins. co still have jobs. As for salaries, nurses are still in the free market (whatever it will bear).

[fergus51]

Originally posted by mattsmom81
If inadequate access is really what is behind the abuse I see of healthcare (by patients who will not pay for services), I would support universal healthcare.

I would like to see for profit, private facilities still in existence for those who wish to use (and pay for) them. I would like to see more county/tax supported facilities too.

Sounds more like the UK model, and I definitely think that would have a better chance of happening in the US.

I think the real benefit is that everyone has to contribute in a universal system, unlike the current system as kitkat pointed out. The problem with comparing tax rates is that it ignores how much private insurance costs. Add that to your tax rate and you may not see a huge difference.

[fergus51]

By the way, you should know that the Fraser institute has a very clear political agenda and is not usually considered unbiased here if that's important to you. Their lobbying of the use of private facilities has been a long pattern, but unfortunately the experience in Calgary and Edmonton showed that wait times and cost actually increased when private clinics were introduced for eye surgery. I was impressed that they admitted that 90% of Canadians think ability to pay should not determine who gets medical care, even though they minimized the importance of that belief. That certainly fits with what I know.

So kitkat, have you thought of any solutions for the US's problems? How do we control costs? How do we improve access for those who need care (not getting any care at all is just as bad as having to wait weeks for it)? How do we get people to contribute to the system? How do we improve patient outcomes? How do we decrease the waste (single payer systems don't keep costs down alone, but it does decrease the amount spent on beaurocracy)? How do we deal with people who must declare bankruptcy because of medical bills? How do we deal with people who can't get insurance because of a pre-existing condition? How do we make the technology we have available to the public (the number of MRIs is unimportant if they are not being used well and gene therapy is useless if the cost is so prohibitive that no one can afford it)? How do we improve nurses' conditions when it comes to things like mandatory OT? How do we deal with companies like Tennet that steal money? What are your ideas?

[kitkat24]

Fergus,
I wish that I had the answers. Unfortunately, I am trying to get to the bottom of all of the information myself. Maybe, when I read all that I have found I will understand better.

Interestingly, Fergus, you mention that the Fraser Institute has a clear agenda. From what I have found, scholarly journals, and academic professors have their own agenda. Instead of learning to trust, scholarly, peer-reviewed journal articles that we use in college, I have learned that they too are biased and form opinions and shape data to show statistics that support their ideals and opinions. All of my college professors have clear political agendas and they are all left and liberal. One even required that we attend MNA Day on the Hill. MNA being a totally left wing union that has always supported democrats and is totally pro-universal healthcare.

College is charged with educating people to better make decisions and sort through information. Scholarly journals should, in fact, not be biased to the left. Fraser Institute is not charged with educating our young. At least, their political agenda is clear, so we know what we are getting. College professors hide their intentions so that their student body are unaware that they even have an agenda, unless they are politically active.

Another interesting fact, Fergus, is that to suggest universal healthcare suggests that if I do not have insurance then it is your problem. That view casts healthcare as a legal right.

Nobody ever discusses a free-market healthcare system, with tax credits, and medical savings accounts. What if doctors were totally dependent on the patient for pay? Do you think you'd get better customer service? What if the doctor, like a sales person, was required that you be happy and content with your care? Do you think that most doctors really care what you think of the care they provide? No, they don't. They care more about who is paying them, and that is not us, right now. That is government and insurance HMO's. So, they care more about those two entities than the patient.

Just my humble observations so far....

And, if you choose not to buy and pay for healthcare, and I do with high premiums, then why should I care if you have to file bankruptcy? That would be your own fault. We have to have personal responsibilty at some points in our lives. Everything is not everybody else's fault. I do not make $50,000.00 per year. I buy healthcare. Why should single men in their thirties making $50,000.00 a year get free universal healthcare? They get sick and go bankrupt? too bad.... should have sought out a plan, I guess.

Kitkat
Free market healthcare is looking better and better....

So, a wait for healthcare for all is better? That sounds like utilitarianism.... Peter Singer is a utilitarian.

[pickledpepperRN]

Originally posted by fergus51
I think the real benefit is that everyone has to contribute in a universal system, unlike the current system as kitkat pointed out. The problem with comparing tax rates is that it ignores how much private insurance costs. Add that to your tax rate and you may not see a huge difference.

[marilynmom]

Originally posted by kitkat24
Table 3

2003 profile:

California’s Uninsured

Average Age 30

Average Income $42,214

%Male 48%

%High School Graduates 52%

Where at in California did it say? Cause a lot of my family is from california (San Diego and San Fran areas) and you can't live in Ca on only $42, 214 a year. A "starter" home is like a quarter of a million $$ out there, no joke. A lot of my family has had to leave because they can't afford to live, let alone have health insurance for all members of the family.

A good friend of mine lives out there in a 2 bedroom apartment with his 3 teenage sons and it costs, just for rent, over $1100 a month. Its about 800 sq feet. And I can't imagine how much it costs to feed himself and his 3 teenage sons.....let alone all the other bills, etc they have. They talk about moving out of Ca but they dont have the money to move...its expensive to move.

And I really don't know the answers to the health care problems, all I know it is getting worse and worse and there is no end in sight. Universal health care does appeal to me, but I also wonder if the idiots who run our country could even manage it since they seem to screw a lot of things up.

Marilyn