Physician burnout a danger to patients

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When the last straw came, Dr. Aaron Fraser was seeing 120 patients a week for 5-7 minutes each. He was putting 40 hours a week on the timesheet but unofficially working more than 60.

He had some of the best patient satisfaction rates at the Air Force Academy — and was taking care of some of the sickest patients.

He was taking all of that in stride. Then an administrator told him he needed to increase his “bookable appointments” to 90 patients.

Yes, Fraser was already caring for far more than 90 patients per week, but he was seeing 35 of them in a clinic setting he’d developed for his “worst of the worst diabetic patients” — and they didn’t count as bookable appointments.

“I said, ‘So you’re asking me to add five more appointments above and beyond what I’m doing, when I’m already going above and beyond?’” Fraser recalls. “I said, ‘All right, we’re just going to get rid of everything, we’re just going to go to 90.’”

The administrator was back next quarter, “sweating bullets and … saying, ‘Can we go back to the way things were?’” Fraser said. “But I was pretty much done.”

Within months, he left to establish Flying Horse Medical Center with business partner Ryen Hitzler, also a former Air Force officer. They wanted to focus on patient care and relationships, not paperwork and metrics.

“One thing I did learn in the military is if you want to do something about it, do something about it — don’t just complain about it,” Fraser said. “I saw the way we were practicing medicine was unsafe. I was getting burnt out. It was very frustrating because I was being dictated how to practice medicine based on numbers that had nothing to do with patient well-being and had more to do with numbers that were arbitrary.

“What we did here was something completely different,” he said.

The frustrations Fraser faced are not unusual, according to El Paso County Medical Society CEO Mike Ware. Demands on physicians’ time have been increasing, along with paperwork, regulatory burdens and financial pressures.

“Physicians are working two more hours per week than they did in 2011, but seeing 10 percent fewer patients,” Ware said. “At the same time, there’s an increasing gap … between the cost of running the business and what’s being paid.”

The Affordable Care Act also significantly increased pressures on physicians.

“I recognize that can be a controversial topic, but whether people agree with the premise and the purpose … a lot of regulations and a lot of additional paperwork have come out of that,” Ware said. “A lot of that time takes away from patient care — one of the top complaints we get from patients is the time they get with their physicians has gotten shorter.

“There are only so many hours in a day and just to pay their bills [physicians] need to see a certain number of patients, and they’re spending all this additional time on paperwork,” Ware said.

He said burnout is a key issue in patient care and practice management, with more than 50 percent of physicians nationwide reporting symptoms.

“We get calls from physicians asking for help finding resources because they feel like they’re at the end of their rope and they just need somebody to talk to,” he said.

Some physicians faced such financial pressure, they dipped into retirement savings to keep their practices open — especially after the economic downturn.

“We still hear that in some cases, just not as widespread,” Ware said.

As a physician in the military, Fraser didn’t face such a choice — but he saw a lot wrong with the way medicine was being practiced both there and in private practices.

“You’d be surprised, we can do a lot [in 5-7 minutes] but it’s very frustrating and we miss[ed] a lot. And it’s dangerous,” he said.

Physicians didn’t have time to talk and listen to patients, or to deal with multiple issues, he said. Many patients didn’t make that second or third visit for other ailments “because they were frustrated and getting an appointment was difficult.”

Like Ware, Fraser said the ACA increased the burden on physicians.

“I’m not trying to get political whatsoever, but with the institution of the Affordable Care Act you added 10 million patients to the patient population. You did zero to address the people who can take care of those 10 million patients,” he said.

“They’re starting to realize that afterwards and it’s been implemented for seven years now. They’re starting to address the huge gap.”

But physicians have a minimum of 11 years post-secondary training, so the shortfall isn’t going away soon.

Colorado Springs pathologist Dr. Karen Anthony said: “The literature shows — and physicians report — that they’re stretched too thin; they feel burned out; they feel devalued; they feel like they’re losing control over their practices; they feel like they cannot directly treat patients like they used to because of having insurance companies or big health systems in the way, or because of the fact that they are employed by a big health system and have to follow protocols established at some level that didn’t really include much of their input.

“It definitely decreases productivity when we have people feeling this way,” Anthony said. “I think it all goes back to the turmoil that’s currently happening in health care.”

Anthony said she had been able to take more control over patient care by starting her own practice, independent from the hospital.

“Most  physicians are not doing [that] these days,” she said. “But I can tell you for me it’s worked really well and I have a lot less stress than I did five years ago when I was working in the hospital, when I did feel stretched very thin.”

Fraser said the direct primary care model at Flying Horse Medical Center cut 90 percent of administration and removed all billing and coding.

“We’re still accountable, but we’re accountable to who’s important — our patients,” he said.

Patients pay a monthly fee for as many visits as they need, including same-day appointments. Appointments are 30-60 minutes, and first-time visits are 90 minutes.

“We get to actually know the patients, their families, what’s going on in their life — our patients tell us their goals and we try to help them achieve their goals,” Fraser said.

“Both of us made more money in our previous jobs than we do in this job,” Hitzler noted, “and we’re OK with that because we have 1/100th of the stress.”