Have you ever wondered why Dante Alighieri’s epic three-part poem is called the Divine Comedy when it isn’t particularly funny?  “. . . the “comic” style is what, in modern terms, we would call “medium,” halfway between a low stylistic register, which Dante defines as “elegiac,” and a high one, for Dante “tragic” (1).”  In homage, I will thus attempt to thread the needle by addressing the heavy topic of physician burnout with a light hand, halfway between satire and truth (or possibly more than halfway).  I would never compare myself to Dante as a writer or theologian, although we both have theories on Satan’s true business.    

     I just finished reading Wealthy Doc’s article, Clinician Burnout, and as usual, I have thoughts.  Recently, I have found myself writing comments on other blogger’s posts that turn into thousand-plus-word rants.  This is exactly what happened here, but instead of cleaning, cutting, and editing my rambling response into a coherent, readable reply, I decided to go all in.  What came from this was clearly not publishable on someone else’s site, so here you go.     

     Warning: If you haven’t figured it out by now, this post is a farcical piece of prose written for my own amusement.  But I’m only half-joking; you get to decide which half.  


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Clinician Burnout

      “Clinician Burnout is defined as high scores on at least two of three subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy (2).”  Wealthy Doc’s article states that 93% of doctors frequently experience burnout.  With this as the scale, 93% seems suspiciously low.  How could burnout scores not be higher?  What physician isn’t exhausted, cynical, and rendered inefficient by our current system?  Physicians have always worked long, hard hours.  Everyone in the country under the age of 40 is cynical, and so are quite a few of us who are older.  How can any physician be efficient with an ever-increasing documentation burden and patient load?  I strongly suspect that 7% of doctors are delusional or lying.  

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Who wouldn’t be burned out after this?

     I believe these are merely symptoms of a more indolent, pervasive disease process.  Like a more acerbic Dr. House, I have sleuthed to find the following maladies as the true culprits in clinician burnout:  1) A loss of autonomy, 2) The deterioration of respect and social standing, and 3) The corporate takeover of medicine.  

Loss of Autonomy

      The loss of physician autonomy has several causes.  74% of physicians are now employees in the U.S., the highest in our nation’s history.  With employment comes an employer who subtly or not so subtly influences your decisions.  Insurance companies dictate what we can and can’t do for our patients.  Additionally, we have an ever-demanding governmental nanny directing our actions.  Often, the goals of those telling us what to do are not in alignment with our own (or our patient’s).  This emasculation has taken its toll on the psyche of our nation’s physicians.  Before you complain, I tried to be inclusive, but interestingly, effemination means the same thing. 

Deterioration of Respect and Social Standing

     Physicians have lost respect and social standing in our society.  What once was seen as a noble and selfless profession has now been marred by propaganda that would make Madison Avenue or a communist dictator proud.  Insurance companies paint us as greed-ravaged monsters willing to do anything to upcharge our poor patients.  Fortunately, the unsuspecting American population has our fiscally responsible government and altruistic insurance companies to keep our innate avarice in check.  According to the corporate overlords who now run healthcare, we are antiquated, overpaid, overeducated dinosaurs begging to be replaced by younger, less educated, less expensive assistants (and practitioners) who they will eventually replace with A.I. robots that will work 24/7 without complaint.

     In contrast, medical malpractice lawyers, with their fancy phone numbers and billboards, claim that we are undereducated, egomaniacal sociopaths, callously unwilling or unable to meet the standard of care that they set to selflessly protect their clients from our incompetence and negligence.  Finally, the general public views us as prescription writing gatekeepers, nightclub doormen with stethoscopes preventing them from getting what a pharmaceutical commercial, Dr. Google, and their best friend told them they needed.  Just past those velvet ropes are the antibiotics and steroids they need to make their cold better, and if they don’t get them, they will write complaint letters, leave negative online reviews, and even occasionally commit assault. 

The Corporate Takeover of Healthcare 

     Finally, at the core of the disease is the corporate takeover of medicine.  Private equity firms have been buying up healthcare companies at an alarming rate, with annual acquisitions rising from $2 billion in 2001 to $151 billion in 2021.  With Wall Street money comes the Wall Street Golden Rule.  He who has the gold makes the rules.  Patients have now become customers in the McDonaldization of healthcare.  Would you like a Rocephin shot with those fries?  A few lucky physicians have been chosen to become traitorous overseers, shepherding their colleagues through the inevitable corporate shearing process.  Most of the others have been reduced to transactional middlemen, peddling healthcare at the bidding of their superiors in three-piece suits.  Those that resist and hold on to their independence and private business are tempted with enormous sums of, until recently, low-interest capital borrowed by P.E. firms from government-backed too-big-to-fail banks. 

Inferno, Purgatorio, Paradiso 

     This triumvirate of diseases, this epic three-part poem of burnout, has mutated and metastasized, spreading throughout the healthcare system, intertwined in a cancerous plot to make physicians a mere commodity, sold to the highest bidder.  It has already happened in emergency medicine, and without Virgil guiding you, you may be next.   

   
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The Cure

     What can we do to combat burnout?  Treat the three diseases I mentioned.  And I don’t mean treating them with expensive, patented medication designed to be taken for the rest of your life (or at least until the patent wears off and they just happen to find it causes Q.T. prolongation).  I mean a surgical cure. 

     The treatment is Financial Independence, and fortunately, it’s generic.  If sites like WCI, PoF (before the site got purchased and stopped publishing readable blog posts), Wealthy Doc, Business is the Best Medicine, The Loonie Doctor, The Motivated MD, and many, many, many others can teach every last physician to become financially independent, maybe we can start to make the necessary changes.  The sheer number of F.I. Physician websites is clearly a manifestation of clinician burnout.  There is no other possible explanation. 

So, read up, and get your own financial doctor mansion in order so that you don’t have to work for the proverbial Man or at least the proverbial private equity firm.  Start your own medical business.  Organize and fight back against the corporate raiders pillaging healthcare like newly landed Vikings on Adderall.  Lobby your local representatives (any that aren’t already on the insurance company’s payroll) to fight back against insurance company overreaches.  Or contact your local priest, since in my article, An Emergency Physician’s Guide to Working for the Devil, I conclusively proved that instead of a three-faced demon encased in ice from the waist down in the ninth circle of hell, the devil is actually BCBS.  Sorry, Dante.      

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     I hope you enjoyed this post and it didn’t offend anyone too much.  If it did, toughen up.   It’s called satire.  Read some Voltaire.  Please subscribe below to experience all future unhinged Business is the Best Medicine releases.  

References

  1. https://literature.stackexchange.com/questions/22787/why-is-dantes-magnum-opus-called-a-divine-comedy#:~:text=%22Comedy%22%20because%20it%20moves%20from,Sacred%20Poem%2C%20il%20Sacro%20Poema.
  2. https://wealthydoc.org/clinician-burnout/