Physician Burnout: Why Hospitals & Administrators are to Blame and Meditation is not the solution 

As a RN, I know what burn out is. Usually it is when I am placed in positions where I am given all the responsibility but have no power to act on my given responsibility. Add 10 hours a day of running and multi-tasking and that will generally do the job.

Courageous talk. Best 40 minutes of RU-vid content I've heard in awhile. And from a (relatively) young physician. Burnout is becoming the norm in medicine. One of the most poorly-understood and underappreciated career phenomea today.

Overall great talk, and I appreciate very much your eloquence and straightforward analysis/discourse on this topic. I especially love your final point - that duty is vital to living a satisfying and fulfilling life. It's just when people are driven past the point where they feel unable to adequately perform their duty (through self-assessment of their ability vs outcomes or being given a bunch of BS to do that really has no bearing on what they feel their duty is, but are still obligated to perform (like doing modules etc)) that burnout really starts taking hold. People start really examining what they're doing and why, and asking whether it's worth jumping through all the hoops and obstacles. Doctor/healthcare types have a strong desire to help others, but if every day is a constant slog through administrative useless garbage, it starts eating away at that desire, leading to "You know what, I guess not. Sucks but whatever, I guess I'll go do something else." SUCH a shame about the admin/faculty ratio you mentioned too; you really feel that in the hospitals, where instead of hiring/retaining more frontline staff, the admin will just hire another 6-figure "director" to have more meetings about the problem or design another module, when for the same amount of money you could hire multiple more doctors or a small army of nurses to spread the workload. This constant grind for profit is laughable and exhausting. Please keep up the great work and advocacy doctor!

I just met someone whose husband is a doctor and is opening up a self-pay only clinic. Sounds like a great idea. Perhaps that way he can have greater autonomy, and the patients can get more personalized care. I hope it succeeds. As a patient, I find that dealing with insurance tends to be the most troublesome part of getting medical care.

I probably would not be accepted to medical school today. My focus 50 years ago was to study hard in college, score well on the MCATs and ultimately become as good a practicing clinician as I could. I had no interest in bench research or globe- trotting in search of worthy causes to boost my admission odds. Over the course of my subsequent career, I went from “Doctor” to “healthcare provider” to an interchangeable cog in a corporate health care machine. I never felt burnout until the respect and autonomy were eroded.

We bought the Kool aid by becoming employees of hospitals rather than controlling ourselves this made much easier for insurance companies and goverment to take over medical decision making

Personally, I experience burnout when someone over-cuts my work when they know far, far less than I do about the job at hand.

They have taken the fun out of being a professional. You are not allowed to think for yourself. You spend your time filling out checklists instead of taking care of people. Good talk.

Dear Dr Prasad, I am very much older than you and retired from a different profession. During the last few years, we had to do what you call modules and we all felt it was such a waste of time. I totally agree with you about having a sense of duty bec when you give your all to family and profession, you feel a great sense of peace and happiness. I have listened to so many of your videos. You seem like an amazing person and Dr. So much insight for someone your age. The medical profession is very lucky to have you.

Lets go VP!!!

Its not just physicians. I'm an electrician and the the company sets unrealistic due dates that can only be met if you do alot of overtime. I don't mind alittle bit of overtime here and there but I have a life outside of work and want to work mostly 40 hour weeks. I don't want to put the boss in a situation where he can't make due dates and I dont want to leave the crew short hand but I need more balance and after so many long days I'm starting to dread comming to work/not care as much about work quality. There is a shortage of electricians and this sort of thing doesn't attract people to the field. I also had to lead a crew and there was one terrible worker that needed to be fired he literally spent 1.5 hours a day in the bathroom and wouldn't do anything unless you micromanadged him but they didn't give me the power to do anything I had to tell him do better or else but couldn't follow up on any of my threats I also wasn't fair to my good workers when he did didly squat.

Who will solve doctor and nurse burn out? Only doctors and nurses. You must take control of your situations.

Excellent talk. The changes you discuss over the 45 years since I began Med School have progressively threatened my ability to discharge my duty. I haven't felt as much "burnt out" as betrayed.

Thank you as always! From a patient's point of view: If I don't want to be treated by a burned-out physician and staff, I do what I can to maintain my health, avoid preventable office / ER visits and not be whiny and demanding when I do need attention. I'm more wary of hospitalizations, tests and treatments than I am of viruses and vaccines. We have health insurance but not necessarily health care. Seems like any machine or human would 'burn out' after furiously spinning it's wheels while going nowhere. Just a thought...

"moral injury"

Take a look at the research on happiness, Martin Seligman is a good start. True happiness is contentment, not elation, and one critical factor is a sense that we are contributing to the greater good, so there is a direct link between duty and true happiness. This is a great talk, I spent 50 years as a doctor in primary health care, medical education, medical administration, population health and health politics. in retrospect, I burnt out at least three times.. The factors of burnout and dissatisfaction have been constant. One issue you could add to selection is matching your career path to your personality type, the delta in salaries and conditions is so great that often the wrong personality types are attracted to the wrong career path.

I will fan girl over you all day. Your call to duty is something I share with you, in my nursing career, and I strive to uphold above all the distractions. Thanks for another great lecture!

This guy gets it. Only god knows how much bullshit where I had no interest that I did only to get into medical school

Thank you, this is high octane reality

Brilliant as I had expected. You are a fine philosopher and a great thinker and not just about medicine. Well done. Kudos! 👏👏👏

sounds like our country is really doing a horrible job in too many ways.....very disturbing! wish the government and/or Universities would take your advise!!!!!!!!

Dr Prasad: Thank You. There is NO ONE I would rather listen to!

As an MD, the biggest thing that causes me burnout is the cognitive dissonance between what’s actually true and what many of my colleagues brainlessly parrot uncritically (like that saturated fat consumption causes coronary atherosclerosis, or the completely unscientific COVID nonsense we’ve all had to pretend to believe for 3 years when any idiot can see we (by we I don’t mean myself) are lying to them.

we need doctors and scientists not shills, I'd imagine 'burnout' is a psychological reaction for disappointment in self.

Burnout is so prevalent in healthcare and people are leaving in droves: nurses, NPs, pharmacists, MDs. I loved my job as a heme/onc pharmacist for 8 years but the hospital told me they didn't think my service was worth my salary despite me working 10+ hours and being paid for 8. Now I work for industry where I'm treated better and have better benefits/salary. You never hear of administrators being burned out or making sacrifices when it's time to "get lean". They have figured out how to exploit our "passion" for taking care of patients.

The only ones who are leaving my hospital are the nurses. The main reason is Covid and the violation of do no harm. The doctors offered very little support regarding questioning the medical nonsense. The pushback on behalf of the patients, came predominately from the nurses who refused the shot...took a lot of courage and I do think some people out there noticed.

Thanks for your sharp insights. Management is mainly concerned about burnout because it costs money, particularly when a physician quits their job. As you pointed out, administrators don't want to take responsibility for CAUSING burnout. It's your lack of resilience. It's your lack of efficiency. It's not the workload the institution imposed on you to bolster the bottom line. All of your colleagues can do it, why can't you? It's another case of offloading responsibility onto the victim in the process of virtue signaling. Ironically this just exacerbates a physician's sense of self-worth. Much of doctors' distress is caused by the mixed message we get. In med school, the patient is highest priority. In residency, the attending is the highest priority. In current US medical practice post residency, so-called "productivity" (patient encounters, RVUs, and research funding) is top priority. The patient is sinking to the bottom of that list, and that causes distress for doctors who went into medicine to take care of patients. Medical schools are not preparing doctors to cope with that reality, let alone combat it. The resulting inner conflict and disappointment are likely contributing to the high rate of physician early retirement and, tragically, self-harm. Let's work toward a better treatment for this problem.

I'm an RN and traveled during the pandemic in the ICU. I found out through a friend that a doctor went to the hospitals roof (5 minutes from my home)and committed suicide by jumping.. it was completely covered up. I felt so angry. Knowing how poorly healthcare workers are treated is absolutely unacceptable. I now have PTSD. Practically unable to work. I'm so destroyed by how we are all so abused and NOBODY cares...

I am off from work (frontline worker) with burnout for the last two months. I didn’t even had energy decorate or cook for my family on Christmas.. I am just a zombie.. but getting help!

Content is so true I'm surprised RU-vid didn't censor it.

Oh this is the BEST F****ing thing I've heard in a while!!! You are spot on. 😂

Love it. Is there a version that includes the slides?

The bureaucratization of medicine. O care made it worse. Get the government out of it.

Thank you sir

Imagine committing years of your life to reach a goal, doing everything you're expected to, being completely qualified, then having it amount to nothing based on luck. No thanks. And let's be serious, whoever knows the right person would be extra "lucky".

Always informative and a joy to listen to Vinay or (Dr. PRASAD)! 👏👏

I am a retail pharmacist so I can not relate to every aspect of this video but I have been thinking about the problems in our system for many years. Healthcare has become a monopy system. We need many independent practitioners so their is choice for those of us working in the industry. Since Medicare part d was started and then Obama care it has created a regulatory environment that is so complex and difficult on giant corporations can afford the lawyers needed to battle the insurance companies and the government regulators to eek out a profit. We need to go back to direct doctor/patient/pharmacist relationship. If a doctor wants to start his only small hospital that should be allowed. Government can not hold all of the purse strings for Healthcare and therefor dictate how we practice.

Interesting that a major cause of burnout wasn't mentioned....that of an ever growing % of patients who are unhealthy due to poor lifestyle choices, and are not inclined to improve their choices - obesity and T2D, sedentary lifestyle, poor impulse control, etc. Hospital wards are full of such people. Where's the satisfaction treating such people?

Very much agree with your ending comment.

it's true. Life isn't about happiness. Or it is kinda, but happiness shouldnt be the singular overwhelming goal we strive for. Life is about duty, this is correct. Thank u

I totally agree this ongoing recertification is a money motivated thing. Also, they told us every 7 years retest then said theyll make it every ten if we also do MOC. But then, they make that every 5 yearz. It makes me so mad. Then they say you dont need the test if you answerquestions every quarter of the ear. I think its gojng to be just for that one yeat in substitutfor the test. But NO, itsevery 3 minths for the test of our careers. Trapped! But the one that gets me most is the arbitrary procedure privileged requirement of having done the procedure with in the last year. This is a main reason rural medicine is limited. I want to see the study.

Thank you ❤ awesome 👏 and true.

Lots of gaslighting and hypocrisy at the leadership level. It’s disgusting

My friend’s child finishing medical residency, had to deal with three suicides by hanging in their pool of residents….

The problem is embedded in the very nature of the job. Who wants to spend the day listening to people complaining , warranted or not And particularly irritating is the exaggerated expressions patients use No one has just a sore throat , it’s “ like swallowing razor blades” Headaches are “ my head is exploding”. Followed by a look to see if you are suitably impressed After a while , you roll your eyes and think of the beach

Good news.. Now we have AI to reduce Physician burnout

Hey Dr. you just said three weeks for an MRI? That’s outrageously good . In Israel we need to wait months usually

Might you some time sit down with a high-level administrator (possibly recently-retired) and try and go over with them why they are making the decisions that they are making? I have to assume that many of these decisions which impact medicine are at least made with good intentions, and it would be interesting to see why they thing eg. another training module is worthwhile.

*heard it on the pod feed early:* but a fantastic entry as always.=) _JC

Thank you!

truth

I am RN and I totally agree....

Lying like used car salesmen is stressful.

💯 Babylon System is the Vampire.

I just think it is all not cohesive as you are talking about the purpose of life being duty and giving a talk on burn out affects physicians and also saying that you don’t want to go to that 6 pm meeting. Everything just does not make sense when it comes to physicians talking about physician burn out it almost seems like physicians don’t want to own it.

♿️

“Too many interruptions” Dude. Try being a cloud infrastructure engineer. Seriously. Every two minutes my cloud infrastructure guys were getting poked about random junk. That’s life for literally every high performance job. If you can’t handle that, then you need to retire.

Very disappointed with your last show with ZD.