Physician Burnout and Medical Malpractice

 

There is no doubt there is a physician shortage that is getting worse. The reasons for this trend include early retirement, physician burnout, declining wages, decreased independence, electronic health records (EHRs), and government intrusion into the practice of medicine.

According to the Association of American Medical Colleges in 2018, there will be a shortage of 120,000 physicians by 2030. That’s an increase of 14% over last year’s estimates.

By some estimates, doctors now spend half of their time on EHRs – and barely 25% of their time seeing patients. As recently as 2000, doctors spent 60% of their time with patients. This has led to two-thirds of doctors today who describe themselves as burned out, depressed, or both. If we ever see single-payer healthcare in this country, as many progressives want, those numbers will surely increase.

What is the impact of medical malpractice on physician burnout?

As discussed above, there are many reasons for physician burnout. But certainly an important one is the threat, real or imagined, of medical malpractice litigation.

In 2011, Batch et al. surveyed 7,197 members of the American College of Surgeons and found 24.6 percent had been sued during the previous 24 months. Compared to members who were not recently sued, those who were had higher rates of burnout, symptoms of depression, and suicidal ideation.

The authors addressed the question of causality: “Since burnout can contribute to poor decision making, less compassion, and diminished dedication to safe, optimal care, it is reasonable to suggest that these physicians were more likely than their nonsued counterparts to be at risk for error.” A study in Oregon would seem to prove the point when they found the risk of receiving a second malpractice claim, after a first one, doubled in the following year.

The impact of a malpractice claim on a physician’s life was estimated in a study of 41,000 doctors by Seabury et al. They found that during the course of a mean physician career of 40 years, the average doctor spent 50.7 months, or more than 10 percent of that time, with an unresolved, malpractice claim.

Does burnout increase the risk for malpractice or does malpractice increase the risk for burnout?

Eeric Truumees, M.D., writing in AAOS Now, says we don’t know the answer to that question yet. We do know that the risk of medical malpractice has several other impacts on the healthcare system.

  • Increases the practice of “defensive medicine” – ordering unnecessary tests
  • Increases the cost of healthcare
  • Influences the movement of physicians to lower-malpractice-risk states
  • Influences the decisions physicians make in “high-risk” patients

 

What can be done to lower the risk of medical malpractice while maintaining high standards of healthcare?

A recent interview of several health policy experts by The New York Times reporter Margot Sanger-Katz revealed several suggestions:

  • Shielding doctors if their care adhered to accepted standards
  • Using administrative courts in lieu of juries to determine liability and damages
  • Implementing no-fault systems – currently widely used in worker’s compensation systems and in vaccine litigation.

 

The solutions are not clear – but the problems of physician burnout and physician shortages are not going away. Something must be done soon or we face a future with inadequate numbers of physicians to take care of our growing and aging population.

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