Why do women physicians experience burnout more than men?

Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The series continues with this blog by Rebekah Bernard, MD, a family physician at Gulf Coast Direct Primary Care in Fort Myers, Florida. The views expressed in these blogs are those of their respective contributors and do not represent the views of Medical Economics or UBM Medica.

Dr. BernardThe statistics are clear:  Physicians are burned out, miserable and trying to get out of the clinical practice of medicine, and women physicians are leading the pack at twice the level of burnout as their male colleagues.[i]

Even more frightening, women physicians have high rates of depression and commit suicide at a level 2.4 to 4 times higher than the general population.[ii]

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But why are women doctors so burned out?  And more importantly, what can we do to help?

Here’s what we know about women doctors: First, the good stuff. Women make terrific doctors and may even get better outcomes for their patients, with a recent study making headlines when it showed that patients treated by female doctors had lower mortality and readmission rates compared to their male colleagues in the same hospital.[iii]

Women doctors spend more time with patients on office visits, emphasizing preventive care, education and counseling, and focusing on the psychosocial aspects of patient care.[iv]  

However, this difference in communication style creates a cycle in which women physicians tend to attract more female patients, who are more likely to have depression and other psychosocial issues in addition to the usual medical conditions. Additionally, studies show that both male and female patients tend to talk more during office visits and are often more demanding to women doctors than they are to male physicians.[v]

Here comes the dilemma: While helping patients deal with psychosocial issues is one of the keys to improving many of society’s ills, this type of care requires time and is emotionally draining. Our current healthcare model, based on seven-minute office visits that incentivize procedures and technology, fails to reward physicians for spending the time that patients need. This may explain part of the physician gender pay gap, with female physicians earning about $20,000 less per year than male physicians.[vi]

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In addition, our current model places additional demands on doctors to become data-entry clerks and electronic health record (EHR) technicians, which is especially troublesome for doctors who are trying to manage patients with psychosocial distress. Back in the days of paper charts, most physicians found it relatively easy to provide eye contact and show empathy while documenting or reviewing the medical record. It’s relatively easy to discretely handwrite notes or flip through a paper chart while still demonstrating to the patient by body language and eye contact that you are listening.   It is completely another matter to try to show empathy to a patient while awkwardly clicking and scrolling through computer screens. 

Once an electronic health record is introduced into the exam room, documentation during a complex psychosocial visit becomes downright impossible; a physician simply cannot meaningfully engage with a patient in distress while hammering away on a keyboard. 

Next: Something has to give, but what can be done?

Something has to give: Either the patient-physician interaction suffers, the documentation doesn’t get completed (and therefore doctors don’t get paid), or most likely, women physicians will resort to completing notes and documentation until after patient care hours, now cutting into time that they could and should be spending at home or with family.

So what can be done?

Here are five steps that women physicians can take immediately to reduce the stress that causes burnout:

1.     Take control of your schedule. Since women doctors spend more time with our patients, we need to get realistic and adjust our schedules. Running behind throughout the day is incredibly stressful, and a major source of burnout. Enlist the aid of your clinical assistant or office manager to help you track the actual amount of time that you spend in the exam room. Then add the amount of time necessary to complete office notes immediately following the office visit, and adjust your daily schedule accordingly. It may be that we only need to add five minutes to each office visit, or allow a schedule gap in the late morning or afternoon to make a tremendous improvement in stress levels. 

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2.     Schedule frequent follow-up visits. The key to coping with emotionally challenging patients is to schedule frequent follow-up visits. Patients in psychosocial stress often have a multitude of symptoms and complaints, which can never be dealt with in one visit. Encouraging patients to discuss their top one or two concerns today, and scheduling an appointment for the near future to discuss the rest, helps keep doctors running on time. Additionally, patients that are considered difficult by doctors often fear abandonment, which makes them engage in behaviors like frequent phone calls and drop-by visits that can create chaos in a busy day. Frequent, scheduled visits provides patients with reassurance and improves the therapeutic relationship.

3.     Refer patients to psychology. While physicians can help patients with many psychosocial issues, there is absolutely no substitute for counseling with a licensed mental health professional as part of a comprehensive treatment plan. Women physicians are perfectly placed to encourage and even insist that patients with complicated psychosocial stressors get help with an excellent psychologist. This helps our patients and frees our time up to be available for other patients. 

4.     Minimize documentation. Electronic record keeping is a major stressor for many physicians, especially those of us with perfectionist tendencies. In order to improve your work-life balance, the best strategy is to finish your notes in real time, after each and every office visit. This is easier said than done, and requires dedication and support from your staff, but will massively improve your work-life balance when you find yourself at the end of the day with no work to take home. Keep notes short, use bullet points whenever possible, and only write down what you absolutely need. Avoid agonizing over spelling or grammatical errors-get the note done and locked as quickly as possible.

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5.     Renegotiate your salary and support staff.Women physicians are currently paid about 70% of male physicians, even when all other variables are controlled. Women are also given less resources to do the same job as their male colleagues.[vii]  Women physicians can start by recognizing our value and having the courage to request fair compensation for our labor and adequate support to do our jobs.  We need to negotiate our salaries, and we can start by requesting a 30% raise effective immediately. What would happen if every single employed female physician walked into their administrator’s office tomorrow armed with the data that shows that women physicians improve patient care, and yet we are grossly underpaid and undersupported?  When women physicians feel treated fairly, and are given the resources that we need, our burnout levels will decrease.  And less burned out doctors means better health care for everyone. 

Rebekah Bernard is a family physician and the author of How to Be a Rock Star Doctor:  The Complete Guide to Taking Back Control of Your Life and Your Profession.  She can be reached at her self-titled site, Rebekah Bernard, MD.

[i] http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2000.im9908009.x/full

[ii] http://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.12.2295

[iii]http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2593255

[iv] http://psycnet.apa.org/journals/hea/13/5/384/

[v] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495474/

[vi] http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2532788

[vii] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495474/