From day one of his administration, President Donald J. Trump has pledged to repeal and replace the Affordable Care Act, an effort that gained and lost steam repeatedly. Efforts to chip away parts of the law continue both inside and outside of Congress. The Medicare Access and CHIP Reauthorization Act (MACRA), moved from acronym to reality as physicians began reporting data in hopes of avoiding reimbursement cuts, or receiving financial bonuses in 2019. And that’s what happened just in Washington, D.C.
On the front lines of healthcare, physicians continued to find themselves stuck in the middle. They are torn between patients and paperwork for their time. They are caught in between payers and patient requests. And with their career, many want to remain dedicated to medicine while fighting against the forces that further divide their time and attention.
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For the fifth consecutive year, Medical Economics reveals its list of obstacles physicians say they face next year and, more importantly, how to overcome them. As we’ve done before, we asked readers to tell us what challenges they face each day and where they needed solutions.
Here are their responses, starting with the biggest challenge of the coming year.
1. Avoiding burnout/remaining dedicated to medicine
For primary care physician Dan Diamond, MD, the signs of his looming burnout were evident.
“I was waking up as tired as when I went to bed and I was going to bed incredibly tired,” he says. “I had intense physical and emotional exhaustion and doubted whether I was actually making a difference in medicine for such incredible sacrifices.”
But something happened to Diamond after Hurricane Katrina in 2005. He served as director of the mass casualty triage unit at the New Orleans Convention Center. Surrounded by disease and death, he had a personal and professional epiphany.
“What got my attention were the people that in spite of losing everything, did not become victims,” he says. “Instead they became unstoppable and I wanted to become unstoppable myself.”
Today, Diamond deploys to sites of international disasters with Medical Teams International and with healthcare professionals on how to overcome burnout, build stronger teams and transform their organizations.
He is the first to acknowledge that the medical environment in the U.S. is “brutal” right now, between increasing regulations, physicians being tethered to their electronic health records and payers bringing productivity to a halt with prior authorizations and other requirements. Over time, those who went into medicine wanting to give back can get weighed down and this leads directly to burnout.
“I don’t think we can change whole organizations and cultures, without starting on individual mindset,” Diamond says.
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He encourages physicians to remember their passion for medicine and not let the challenges of the day—from a busy waiting room to cranky patients to dealing with payer rules—slowly drag them down.
Instead, he wants physicians to become “empowered givers,” focusing not on themselves, but rather their medical practice team and their patients first. By shifting attention to the team and its performance, the work becomes more manageable and care improves.
“As empowered givers, physicians can work to make the members of their team successful,” he says. “And then rally the team to look at the teams around them in [their medical] sphere of influence and do what we can to make the other team successful. I don’t see how we can go forward as a profession any other way.”
For more on physician burnout, visit bit.ly/18-burnout