Rural family doc • Co-founder of
@MedicineForward
• Burnout Warrior • Accomplice in a broken healthcare system • Here for the transformation •
#fightburnout
Today is a day to remember. A call for something better has been made. So, what matters to us most? What belongs in our "Declaration of Independence" for medicine? Our constitution? Who will be our founding mothers and fathers? What will we fight for? Who will stand up?
Privately, doctors feel despair about their appalling working conditions and the deteriorating doctor-patient relationship. But there have been no marches on Washington, no picket lines, no social-media campaigns. Why not?
There is no CPT code for "time spent building trust and rapport" — which I would argue is one of the most important parts of an effective patient-doctor relationship.
People who build EHR's should have to use their product themselves under the same time pressure as real clinicians for two weeks -- and then see how long it takes for them to realize they need to scrap the whole thing and start over with human centered design.
Mayo Clinic found that giving physicians a way to gather in small groups for semistructured, private discussions in restaurants, coffee shops or reserved rooms results in measurably lower burnout and social isolation
Anti-burnout principle: ⬆️ community
@AmiEverAfter
You don’t always have to do what they want. We have a basketball hoop in the street. Dead end road and our next door neighbors don’t mind. It was there when we bought our house. HOA got cranky, but when we realized it’s a public street outside their domain, just told them to call
My ❤️ broke today. Patient who is dear to me came in. She has a hard time trusting docs to begin with. Said when she started seeing me I was like the "country doc" she grew up with. Enough time to care. Now, I move her through the machine just like everyone else 😢
#fightburnout
Paying doctors more for doing things to people is not only a huge conflict of interest — it also crushes our altruistic intrinsic motivation with carrots & sticks. Let’s pay doctors for spending trusted time with patients and drop all the incentive BS. This experiment has failed.
These are the faces of physicians who risked their lives and those of their families this year. Not a single one ‘profited’. We are better than this. In the words of
@BarackObama
- don’t complain, VOTE.
"Physicians don’t hate technology – they have smartphones, fitness trackers and tablets just like everyone else – what they hate is bad technology."
Truth.
#fightburnout
“Categorizing burnout as a disease was an attempt by the WHO to provide definitions for what is wrong with people, instead of what is wrong with companies,”
—Christina Maslach
Just had my first patient die from COVID-19 — Kind, 60's, small business owner, husband, above average health, active, my friend — this is real, Montana.
@GovernorBullock
@CMichaelGibson
Doctor of Philosophy is fine to expect to be called doctor in the classroom. In a medical care setting doctor is shorthand for physician. Don’t confuse people.
Wait. What?!!!:
"One of the things that made Epic strong when I wrote the original code was that it never occurred to me to do anything other than put the patient at the center. I developed a clinical system at a time when the health care world had pretty much only billing and
What if I told you there is a billionaire who controls your medical records.
She started Epic Systems in a Wisconsin basement in 1979.
And now she's the richest woman you've never heard of.
10 matter-of-fact messages from the Midwest billionaire, Judy Faulkner:
1. “If you see
Chaps my hide when my patient says the cost of their medication went up to $140 dollars, and I find a coupon to get it for $12 on GoodRx. This can't be the best use of a doctors' time, shopping for drug deals.
Yes, it's my birthday today. If you want to give me the best gift ever, lift up a clinician who is special in your life today. Could be a hug, a smile, a thank you text, doesn't matter. These people dedicate their lives to caring for us, and they need us now more than ever!
Nitrofurantoin was denied for chronic UTI in an 80y old. Guess what the covered alternative was?... Nitrofurantoin 😂. Guess how long I spent on the phone? 20min.
#FixPriorAuth
For every 20 travel RNs eliminated, a hospital can save $3,140,000 on average. Every RN hired saves $157,000
…Time to treat our nurses well enough that they choose to stay!
My annual birthday wish today. If you want to give me the best gift ever, lift up a clinician who is special in your life. Could be a hug, a smile, a thank you text, doesn't matter. These people dedicate their lives to caring for us, and they need us now more than ever!
All healthcare workers are at the brink of collapse. A new study found that over 50% are stressed, overworked, and ready to quit. How much longer can we ignore their cries for help?
#fightburnout
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Most valuable thing I did at work today was take the time to be present with someone who was overwhelmed with a new diagnosis of cancer. Some things should never be rushed.
#TakeMedicineBack
@OslersAlliance
Help!
Montana NEEDS help!!!!!!!!!!
-Mask mandate lifted
-Top health officials resigning -Teachers resigning
-Safety disintigrating
-Infrastructure crumbling
-Liberty over life
-Politics over science
I don't know what else to say—but pray for us 💔
One of the things that makes me the happiest is giving away
#fightburnout
tees.
Let's play a little game.
Know a friend doing something amazing to fight for the doctor-patient relationship? Let me know. I'd love to send them one! :-)
This should tell you a lot about the problem:
"About half of all doctors surveyed said they would be willing to take a substantial pay cut to achieve a better work-life balance"
#fightburnout
@htubbscooley_RN
This turf war stuff about what "doctor" means looks ugly on all of us. The word doctor comes from the Latin verb docēre — it means 'to teach'. Let's teach that we can work together as professionals, each to the best of our ability, to help others.
My question of the day:
You're a burned-out physician. What do you want right now, this very second, that would help you?
Time to get practical. Let's start with things that actually exist.
Ready? Go.
#fightburnout
I think I was about 2x as fast doing my notes with an AI scribe. Even more important—I had much less decision fatigue at the end of my day .
(all that EHR clicking is wasted mental effort)
#FightBurnout
The ball is in motion. Yesterday we had 1k docs join. Today 1600. Let's keep it going. Imagine 1M physicians being heard. Imagine us taking action to
#TakeMedicineBack
!
Please sign up at .
@ZDoggMD
"Geisinger Health said it will choose 40 students per class who commit to practicing primary care for four years after their residency. It will pay full tuition and fees plus a monthly $2,000 stipend through medical school."
Awesome!! 👍
My annual birthday wish today. If you want to give me the best gift ever, lift up a healthcare worker who is special in your life. Could be a hug, a smile, a thank you text, doesn't matter. These people dedicate their lives to caring for us, and need us now more than ever!
For the last 2yrs I've poured my heart and soul into the question of "how do we bring doctors together as a movement to save the future of our beloved profession?" 🧵/x
@ShikhaJainMD
I'm a PCP and I agree 💯%. Too much business driving the practice of medicine. In primary care we can't give shingles vaccine and often Tdap because it's better reimbursed to get it at the pharmacy. So patients have to make multiple stops to get recommended imms! Just ludicrous.
"a whopping 75% of physicians have at least one chronic disease, and 74% attributed their conditions to added workload and work-related stress"
Worrisome. Our caregivers are sick, and our medical system is a major cause!
@ColinWestMDPhD
Thank you so much for writing this,
@chrissyfarr
. We can always count on you to keep it real. If Epic wanted interoperability, we would have it. They want a monopoly. Real interop threatens their business model.
@EPICEMRparody
We doctors complain about our jobs a lot, but I want to take a minute to say I also love what I do. There is no better feeling than the sense that you are really helping people. That's why I care so much about making it sustainable.
#fightburnout
🔥
I'm working on a special project, and I need help.
Question:
What is something unique about your specialty as it relates to burnout?
(Extra credit for something unexpected)
#fightburnout
#physicianburnout
#medtwitter
@ChristaCalap
@AmiEverAfter
If the streets are public (and I would absolutely confirm this), HOA has zero jurisdiction. They hate this BTW. The city could potentially give you a ticket (doubtful), but the HOA itself is powerless.
In software, it’s common to rewrite code from scratch when legacy systems are holding you back. In healthcare, we just keep adding and adding to our same old mess.
'approximately 70% of physicians wouldn’t recommend a career in medicine to their children. “To me, that speaks volumes about the depth of the problem,”'
#fightburnout
🎉 It's my birthday today! 🎂 Instead of gifts, I have a wish: let's all advocate for a better workplace for healthcare workers everywhere. 💪🩺 They give so much to keep us healthy; it's time we give back. Share if you're with me! 🙌
#FightBurnout
🔥
@CMichaelGibson
Med students are too smart to take the jobs we’re offering. They know better. Fix the workplace to make jobs desirable, fulfilling, sustainable. See what happens. 🤷♂️
Been thinking a lot about the value of scribes and have a burning desire to share this:
Docs like scribes because their reason to exist is to serve our workflow. If they don't, we can fire them.
...what if the EHR was like that? Vendors would shape up, STAT.
Why do I fight for something better? Because our future generations deserve so much more. Join us in building a new kind of community — one to bring all doctors together for the greater good!
Join the conversation @
#TakeMedicineBack
#FightBurnout
Am I the only one seeing the disconnect here? Shouldn’t the solutions be:
- Less bureaucratic tasks
- More respectful treatment
- Less hours at work
- More autonomy
???
#fightburnout
A physician’s competence is now determined by how many boxes are clicked in the EHR and reporting of metrics determined by non-physician health organizations.
#FightBurnout
MRI ordered for pt with lumbar DDD & severe sciatica with paresthesia for months. Can't stand to do work. No improvement with conservative treatment. Prior auth peer denied b/c "doesn't meet medical necessity". Wrote appeal w/ exactly same info and it was approved.
#FixPriorAuth
My friend just applied for a job at United Healthcare and was told he’d get a $500 commission for every senior he signs up for Medicare Advantage. Annual bonuses too. Insurance is off the rails.
"EHR Use Yields ICU Physician Fatigue, Suggests Usability Issues."
...um, yeah. Glad to have more data to back up what every single doctor can tell you.
#fightburnout
Me: won't it be nice when you don't have to wear a mask to school anymore?
10yo: I don't really mind, dad. It's not a big deal.
Me: kids are amazing!!
10yo: maybe adults can be amazing, too.
🤯
#MasksSaveLives
@LooseyJackie
Yes, MyChart can be handy. But, what about when you see your doctor for appointments? Do they make eye contact? Do they spend enough time being present with you? Or, is it more like this? And, the cumbersome way Epic works for docs is absolutely why that happened to your dx’s.
I’m speechless. With zero evidence to support MOC making us better doctors, ABFM decided to double down and change it from a 10y to a 5y certification. Now? Really??!!!
@AaronGoodman33
@InfoNbpas
@doctorwes
@otten_todd
ABFM is excited to introduce Certification 2025: the new Continuous Certification 5-Year Cycle. Built on the same foundational components as the current certification process, the new 5-Year Cycle offers increased flexibility and convenience to customize your certification.
The problem with thinking wellness is the antidote to burnout is that that's fundamentally a mistake.
The opposite of burnout is not wellness... it's professional fulfillment.
We're not even shooting for the right goal.
#FightBurnout
Event is tomorrow. Support for the mental health physicians is just the beginning of our advocacy to transform healthcare to be better for everyone.
Registrations
Today: 136
Last event: 750
Help spread the word!
@rocketgirlmd
@DGlaucomflecken
@ETSshow
@darakass
@Cleavon_MD
Antidote to burnout (professional fulfillment) is well established:
⬆️ value alignment
⬆️ strength of community
⬆️ sense of control
⬆️ sufficient rewards
⬆️ fairness
⬆️ reasonable work load
From
@CMaslach
. Her research is world class on how to
#fightburnout
Thought experiment. Send EHR vendor CEO to medical school + residency. Then have said executive see patients using EHR w/ same volume + constraints we have -- indefinitely. How fast would things get better?
#SkinInTheGame
#FightBurnout
There’s a sickness in healthcare, and it’s called the executive salary — a salary that comes from extraction from care delivery.
My take: most execs are way overpaid for how badly we are failing to achieve the quadruple aim.
Nearly half of Mass. General doctors feel burned out, according to the hospital’s own surveys. Burnout worsened after the 2016 rollout of a complex new EHR system, which demanded more time of doctors, even for simple tasks.
#fightburnout
Putting an armful of
#fightburnout
shirts in the mail at the end of a LONG clinic day helps revitalize my optimism. Grateful for all my wonderful friends who inspire me & lift up my spirits 🤗
What makes me cranky about this piece is that nowhere in the solutions is talking about a plan for making primary care desirable / sustainable. Don’t want a doctor shortage? Fix the workplace!
#FightBurnout
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"The total cost of recruiting a physician can be nearly $90,000, but the lost revenue per physician who leaves is between $500,000 and $1 million, even more in high-paying specialties"
doctors don't need to be told to do yoga or meditate to
#FightBurnout
; they need a system that values their devotion, offers proper training for disasters, and provides the protection and support they need to do what they do best: take care of patients
"Nearly three-quarters of surveyed physicians (74 percent) say the challenges of practicing medicine in today’s environment have caused them to consider career options outside of clinical practice."
...this is tragic! We must do better!!
#fightburnout