Physician Spotlight: J. Matthew Knight, MD, FAAD

Physician burnout—defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment—is a real and growing threat to dermatology. Forty-six percent of dermatologists reported feeling burned out in the Medscape Dermatologist Lifestyle Report 2017. And the consequences of dermatologist burnout are far-reaching and dire, says J. Matthew Knight, MD, FAAD, founder of Knight Dermatology Institute in Orlando, FL.

Why is dermatologist burnout on the rise?

Dr. Knight: This wasn’t something that was measured or even thought about until the last decade or so. A Medscape Physician Lifestyle Report signaled that the number of physicians who felt burntout was climbing, and a report published in Mayo Clinic Proceedings a couple of years ago shocked everyone: more than 50 percent of US physicians were professionally burned out. Incredibly, dermatology saw the largest increase of any specialty. Dermatologists continue to do poorly in terms of burnout severity; several of our peers are looking for the exits.

What role does technology and bureaucracy play in dermatologist burn out?

Dr. Knight: Bureaucracy and regulation play the largest role in physician burnout, leading to emotional, physical, and financial exhaustion. The impact of electronic medical records here can’t be understated. Several recent reports note that doctors suddenly spend up to two-thirds of our time on paperwork, and our patients and families suffer as a result. In order to get paid for our work, we were forced to adopt expensive, cumbersome technology that has never been shown to improve our patients’ health. Now many dermatologists find themselves signing notes in their PJs on the couch instead of enjoying family time or exploring hobbies. This leaves little time to recharge for tomorrow’s clinic. Adding insult to injury, now we have to learn how to comply with the Merit-based Incentive System (MIPS), which almost no one understands. It’s worth noting that feelings of cynicism (thanks to Yelp!, et al.) and worthlessness (largely due to the commoditization of our services) also play a huge role in dermatologist burnout.

What are the consequences of ignoring the symptoms of burnout?

Dr. Knight: Doctors burn out slowly and then all at once. Due to guilt and shame, they may ignore symptoms until the levy breaks. This may mean leaving the profession and/or succumbing to alcoholism. There is a suicide epidemic among physicians, and a lot of this can be tied to substance abuse. Burnt-out doctors offer worse care for patients. The end of the rope is nowhere to be in medicine.

What is the antidote to dermatologist burnout?

Dr. Knight: There are some things we can’t change, but there are many things that we can. A lot of people hope that joining a hospital or large private equity group is a way to reduce burnout, but these options often mean even less control over our destinies and can make things worse. The first thing we can do—which is slowly happening—is to take the taboo off of physician burnout so we no longer feel ashamed or guilty about it. Most of us get on this conveyor belt in medical school and are programmed to selflessly work until our eyes are blurry—often neglecting our own needs. The No. 1 way to mitigate burnout is to focus on “you.” I am a big advocate of things like exercise, proper sleep, and a healthy diet. There are a lot of great articles about the benefits of mindfulness when it comes to helping docs cope. We need to remember that substance abuse and burnout go hand-in-hand.

We need look at ways to take control of our day-to-day lives and get that good feeling about medicine back. It’s OK to not see eight patients an hour, and if there are procedures you hate to do, stop doing them. If there are insurance companies you can’t stand, stop taking them; a lot of our peers are even migrating to a direct-care, no-insurance model. If your office is bedlam, make immediate investments in your efficiency and work flows to help bring order to your day. Our careers are supposed to be a marathon, not a sprint: make work your happy place.