Just One More Thing

Physician burnout is on the rise. Mayo Clinic Proceedings reported that burnout rates among physicians rose from 47 percent to 54 percent from 2011 to 2014. Even more remarkable, burnout rates amongst dermatologists rose from 32 percent to 57 percent during the same time period. There are numerous theories to explain this increase. Common hypotheses include burdensome EMR systems, increasing insurance hassles, and regulatory hurdles like MACRA and MIPS. While these things have played some role, I have become convinced that physicians are burning out because of the just one more thing phenomenon. Here are some examples.

In 2018, we are dealing with new PDT billing codes. These new codes require that physicians apply Levulan and turn on the blue light. Therefore, the physicians at my practice have to pause from their jam-packed clinic schedule to perform these tasks. When we heard about this change, we were a bit annoyed, but we put it in perspective. After all, it will take just a few minutes a day. It’s worth it for patients and the practice. And it’s really just one more thing that we have to do. We can certainly do one more thing for patient care.

Correctly diagnosing dermatologic conditions is always challenging, but nowadays the treatment plan consumes most of my time and energy. Traditionally cheap medicines like desonide, clobetasol, and doxycycline are often too expensive to prescribe. Brand name medications are often cheaper for the patient because of coupons and specialty pharmacies. Every day, in order to treat my patients, I have to send particular prescriptions to a particular pharmacy, use a specific coupon, avoid certain meds with certain insurances, discuss the meaning of a high deductible with patients, and always try to enter prescriptions under a certain FDA approved diagnosis. Playing this game consumes a great deal of my time and brain power, but I do it because it’s just one more thing. And I can certainly do one more thing for my patients to get the medicines they need.

Just today, I saw a pediatric patient for a few dermatologic concerns. We were wrapping up the visit when mom says, “I know you probably hate it when people do this, but…” I already knew where this was headed. She proceeded to tell me that her other child has a spot of concern and she thought about making an appointment, but instead opted to bring in a picture of it. She figured that would be easier, since she was going to be in the office, and I was going to be there, and it was just going to take a second. After all, it’s just one more thing. And it’s easy for me to do one more thing to help out this patient’s family.

This list could go on and on. Each one of these things is not a big deal. But every month, every week, and every day we are given just one more thing to do during our work day. And I think a lot of us are getting just one more thing-ed to death.

On the bright side, these moments force me to take a few deep breaths, reach inward for my resiliency, strive to elevate my grittiness, and try to think of why I do all of these one more things. I think of the moments that I have had a real impact on a person’s life. I think of the moments that I have made someone’s life better. I think of the moments that a patient’s words of gratitude brought tears to my eyes. And then I’m ready to keep doing just one more thing.