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Weekly Rewind: Burnout in Nephrology

By Beatrice Concepcion posted 07-05-2018 09:07


By Beatrice Concepcion, MD, FASN

Burnout.  This topic evokes such a varied range of emotions and opinions from doctors in many fields.  It is a condition that is inherently understood though it presents in multiple ways.  At its core it signifies loss.  It could be a loss of energy, of compassion, of hope or any number of things we hold valuable and important in our lives, both personal and professional.

It is a topic that has stirred a spirited discussion within our Open Forum Community with over fifty comments posted.  @kenarjhaveri opened the discussion with a link to a post on his blog found here.

The subsequent thread discussed members’ views on factors that lead to or contribute to burnout and some proposed solutions.  Find the entire thread on ASN Communities.

An analysis of how burnout occurs or persists among nephrologists highlighted a few salient points:

  • The role of EMR’s in increasing the burden of documentation, instead of facilitating care, was mentioned. 
  • So too was the loss of control or purpose as doctors and their practices need to work under the policies and protocols of larger institutions or under the direction of payers. 
  • Dated models of health care that do not sufficiently account and reimburse for the value of cognitive skills versus procedural skills do not allow providers to spend the time necessary to provide comprehensive medical care. 
  • The burden of sustaining a viable practice is increasing as inefficiencies such as travelling to multiple sites are shifted to the nephrologist. 
  • A sense of disrespect or lack of support from physician colleagues was brought up. 
  • Tribalism, lack of leadership, inefficient systems of care and communication, unmanageable call schedules and increasing inpatient volumes were among the other factors that came from multiple contributors worldwide. 

As we recognized the many contributors to physician burnout so too did we come together to share what solutions are being worked on.

  • @SamirNangia wrote that today’s nephrologists are part of the solution in cultivating Nephrology’s leaders of the future. 
  • @SusanQuaggin enumerated a few of ASN’s initiatives that are currently underway. 
  • @DeniseLink mentioned integrating midlevel providers to provide more efficient systems of care.  Political advocacy as a tool to promote changes in payment models or in creation of appropriate quality initiatives was considered valuable. 
  • Political advocacy as a tool to promote changes in payment models or in creation of appropriate quality initiatives was considered valuable.
  • @Terrence O’Neil pointed out that making payers responsible for the outcomes of the patients would go a long way towards aligning incentives with physicians. 
  • Other contributors brought up additional tools to combat burnout including relying on family and friends for support, learning from and following our thought leaders and mentors, and advocating for change under the leadership of our professional organizations. 
  • Enterprise level solutions such as multidisciplinary care, telenephrology, and practice innovation were also discussed. 

With such a broad range of topics and discussion it was good that @TejasPatel created a summary of the main points.

We recognize the risk of burnout to be an ever-present one.  As the world itself keeps on changing so too do the stresses that put us at risk.  It falls on us to support each other as we work towards solutions to the challenges we face.  It is through communities like ours and organizations like ASN that we can take the first steps to combat burnout.