Friday, November 13, 2015

Retire Early and Come Work for Me for Free: Plenty of time with patients, flexible hours, no hassles, and no documentation!

I hear it more and more- "They've taken all the joy out medicine."

According to some, doctors are retiring early (purportedly due to the Affordable Care Act). 

Job satisfaction among physicians is low and getting lower, with a survey showing most would quit if they could. The typical reasons are rehashed: stress, poor work-life balance, busy work, reimbursement, etc. But I personally think it boils down to what Mark Linzer described as the root of burnout: failure to achieve meaningful change in the world.

So, what to do with a glut of retired doctors? These are seasoned clinicians who don't have loans to pay off, and presumably are seeking a sense of joy that has been lost to the drudgery of 15 minute office visits and the bureaucracy of the patient centered medical home.

What if we set up clinics where these early retirees could volunteer their services? The promise to docs is that they would be offered everything possible to facilitate an enjoyable work day, which probably means opportunities to make meaningful change in the world, ie provide good healthcare. In exchange for having fun practicing medicine, they work for no salary.

Physician salaries represent 46% of total operating costs. Volunteer doctors would open up almost half the budget of a primary care practice to hire support and otherwise innovate to keep these doctors happy. Doctors could have plenty of time to talk with patients because there would be less pressure to maximize throughput. Each doc could have a scribe to handle documentation. There would be a full time mental health professional on site for immediate in-person referrals. A physician could be hired to take call at night and on weekends. Finally, clinicians could be spared the need to try to keep up with quality metrics in an effort to boost reimbursement (and don't reflect quality).

If volunteerism were high enough, hours could be quite low, affording docs plenty of time with family and friends.

I bet patients would love to see a senior, happy, un-hurried and un-harried doctor.

This matters to me because it matters to patients. Simply put, if doctors don't feel like they're making meaningful change in the world, then it's a safe guess that patients aren't getting good care. It's hard to conceive of a world where doctors hate their job, and yet patients are doing great. I cringe at the thought of advocating for doctors, but I think their sad state is rooted in the same systemic problems that drive patient dissatisfaction and poor health.

Changing the healthcare system is important, but it will take a while, far too long to salvage the doctors who are retiring early. Why not give them an option to make a difference?