The Widespread Problem of Doctor Burnout By PAULINE W. CHEN, M.D.


The patient, a powerfully built middle-aged restaurant worker, had awakened one morning with a tight pain in his shoulders that traveled down his right arm. At work, he could barely shrug his shoulders or turn his head. “My fingers were so weak,” he recalled, “that I couldn’t even get a good grip around a glass of water.”


A senior doctor at a local clinic diagnosed a pinched nerve and prescribed a muscle relaxant. Two weeks later, only more incapacitated, the patient went to another clinic, where a younger doctor made the right diagnosis: A malignant tumor in his chest was pressing against a nerve to his arm.



“That first doctor couldn’t be bothered by what I was trying to say,” the patient said. He was now receiving chemotherapy and was hopeful his cancer had been caught early enough, but the near miss still haunted him. “He acted like he just didn’t want to be there with me. Or with any patient.”

After reading a study published this week in Archives of Internal Medicine, I’ve been thinking a lot about this patient’s experience. And I’ve come to two conclusions. First, the older doctor had classic symptoms of burnout.

Second, mistakes like his may only become more common.

Research over the last 10 years has shown that burnout – the particular constellation of emotional exhaustion, detachment and a low sense of accomplishment – is widespread among medical students and doctors-in-training. Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling, quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.

Now, in what is the first study of burnout among fully trained doctors from a wide range of specialties, it appears that the young are not the only ones who are vulnerable. Doctors who have been practicing anywhere from a year to several decades are just as susceptible to becoming burned out as students and trainees. And the implications of their burnout — unlike that of their younger counterparts, who are often under supervision — may be more devastating and immediate.

Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors’ responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.

“We’re not talking about a few individuals who are disorganized or not functioning well under pressure; we’re talking about one out of every two doctors who have already survived rigorous training,” said Dr. Tait D. Shanafelt, the lead author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn. “These numbers speak to bigger problems in the larger health care environment.”

The doctors’ burnout appeared to have little to do with hours worked or even the ability to balance personal life with work. Instead, the only factor predictive of a higher risk was practicing a specialty that offered front-line access to care. More than half of the doctors in family medicine, emergency medicine and general internal medicine experienced some form of burnout.

The study casts a grim light on what it is like to practice medicine in the current health care system. A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer.

In this setting, “doctors are losing their inspiration,” Dr. Shanafelt said, “and that is a very frightening thing.”

What patients must face in the examining room is no less alarming. Doctors who are suffering from burnout are more prone to errors, less empathetic and more likely to treat patients like diagnoses or objects. They are also more likely to quit practicing altogether, a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.

“Doctors are coming to this expansion already pretty stretched and stressed out,” Dr. Shanafelt noted. “I don’t think there is going to be a lot of room to maneuver without some significant structural changes.”

Dr. Shanafelt and his colleagues are in the midst of studying the effects of workplace initiatives aimed at providing greater support for doctors while improving efficiency, which they believe is critical for doctors and patients as well as the large health care organizations that aim to serve us all. Without decreasing the total hours worked or the number of patients a doctor must see, a hospital system might, for example, restructure its clinics so that doctors could spend more time with patients and less time on the phone getting authorization from insurers or in front of a computer completing administrative tasks.

“If people work in an environment where they believe there is meaning, they will put up with a lot,” Dr. Shanafelt observed. “It goes beyond the significant personal consequences for an individual physician. It affects whom patients can see when they are sick, the quality of care they receive and their safety.”

Being Toastmaster…..

2 weeks ago I was asked to be “Toastmaster” of the August 21st toastmaster meeting by a very educated, brilliant , and capable young lady Karen McKinney who is VP Education of our chapter, and this is how the conversation transpired:

Hello Kevin.

Can you fill in for Michelle as Toastmaster for next week.


Attached is the agenda with instructions regarding how to send out the meeting notices to the members.  The instructions are listed in the tab called ‘ Toastmaster – Email Template’. The agenda would need to be filled out by you as well with the role holders once confirmed and speaker’s speech information.  The Grammarian would provide you with the word of the day, or you can create one.


The agenda also has instructions of what you would do during the meeting.


Please let us know by tomorrow so that a replacement can be found if you are unable.

Karen McKinney


I contemplated whether or not to accept the role of Toastmaster of our next meeting. So my response to Karen was very precise:


I would be honored to be Toastmaster next Tuesday.





I am now locked into a role that I have no idea of what to expect, and immediately thrust into what I feel is the most important role of the Toastmasters meeting. So I do what most would do, procrastinate and bring more unwanted pressure upon myself by following the directions Karen sent me,  but not really following the directions Karen emailed me.  But hey.. I’ll somehow get through this challenge in my life like any other thrown on my way, wing it! Bad decision, I not only got no  response from the assigned duty holders, nobody held my hand throughout the process, none of the tenured members even reached out to me to ask me how things were going leading up to the meeting.  I thought to myself I am so blessed to be a part of The Arts District Toastmasters,  they are not only teaching me to not only be a great communicator , but to pay attention to detail along the way.  Below is some feed back from my fellow Toastmasters on how I did as “Toastmaster” last week.

Thank you Kevin for being Toastmaster yesterday


You did a great job!   Your willingness to perform various duties for the club shows that you are a true leader.


Have fun on your vacation next week and we look forward to seeing you at the Toastmasters meetings!


Karen McKinney

VP Education, Arts District

Congratulations Kevin.  Your first Toastmaster duty is a huge step in becoming an accomplished facilitator.  We appreciate your stepping up!











Social Media Tips for Physicians

With these 10 short tips you’ll learn return on investment (ROI) strategies for social media, avoid issues with HIPAA, and discover how to protect your efforts for long-term success.

1. Before you attempt anything else on the Internet please fix your online reputation first. The last thing you want to do is attract attention to a negative reputation. Read one doctor’s eye-opening story first.

2. Physician ratings are the most socially-relevant channels in 2012. Starting in January, these companies have started spending millions of dollars urging patients to screen doctors. Angie’s List, one of the most disturbing review sites as there is no verification process, has literally taken over the entire medical industry by storm. Planning for this should be a priority. Bad online reputations are disastrous for practices. For some doctors with negative reviews, our reputation management program can save them from lawsuits and protect their patient volumes, but for some it’s too late for a quick fix. My advice is to establish your online reputations now because it’s harder to destroy a reputation that is positive. One bad review is not going to bring your practice down. But if it’s the only review, you can bet that this will affect your new patient volume.


3. Google Search is the most cost- and time-effective social media tool available. Plan on being on page one of results for key terminology. Where do patients find you first? Twitter? Facebook? No, Google. Once they find you on Google, they will go to your website, and only then will they want to further screen you on your other social media channels. If you don’t have a website you’re simply missing out.

4. For doctors who perform elective procedures, who accept out-of-network benefits, or have fee-for-service practices, social media is a requirement. People earning incomes of $100,000+ are influenced by social media more than anything else. Take a look at this interactive tool from PWC for some eye-opening statistics

5. Learn to blog. Too many doctors and their administrators jump on Twitter and Facebook without learning how to plan for success with a medical blog. Your blog is the opportunity for you to become the most trusted source of medical education for your patients and referring doctors.
• Have you read something interesting in a medical journal for your specialty? Put together a summary for your network without the medical jargon. Also, learn how to respond to comments on your blog first.
• Think of the time savings when you make it a requirement for patients to read your blog posts before they come in for appointment or while they’re in the waiting area.
• There are no HIPAA issues here. Have a short info link on your blog that explains your social media policy.

6. Learn the basics of medical search engine optimization (SEO). I have resources from top medical SEO experts in the country and will make them available upon request. Five terms you absolutely need to understand are meta titles, meta descriptions, H1, H2, and H3. Social media lasts seconds. Social media with SEO lasts months or years. Why do you need SEO? Blogging, Tweeting, and using Facebook are ineffective unless you understand how to optimize every single time before you hit “Enter.” If you’re spending a few minutes of your life writing something, plan on it to last. Without planning, you’re just “blurping.” Blurping has no ROI and loses relevance in seconds.
• This is especially valid for physician bloggers. I’ve seen doctors who are very active on Twitter whose blogs have hundreds of articles. But when you go to their blogs there is no organization, you see only five blog posts —the rest of articles are hidden in archives that nobody will ever read, and they lack even the most basic SEO components. Planning for user experience is just as important as SEO.

7. Link to articles and resources that are yours. Remember, you spent serious time and money on getting that one person to come to your Facebook page, Twitter page, or blog. Don’t send them away. If you don’t have the time, hire someone that will spend the time researching what your patients and referring doctors love to read and how it relates to your expertise. Write short summaries and articles about them on your blog. This is the biggest social media ROI strategy: Link your Twitter and Facebook posts to your blog and nowhere else. If you must link to an external resource make sure that clicking on it will open a new browser window.

8. Do not advertise your services. Advertise your expertise through educational resources. At all costs avoid saying things like “top surgeon” or “best doctor,” etc. This is an automatic red flag for anyone with a brain. In several case studies, when we eliminated such terminology case volumes dramatically increased. If you want to advertise on your blog or website the only thing you should advertise is “Schedule an Appointment.”

9. There is serious ROI that can be identified with Google Analytics. Install it into anything and everything.

10. Protect your social media ROI. You’ve spent hours, days, months learning how to blog and how to build effective social media campaigns. Don’t let Internet companies plagiarize content from your blogs, websites, and articles and monetize on it. Don’t get sucked in with the promise of “badges, recognition, etc.” Just because your colleagues are doing it doesn’t mean you have to. When in doubt, just ask me. Google your website, your articles, and your name often; at least once a week. Every month, hire someone or spend an extra hour to Google all the titles on your blog.

Christian Head, Black UCLA Medical School Doctor, Files Lawsuit After Alleged Gorilla Depiction


A faculty professor who filed a racial discrimination suit against UCLA, saying that the school ignored racial slights against him over his career, has taken to YouTube to air his grievances.

In a six-minute YouTube video, Dr. Christian Head, an otolaryntologist at the UCLA’s medical school, says he was the subject of repeated criticism during an annual event in which residents performed mocking roasts of their professors.

“In the final slide was a photo…of a gorilla, on all fours, with my head Photoshopped onto the gorilla with a smile on my face,” Head says in the video. “And a Caucasian man, completely naked, sodomizing me from behind, and my boss’ head Photoshopped onto the person smiling.”

Head later complained to his superiors at the hospital, but says he was told “if you want tenure, [and] make a big stink about this, they’re going to crush you.”

After he was awarded tenure, Head said that the university cut his pay in retaliation for his complaints and blocked him from teaching.

The video states that Head is the first and only African-American tenured professor at UCLA’s department of head and neck surgery. Late last month, Head filed suit against the California Board of Regents, the body that governs the University of California system. According to the L.A. Times, the suit specifically names Marilene Wang andGerald Burke, who are also otolaryntologists. Head accuses them of making “inappropriate racial comments and insinuations about blacks” over several years.

But a spokesperson for the university told the Los Angeles Times that university officials had “investigated this matter and found that the evidence does not substantiate the claims of unlawful activity.”