The Pressure Cooker

Before she has a chance to place coffee and breakfast on her desk, she is met by a triage nurse frantically explaining how a patient walked into the triage booth with bloody clothes requesting help after being stabbed during an altercation. Dr. Green drops her coat, scarf, and breakfast and springs into action. By the time the stabbing victim is stabilized, and hospital bound, she has nine patients on her queue who need medical attention. Three patients are already roomed, one of which swings the exam door open and begins yelling ,cursing, and threatening to sue “the incompetent doctor that doesn’t give a damn about sick people.” Dr Green checks all three patient charts, reviewing their past medical histories and their reason for today’s visit. The patient yelling obscenities has checked in for migraine treatment. Her list of medication allergies include six non-narcotic medications used to treat pain and migraine headaches. Also, there is an eight-year-old child in the adjacent room with complaints of vomiting, fever, and abdominal pain.

Dr Green takes a deep breath and springs into action.

Meanwhile, in the 3rd exam room sits a twenty-nine year old woman with her four year old daughter, who has checked in to have her child examined for signs of child abuse, after spending the weekend with her father two weeks ago. She did not seek care sooner because she did not have time to make an appointment. She also requests a full written report that she can show her divorce attorney.

Tired from having slept only five hours and hungry from having skipped breakfast, Dr. Green decides to evaluate the eight-year-old patient suspected of acute appendicitis. As she walks past the migraine patient’s room who is shouting into her cell phone, she hears the patient say, “be careful in the parking lot tonight.” Dr. Greene suspects the patient is referring to her. She feels tension build-up in her temporomandibular joints.

Before she can attend to her first patient of the day, she has been shouted at, cursed at, and threatened.

Her charts from last night are still not done and a myriad of emails have not been answered, despite cutting back on her sleep to arrive early to complete her administrative tasks. She works in a department dubbed “the trenches” or “the pressure cooker” by other departments in her large organization because daily life for her and her colleagues often feels like a battle in the trenches. During the years she is worked there, multiple staff members have taken medical leave due to stress, depression, heart palpitations, and a host of gastrointestinal and musculoskeletal illnesses. A colleague has decided to apply for permanent disability due to health issues. Another previously well accomplished and respected doctor in the department is in rehab for prescription drug abuse and dependence. Many doctors have simply quit.

Unfortunately, Dr. Green’s experience is not uncommon and days like these have become the norm, leading to a never-ending cycle of emotional and physical exhaustion. This never-ending occupational stress has resulted in an epidemic of physician and medical provider burnout.

What Constitutes Physician Burnout?

To understand this occurrence better, we must know what “Burnout” actually means. According to the World Health Organization, burnout is an occupational syndrome where the medical provider suffers from emotional and physical exhaustion. Typically, there is a sense of cynicism or negativity related to his/her job. Physicians experiencing burnout will often grapple with a lack of personal sense of accomplishment. They will distance themselves from the offending cause, in this case, their work and, most likely display a marked loss of interest in their work to avoid further stress.

Additional Signs of Burnout

1. Feeling drained and exhausted even when not working.
2. Fatigue that does not respond to adequate rest, sleep, or even time off.
3. Feelings of helplessness.
4. Feeling trapped in one’s current circumstances.
5. Changes in appetite and sleep.
6. Procrastination and loss of motivation.
7. Withdrawing from, and isolating from, work functions, family, and friends.
8. Physical manifestations, such as increased muscle aches, headaches, gastrointestinal disturbances, and even lowered immunity.

Who Is at Risk?

In a word, everyone, given the current environment. Burnout does not spare physicians in training either. In a survey, 25% of medical residents said they would choose a different career if given the chance. Almost half of Gen X physicians report experiencing burnout. Another survey revealed approximately 46-50 % of physicians exbibit at least one of the symptoms of burnout. Unfortunately, this malady has not improved since the World Health Organization defined burnout in 2018.

In 2020, 42% of physicians reported suffering from burnout. That number rose to 46% in 2021. To elaborate, the Medscape 2021 Physician Burnout and Suicide Report exposed an increase in this problem. Medscape surveyed 12,000 physicians across different specialties.

The results were tallied and reported in various statistical breakdowns with the six most significant findings described below:

1. The highest rates of burnout were reported among Critical Care, Pulmonary Medicine, Neurology, Infectious Diseases, Rheumatology, Internal, and Family Medicine.
2. Female physicians reported higher rates of burnout. Not surprising, since most female physicians carry added childcare and domestic responsibilities. Additionally, female physicians often end up caring for elderly and sick parents.
3. Work settings can often contribute to burnout. According to the National Institute for Health Care Management Foundations, medical providers who work at hospitals, large integrated systems, outpatient community clinics, outpatient academic settings, and multispecialty group practices report the highest rates of burnout.
4. Burnout is not due to Covid! In the 2021 Medscape survey, 79% of the physicians surveyed said their burnout started before the pandemic. The remaining 21% of physicians who reported experiencing burnout as a result of the pandemic cited factors such as lack of adequate PPE, stressful work conditions due to Covid cases and watching their patients die alone without their families to comfort them. Of those surveyed, only 8 % reported treating Covid patients a source of burnout, compared to 58 % citing too many bureaucratic tasks as a burnout source.
5. Sources of burnout are not a result of treating patients. Top causes of burnout included bureaucratic tasks, as mentioned previously. Long hours at work, 37%. Lack of respect from administrators/employers, 37%. Another top cause of burnout was insufficient compensation, 32%. The next common source of burnout was the lack of autonomy or control over physician medical decision making, 28%. Next in the survey results was the everlasting increasing computerization of the medical practice, 28%. Lack of respect from patients was another cited source, 17%. Yet another source of burnout was increasing governmental regulations pertaining to healthcare delivery, 14%. Out of all the cited causes, only 8 % of those surveyed cited stress from patient treatment.
6. The causes of burnout have remained constant year to year. Regardless of the pandemic, physicians have cited the ever-increasing bureaucratic tasks as a top contributing factor. This is not to say that the pandemic did not worsen this problem. But the cracks in the system were already there; Covid-19 just deepened the already existing angst and hopelessness among health care providers.

The Mental Health Toll of Burnout

Ongoing helplessness and frustration on the part of overwhelmed, underpaid, and disrespected physicians have led to increased rates of depression. Unfortunately, medical professionals tend to feel inadequate if they ask for help. Other factors keeping affected physicians in an endless cycle of depression, depersonalization, and guilt, are the fear of being judged harshly by peers and superiors if
they seek mental health services. Some even fear retaliation and damage to their reputation and careers
if they are found to be suffering from depression and anxiety. Unfortunately, the consequences of not
seeking help can lead to self-medication and even suicide. In fact, physicians are more than twice as
likely to fall victim to suicide than the population at large.

The Wide-Reaching Impact of Physician Burnout

The ability to care for and cure what ails our patients is a source of great personal satisfaction and joy for medical providers. However, regardless of good intentions, it has been shown repeatedly that burned out providers become less effective in their communication with their patients. When information exchange between patients and doctors is compromised, the quality of care given to patients also suffers. What is more, burnout coupled with the pressure of time constraints has been shown to jeopardize patient safety and increase unintentional errors in the delivery of care. It stands to reason that when doctors keep “a stiff upper lip” and push past their fatigue, they can ignore patients’ feelings and wishes in the process.

The adverse effects of burnout on quality medical care has been demonstrated in other countries as well

According to the Canadian Medical Journal, physician burnout decreased productivity, as more physicians call out sick, forcing remaining colleagues to treat a higher number of patients in a shorter amount of time, which led to an increase in medical errors.

Given this unsustainable scenario, one of two things happen. Either more physicians experience burnout and mental health problems, rendering them unable to provide the quality care patients deserve, or the remaining physicians choose to change jobs or careers in order to avoid burnout. Neither scenario is good for health care and will harm the overall health of our communities.

It would not be an exaggeration to say that our health care system needs help!

One way of improving health care is to start focusing on the wellbeing of healthcare providers. For example, if multiple surveys have shown that bureaucratic tasks take time away from the physician’s ability to focus on quality health care, shouldn’t administrators be held to task with regard to simplifying said tasks? Similarly, if long hours on EMR impact the time a medical provider has to interact with patients, shouldn’t we enable EMR to be user friendly and intuitive? In short, when we make physician health and wellbeing a priority, solutions can and will emerge.

Until positive changes occur in the delivery of care, medical providers ought to keep a few things in mind:

1. Remember who you truly are. Who you were before you became a medical provider and where you’d be in life if you didn’t possess the knowledge and credentials you have today.
2. On your worst days, try and remember why you chose your profession and know even the worst days are only 24 hours long.
3. Remember that one of your greatest super-powers is remaining calm. Practice this elusive skill and you will immediately notice the positive impact on your patients, your team, and your wellbeing.
4. Keep in mind, that on your worst days, you still possess the power to treat an asthmatic child who is gasping for breath, you have the power to safely lower your patient’s high blood pressure and high blood sugar. You have the power to calm nerves and to treat pain. You have the power to change the trajectory of your patients’ lives.
5. Remain hopeful that many advances in medicine are headed your way which may be a game changer in how easily you can diagnose and treat a particular disease.
6. Practice self-compassion. It is perfectly OK to set aside time to try new hobbies, make exercise a priority, plan for time away from work, and even time just to be alone and rest. Start planning before experiencing any symptoms of burnout.
7. Incorporate diversity into your medical practice. Consider a salaried part time position while you scale back from private practice. Consider a sabbatical in order to branch out into non-clinical projects, such as teaching or research. Look into an interesting locum assignment either in your area or in another state or country. Locum assignments allow for a great deal of freedom and flexibility, while providing a chance to practice medicine in settings that are new to you.
8. Consider stepping down from a leadership position that no longer gives your life meaning. Conversely, step up to a leadership role.
9. Complete your CME requirements in other states and countries if feasible.

Above all, value your peace of mind and your health.

There is no one else quite as remarkable as you are.

To all health care superheroes, thank you for all that you do.

Ela Grigorian 

Check out my blog at www.thevitaminchannel.com !!

The post Burnout, a Problem Worth Solving appeared first on Medcare Staffing.

History of correctional healthcare

Correctional healthcare did not exist until 1770 and was invented in England by a wealthy philanthropic healthcare former by the name of John Howard and physician John Fothergill. Louise Rene-Villerme a physician and pioneering hygienist published a study titled Des Prisons in 1820, further overhauling the public health concerns in prisons.

According to the CDC the most common healthcare problems reported by prison inmates include:

Infectious disease

• Hepatitis
• HIV/ Aids
• MRSA
• Sexually Transmitted Diseases
• Tuberculosis

Chronic Diseases

• Arthritis
• Asthma
• Cancer
• Heart Disease

Learning disabilities and mental health

The most common impaired functioning that jail inmates report is a learning impairment such as dyslexia or attention deficit disorder. Many inmates also report having been enrolled in special education classes during their youth. Approximately 8 percent of inmates state they suffered from mental health condition that kept them from fully participating in school, work, or other activities.

Pregnancy in incarcerated women

Approximately 3 to 5 percent of incarcerated women are reported to be pregnant when they go into a correctional system. Pregnancies of incarcerated women are usually high risk due to poor nutrition, limited accesses to prenatal care, domestic violence, mental illness, drug and alcohol addiction.

Transgender healthcare

During incarceration, transgender people may face a multitude of problems that may endanger their health and wellbeing. Correctional healthcare professionals must pay special attention to evaluation, screening, referral, and management of mental healthcare needs. Particular attention must be given to hormonal treatments for gender dysphoria and should follow accepted guidelines developed by professionals with specialized in transgender health.

Special attention must be paid to transgender youth who enter into the corrections system. Mental health professionals experienced in working with transgender adolescents  must review the youths current clinical stability, mental health functioning , and possible need for added mental health therapy and intervention.

Overall decreased life expectancy

For every year a person spends in the correctional system, 2 years is taken off of their lives.  With 1.8 million people locked up, mass incarceration has lowered the life expectancy of a significant portion of the human population in the United States.

Healthcare staff within the correctional system:

Physicians: a physicians role in corrections is primary care that can reach highly intensive levels. Physicians medical practice roles include internal medicine, preventative care, urgent care, emergency care, routine patient care, basic orthopedics, dermatology, minor office procedures, chronic care and end of life care. Some patient may need to be transported off site for tests, medical procedures and consultations.

According to the American College of Correctional Physicians, a physician working in corrections must be aware of and balance interests of; good solid medical practice, medical supervision, implementation of process, medical board rules, the safety and security of the facility, the individuals in the facility, and the community. A few examples of medical-custody coordination are:

• Timely access to medical
• Timely treatments and
• Medical training and supervision

Nurse Practitioners: can provide care to adolescent patients to geriatric patients within the correctional healthcare system. Nurse practitioners practice within their scope and can perform physical exams, health screenings, medication management, sick calls and pregnancy and post-partum care. Correctional NP’s are positive advocates for patients and provide education to correctional administrators, judges, caseworkers and correctional staff.

Nurses: provide direct patient care to inmates in jails and prisons. Nurses treat patients in the correctional system for a variety of ailments including emergency medical conditions, acute illness, as well as chronic medical conditions.

Correctional healthcare staff may also be involved in hunger strikes, isolation, sexual abuse, transgender, elderly release pleas, compassionate release pleas and long term involuntary psychotropic medications. All incarcerated people within the correctional system must be treated with fairness and receive comprehensive healthcare. It is the responsibility of correctional healthcare team to advocate for the healthcare needs of these individuals.

Curious about a career in Corrections Health? Try out a Locum Tenens assignment with Medcare Staffing

Medcare staffing has a variety of locum tenen assignments in corrections for physicians, nurse practitioners and nurses in a variety of different states. Click here to find out more information and speak to a recruiter today.

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You Get To Choose When and Where

With the demand for locums skyrocketing, the control is yours. Assignments vary from a few shifts a week, to a few a month with short and long term assignment as well. With MedCare Staffing, we will partner with you while doing our best to find the perfect match.

It’s A Great Way To Make Extra Income

Are you a new graduate with student debt? According to an article posted in December 2018, the class of 2018 medical school students graduated with $196,520 in student loans. Also, according to the Association of American Medical Colleges, seventy-five percent of medical school students in the class of 2018 graduated with student debt. Consider picking up locum tenens assignments and begin chipping away at this financial debt.

Unexpected Benefits of Locum Tenens

Working locum tenens can add to your repertoire of skills and experiences. When a medical provider travels outside of the network that they work in, they suddenly become exposed to various methods of doing things and unique nuances of different practices. And not to mention the cultural differences if one travels a long distance for locum tenens work.

As you can see, there are a few reasons to consider locums even with a full-time position. MedCare Staffing would love the opportunity to share more so feel free to contact us us at 888-474-3380 and let’s begin the conversation!

Who are we? MedCare Staffing is a small, Veteran-owned, family-oriented team; we start every day with gratitude because we LOVE what we do! We are a team on a mission to make a positive difference in the lives of our clients and providers.
What we do. We place Physicians & Advanced Practitioners in Locum Tenens, Contract Positions and Permanent Jobs.

The post Locum Tenens With A Full-Time Job. Can It Work? appeared first on Medcare Staffing.

As a result of physician burnout, physicians who suffer are more disposed to errors, provide less quality of care and receive lower patient satisfaction. This can also lead to higher rates of depression, alcoholism and even suicide.

What Is Burnout?

Physician burnout has been defined as long-term, unresolvable job stress that leads to exhaustion and feeling overwhelmed, cynical, detached from the job, and lacking a sense of personal accomplishment. Does this sound like you? This begins when you are not able to recharge your batteries between call nights or days in the office.

Things You Can Do To Prevent This In Your Medical Career

• Consider starting your day with some quiet time, meditation or reading.
• Take a daily “thank you walk”. According to Jon Gordon “You can’t be stressed and thankful at the same time.”
• Remember to exercise, eat right and get plenty of sleep. You know practice what you preach.
• Take a break from technology. Turn off your smartphone! Don’t open your email and get out of the office for a quick break if you can!
• Consider journaling!
• Try to rediscover the joy of practicing medicine.
• Find a way to recharge!

How Locums Can Help!

Taking on a locums assignment can remove some of the stressors practicing medicine. Looking for a change of scenery? Locums will give you that. Want to travel and see the country? It can give you that as well. Some physicians have said doing locums work feels like a working vacation.

Why Us?

Because we LOVE what we do! As a small, Veteran-owned, family-oriented team, we start every day with gratitude and would love to share this with you! We are a team on a mission to make a positive difference in the lives of our clients and providers.

Please contact us today!

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