A 2017 report by the American College of Obstetricians and Gynecologists (ACOG) states, "The pace of life and its stresses, impact from multitasking, overwhelming information exposure, and electronic medical record expectations have led to some degree of physical or emotional exhaustion or lack of motivation. Physicians have burnout rates that are twice the rate of other working adults, and no area of medicine is immune." It goes on to say, it's "estimated that 40–75 percent of Ob-Gyns experience some form of professional burnout (e.g., losing control, conflicting demands on time, or diminishing sense of worth)." That number is astronomical.
Karen Kaufman, MD, a board-certified obstetrician-gynecologist who runs her own private practice in Louisville, Colorado, says, "It's a recipe for burnout when there is no balance in one's life. It's fueled with exhaustion, stress, and liability issues on a daily basis." Kaufman faced major burnout herself when she was nearing the end of her own pregnancy but still delivering babies every fourth night, up all night long.
Problems with Patient Load
The lack of sleep and physical exhaustion aren't the only contributors. The problem is also with the sheer amount of patients that need to be seen daily.
Kaufman believes that over the past several years medicine has "become less about health and more about the business of seeing too many patients in too short amount of time to make a positive impact."
When patient loads exceed what is ideal for patient care, a domino effect occurs. If insurance companies are giving smaller reimbursements, then doctors opt to pack in more patients to fill the gap in lost income, which results in establishing what can feel like an assembly line of patients to doctors, day in and day out.
Another increased stressor is malpractice litigation.
"There is so much stress on the shoulders of the physician to deliver a perfect baby and very sadly, it just isn't always the case," Kaufman says. "Doctors are always thinking about it, even if subconsciously, and their decisions can be influenced by the threat of being sued."
While she doesn't think some patient issues can be solved in the blink of an eye, she says, "As chronic health problems become more prevalent in this country, doctors, I think, are feeling less empowered to actually help, and helping is why they went into medicine in the first place. So as the demands of stress, liability, seeing more patients in less time, and standardizing care to a one-size-fits-all approach, it can leave a physician feeling uninspired, tired, and somewhat ineffective." All of this creates less joy and increased pressure in the workplace.
To break free, Kaufman exited the standard insurance payment model when she branched out of a shared practice to form her own. Scheduling 45-minute appointments allows her to focus on prevention, longevity, and optimal health outcomes "with or without the use of prescriptions." This extra time helps her unfold patients' lifestyle issues that might impact health concerns as well.
Ellen Hartenbach, MD, who is the vice-chair of the Department of Obstetrics and Gynecology at the University of Wisconsin Medical School, and the former Obstetrics and Gynecology Residency Program Director, has also faced burnout along with many of her colleagues. "Patient volume can be an issue if a particular medical practice does not have enough ob-gyns," she says. "This is a problem in some underserved areas and will be an increasing problem since the workforce projections predict a shortage in the future."
This is not a field that can be swapped out with general practitioners. Ob-gyns are experts in women's reproductive health with vast knowledge for when a complex situation presents itself.
A Shortage on the Horizon
Doximity, a social networking site for health care providers, released a study in 2018 identifying ten metropolitan areas at risk for an ob-gyn shortage. It surveyed 30,000 ob-gyns nationwide, factoring in age and workload, and found five cities most "at risk": Las Vegas; Los Angeles and Riverside, California; and Miami and Orlando, Florida. Even though the population in those cities has grown, the number of ob-gyn residencies has remained stagnant over the past two decades. This statistic may affect rural women the most. ACOG found that more than 50 percent of them had to drive more than 30 minutes to reach a specialist.
Hartenbach, along with University of Wisconsin Medical School, started one of the nation's first ob-gyn rural residencies a couple years ago, with the hopes to help retain doctors in rural Wisconsin. According to the Association of American Medical Colleges, 47.2 percent of doctors stay in the place where they completed their residency.
"Physicians are about ten percent more likely to suffer from burnout than other U.S. workers," explains Hartenbach. "Over half of ob-gyn physicians experience burnout and it is one of the top ten medical fields with high burnout rates." Although there is not an easy fix, she says many national, regional, and local organizations are putting effort into working on the problem.
Remedying the Situation
To reduce stress, Hartenbach suggests decreasing work hours and focusing on outside activities. Allowing time to rest and renew is important to her. The American Medical Association, in response to physicians' needs, developed the STEPS Forward interactive practice, loaded with development strategies to empower teams to identify and attain appropriate goals and tactics suitable to a practice's specific needs and environments.
Kaufman reminds other physicians to take time for themselves and to make boundaries with patients. "They can be high-needs with lots of calls/emails, but as a physician in the 'giving' field, you can forget to fuel yourself with what you need, as well as exercising, eating right, sleeping well, stress reduction techniques of yoga, meditation, deep breathing, and finding an employer or group to work for that has similar values and understands the importance of time away from work."
Article Originally Published on ACOG Career Connection