Burnout By Specialty: Family Medicine

Burnout in the medical field is a hot topic, especially in family medicine. Why do family medicine doctors face such high rates of burnout compared to other specialties? In this episode, we’ll dive into insights shared by experts Dr. Cynthia Chen-Joya, Dr. Alexandra Stockwell, and Dr. Santina Wheat, who discuss the emotional toll of the profession and how to find sustainable practices in an ever-evolving healthcare landscape.

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Participants:

https://doctorsonsocialmedia.com/santina-wheat-md-mph/

https://doctorsonsocialmedia.com/cynthia-chen-joea-do-mph-faafp-dabom/

https://doctorsonsocialmedia.com/alexandra-stockwell-md/

Takeaways:

• Burnout in family medicine is a complex issue influenced by emotional exhaustion, administrative burdens, and loss of autonomy.
• Strong patient relationships and integrating coaching skills can enhance job satisfaction.
• To retain family medicine physicians, it's essential to support work-life balance and foster open communication in the workplace.

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Transcript

Mary Remón: Welcome to Burnout by Specialty. This is the family medicine episode hosted by Doctors on Social Media. And my name is Mary Remón. I am a licensed counselor and a coach for physicians. And today I'm very grateful to introduce the physicians who have joined us. We have Dr. Cynthia Chen-Joea, Dr. Alexandra Stockwell, and Dr. Santina Wheat. Thank you so much for joining and I'd like to ask each of you for a 30 minute introduction, just say your name, your role and your practice setting.

Santina Wheat: Hi there, I am Dr. Santina or Tina Wheat. I am a family medicine program director for the Northwestern McGough Family Medicine Residency Program at Delmar Hospital. I've been a program director for a while. I'm also the vice chair of health equity for the Northwestern Feinberg School of Medicine's Department of Family and Community Medicine and also love helping other people figure out how to find sustainability for themselves.

Mary Remón: Thank you, Dr. Stockwell.

Alexandra Stockwell: I'm Alexandra Stockwell. I see I graduated from medical school in 1998 and I transitioned out of clinical medicine in 2006. I had a small family practice at that time and when I transitioned away, I'd never heard of burnout. Like I actually felt a lot of shame transitioning and looking away from clinical practice.

Now, of course, it's so common. Since 2013, I have been a relationship and intimacy coach. I work with high performing couples on how to improve communication and heat up their intimate lives.

Mary Remón: Thank you for joining. And finally, last but not least, we have Dr. Chen-Joea.

Cynthia Chen-Joea: I am Cynthia Chen-Joea. I'm a physician, career and life coach. And I work with doctors on navigating burnout, career transitions. Ultimately, the goal is always finding long-term sustainability within medicine. And I do this through one-on-one coaching, in-person workshops and retreats. I'm also double board certified in family and obesity medicine. And I practice in Southern California, both on the inpatient and outpatient side.

I'm the inpatient director of a family medicine residency program and I'm a medical director of a private practice, one of the few that still accepts Medi-Cal in this area. And this work is just incredibly deeply personal to me. So thank you so much. I'm so grateful to be part of this conversation.

Mary Remón: Thank you all very, very much. There's so much talk, you're right, about burnout these days in medicine. There was actually recently an article in Forbes Magazine by Dr. Eve Cunningham, and it talks about the six reasons doctors are burning out and how that threatens patients' healthcare. But we want to dive in even deeper. And so what I did is I looked up the top six specialties where we're seeing the most burnout.

And family medicine was one of them. Really would love to hear your inside perspectives and just help the listeners understand what burnout looks like in family medicine and what about family medicine makes burnout look different from other specialties.

Cynthia Chen-Joea: I mean, I think it's just important to talk about, and I don't know that this is unique to family medicine, but the emotional exhaustion within a system that has evolved that I think just no longer supports what family medicine as a true specialty is all about. We're trained to be relational and to be comprehensivist and to provide that continuity of care for our patients across the spectrum.

We're supposed to do that now, the way that healthcare has evolved thoroughly with speed and at increasing volume with additional administrative tasks, right? I think sometimes it almost feels like, you know, it's almost like I feel we're the dumping ground, like all of the forms get pushed to us. And it's true, we still care incredibly deeply about our patients.

But it's really hard to be able to provide the care in the way that we want to and in the way that the patients deserve. And I don't know what that will look like in the next five to 10 years without family physicians really looking at defining boundaries and putting up ways in how we can provide patients our care while preserving our own wellbeing because family doctors are leaving medicine at a faster rate than ever before. And it's just scary to see what healthcare is gonna look like.

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Mary Remón: Thank you for sharing that. Why do you all think that family medicine doctors are leaving at a higher rate than in other specialties right now?

Santina Wheat: I think that family physicians have been greatly impacted by many of the changes in healthcare in ways that some of our other colleagues haven't. I think that more family physicians were the solo doc that was taking care of an entire family for a long time. And we have seen this huge shift where now more physicians are employed than are on their own and have autonomy and don't have that autonomy that they would have had when they had their own practice. So we're in this time in healthcare where we've really lost the autonomy.

And there's this thing about all of us who go into family medicine is that we're really wanting to be able to create our own journey. Most of us come into it because we don't wanna do the same thing every day. At least that's my experience when I talk to residents who are interviewing and excited to go into the specialty.

And then more and more so some of the things that we're excited about are being closed down, whether it's that a hospital doesn't want a family physician to have those privileges or they don't think that they should do that, that they need to send it to the specialist. And often I hear family physicians hearing, well, you're not the moneymaker for our hospital. The moneymakers are those specialists.

And so there is this additional burden that is put on us. And we love these relationships, but then we go home and there's sometimes nothing left to give when we go home is this feeling that many of us have or have had if we don't figure out a way to figure out those boundaries and figure out a way to interact in a way that we can have control over our work-life balance.

Alexandra Stockwell: I want to add having had a unique perspective, seeing my husband, we met in medical school and he was faculty at a family medicine residency program and worked in family medicine for a long time and then transitioned into pain management. And in that he went from being a generalist to being a specialist. And there were a lot of different things that happened in that shift.

The ones that are relevant for this conversation is that he went from 15 minute appointments as the standard of care to hour long appointments as the standard of care. And of course there is a certain complexity and I do not in any way want to diminish what it is to be a specialist in pain management, especially since the referrals that he got were of course challenging to treat that he is the backup resource for the family medicine doctors.

However, there's a way that he gets to have much more nourishing relationships with his patients now as a specialist in a way that he just was not able to, although one could argue that it's more necessary when practicing family medicine. So I think there is this fundamental way that is not so new that our compensation and time allocation and all of these different considerations are just upside down.

Like if medicine is a pyramid, we want to flip it on its head so that there is the capacity to do our best work as family medicine doctors, which usually requires having a quality of relationship with the patients that is just not possible with the way things are set up moving people through.

Mary Remón: That's an excellent point. So I'm hearing a lot of themes that we need to really just flip the whole system upside down. I'm hearing from Dr. Wheat about boundaries and how they're so important. And Dr. Chen-Joea, you also mentioned continuity of care. And that struck me. And I was just wondering with continuity of care and you have 15 minute visits, how does that affect burnout? Is that a source of stress in family medicine?

Cynthia Chen-Joea: I'll tell you for myself when I am in clinic, I am stressed from the minute I walk into my clinic to the minute I leave. It is not enough to have to have the conversation with your patient and dive into the multiple issues that they're coming in for. And a lot of my patients are, I mean, everyone's patients are highly complex.

15 minutes is just not enough. And then we're expected to fully document for that visit, create an assessment and plan, fill out forms, address inbox messages, do all of your refills. And I think there was a study that said the amount of time it takes a family physician to complete all of their tasks in one day was 26 hours. There's 24 hours in a day and we're theoretically employed for an eight or nine hour clinic day.

It is literally impossible for family physicians to complete all of the increasing amount of tasks that is now being placed on the family physician in today's healthcare system.

Mary Remón: Yes, I actually know someone who went into family medicine and lasted less than a year. Based on what you described, it was quite similar. What do you love about it? What keeps you going?

Santina Wheat: I think that all of us have mentioned the relationships. When we do actually have that time with our patients, it's amazing. There are two times that have really highlighted that for me. When I switched jobs, I was saying goodbye to patients. And there was a patient that I actually hadn't seen in a couple of years because as I became program director, I had less and less clinic time myself, but he still identified as being my patient, even though I hadn't seen him in a little bit.

And the tears that came down about how he was able to be heard for the first time in medicine, and he had a diagnosis and just felt supported by me throughout that.

Those are the things that make me excited to get up in the morning and head to clinic. And now with my practice where I'm still seeing new patients all of the time because I haven't been there as long as everyone else, it's the other side of it. It's when people sit down and say, wow, I haven't had anybody sit down and really take my symptoms seriously before or had the moment to take me seriously and I read online that you take people seriously.

I was sort of shocked when I heard that but those are the moments where you feel like, at least for me, I feel like I'm touching somebody's life. I'm really hearing them but that's why I went into medicine in the first place was to be the doctor that hears and so getting to do that makes me so excited.

Alexandra Stockwell: I also think that in the context of family medicine, there's the capacity to do patient education and genuine preventative medicine. And ideally, especially when we can see the whole family, we can see how helping mom change her nutrition impacts the grandparents ultimately and certainly the children as well. That there is a hopefulness in principle in family medicine.

Mary Remón: I love that.

Cynthia Chen-Joea: I was going to mention in addition to what everyone else has mentioned. So as a certified coach, as a certified life coach, I am also able to carry a lot of those skills into the exam room, which I think is so unique. And it has changed the way I actually practice medicine.

I mean, I think we all came into medicine wanting to help patients, right? To me, I think it is such a privilege to be allowed so quickly and so deeply into a patient's lives in just 15 minutes. And I think it has, I think I feel that I have been able to touch patients on a whole other level because of this added skill.

And so I think it goes back to just connection, the being able to offer a safe space for our patients in a world where they maybe don't feel safe or that they trust other people, but they can come to their family physician to talk about their mental health or whatever else is going on in their life. I think it is just an honor to be in that space, to be in that position.

Mary Remón: Thank you. What are your thoughts on how we can retain family medicine physicians? What needs to happen?

Alexandra Stockwell: I have my particular angle as a relationship and intimacy coach and working with a lot of single and dual physician couples, but I'm going to talk personally again about my husband because when he and I really learned to dial in and heat up and just improve our communication, which is not something we had at the beginning of our marriage, I saw that he started to come home earlier.

That as his capacity to connect and be present with me and give me the experience of being seen and heard, that translated into the clinic as well. And I remember noticing, you know, do you have fewer patients now or like what was going on?

And it's that really the capacity to have nourishing meaningful connection for the patient and for the doctor. It is a counterbalance. It's not enough to not work on limiting the paperwork and all of these hassles, but it is something that is an anti-burnout strategy.

Mary Remón: Thank you. That's a great point. Any other anti-burnout strategies?

Santina Wheat: I think that one thing that's important that none of us have said yet about family medicine is family medicine is one of the specialties that is now leading more female than male. And I think that this means that we need to talk about not just for family medicine, but what can we do to limit burnout for women physicians? And that's especially true for our specialty.

And so if we can shift systems to be better about flexibility, about being able to change as someone's season of life changes. I needed much different things when my children were toddlers than I do right now as they are tweens and teens.

And we need to also make sure that leadership is having this perspective because even though there are more women who are family physicians than there are men right now, there are more leaders who are men. And so we need to make sure that we're not losing our female physicians along the way. They need to be part of having these conversations.

And so I think that that's one thing. We just have to look at some of the gender dynamics that hit us in medicine in general that are just really hitting us in family medicine. And we have to change the payment model for our healthcare system so that we are honoring the work and the value that we bring in family medicine.

I know it's not the same as performing a surgery and that moment where you feel like you've fixed someone, but we can do all of the prevention and prevent them from having to be there. And so that currently is not supported in the same way that that high risk surgery might be.

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Cynthia Chen-Joea: Yes, hallelujah. I fully support what Dr. Wheat had to say. So the compensation model was arbitrarily decided decades ago. And I do think it can be redefined as well in terms of compensation and reimbursement rates for primary care.

A couple of other things I wanted to add that haven't been spoken about is the administrative load. So really figuring out how to relieve all of that administrative burden from the physician so that my job is just to take care of the patients.

And whether that might include AI assisted forms like AI scribing or having virtual scribes or hiring someone else to be able to concentrate on documentation, inbox messages, refilling, etcetera, I think could do wonders. That's another factor.

And then really looking at our role as primary care doctors. We fill in the gap for so many issues around the patient that are not just medical. That could be socioeconomic, it could be a million other things.

And so I think looking at the responsibility that the primary care physician takes on in that context becomes so much larger. If something happens to the patient, I can see that the family doctor could feel that they might have responsibility for whatever negative impact could have happened, right?

So I think a huge part in alleviating that emotional exhaustion is shifting into knowing and understanding that you alone are not responsible for the outcome of your patients. For me, I know at least that has made a huge impact on my emotional well-being.

Mary Remón: Thank you for adding the trauma-informed lens to the discussion, Dr. Chen-Joea. And thank you all for this inside view of what it's like to be in family medicine. If you have a take-home message for our listeners today, what would that be?

Alexandra Stockwell: I don't know, starting in high school, certainly in college, we expect to keep learning and growing and learning and growing and taking exams and learning and growing until we get to attending status. And if we're on a leadership track, maybe there's a little bit more of that. But then there's kind of the idea in the culture that then we just continue doing what we know how to do.

And I think that in the context of this conversation, the most important thing to say is that it's essential to keep growing and developing ourselves and learning. And it's just that it shifts from exams and instruction and clinical skills to life skills and leadership and contribution along the lines of what we've been talking about.

Cynthia Chen-Joea: I think my biggest message has always been that there is sustainability in medicine. I love being a family physician, but it also took me a lot of work and coaching for myself to redefine what that identity or the multiple identities that I hope look like and being and embracing all of those things.

So I think it's just really meaningful. I would say for physicians that are still practicing full time that it is possible to love what you do without sacrificing, without being a martyr.

And it is really important to have boundaries and knowing what those non negotiables are.

Because you cannot be helpful to your patients or anyone around you if you are extremely burnt out.

And so I see it as a way of if physicians are able to find happiness, fulfilling satisfying career with our boundaries with our families that we're able to provide excellent care to be fully present with our patients when we are in the exam room or in the hospital.

Santina Wheat: I want to agree with Dr. Chen-Joea. I think that sustainability is absolutely possible. I am working full time and coaching others at the same time and much less, and I'm not burned out today and was burnt out before. And so it is absolutely possible. It requires intentionality like everything else that is worthwhile.

And I think that it's easy to just simmer in the system. I think the system has a lot to change, but we have to work on ourselves as well. And so I think it's important for sustainability to be able to focus on both, to be able to focus on the intentionality of preventing burnout for yourself, and then also advocating for the system to do things that are better for all of us.

Mary Remón: Thank you. Thanks to all of you. I'm so grateful for this conversation. And it's such a unique lens that you have, and you have such limited time. And I really appreciate you taking some of your limited time to share that with our audience. So I really appreciate you being on the show. And I want to also thank Dana Corriel from Doctors on Social Media for hosting this conversation.