Oncology Unscripted With John Marshall: Episode 6: The Weight of The White Coat: Battling Burnout

THE WEIGHT OF THE WHITE COAT: BATTLING BURNOUT

How Do Middlemen Impact Our Practices? [00:00:00]

John Marshall, MD: Welcome back everybody to Oncology Unscripted. It is August and if you're lucky like I am, August is vacation time for me. I am at this beautiful place somewhere in the south, somewhere near a golf course and an ocean; a little river flowing right over there, some egrets and an occasional pelican flying by. There are fruity rum drinks, most evenings, which makes for a very pleasant time away from work. So, I'm on vacation, and I hope you guys have gotten some time away.

We're going to focus on in the second part of our series of three programs on the middlemen in our lives. The last episode, which many of you have commented on and have watched, is around pharmacy benefits managers; their role in our healthcare system and how they've inserted themselves and made a bunch of money and not necessarily adding value. 

Today, we're going to riff a little bit along the electronic medical records, certainly a middle thing in our lives that many of us are sort of frustrated by. And then our next episode will focus on clinical research organizations that I know many of you can be frustrated about, as well. 

Silent Crisis: Can You Admit You're Burned Out? [00:01:27]

But, to set up this EMR vacation setting. I think we ought to talk a little bit about the concept of burnout. Now I'm on record as having officially burned out. It was in, really, 2018, 2019. I didn't really know it. I just thought I was grumpy because I had good reason to be grumpy. But it was actually my wife and my daughter who noticed that I just wasn't my same old self. I had lost my sparkle. And I thought a lot at that time about my own personal burnout: therapy, I ended up taking a sabbatical, my wife and I wrote a book. We had to get away for a while in order to deal with that. 30 years of being an oncologist is a big deal. 

And then I started to look into this issue of burnout and realized that lots of us in our space have a lot of burnout. There's some studies that have been done and basically looks at, sort of, not only our burnout, but how are we dealing with burnout. And given that I'm on vacation, I thought it would be kind of useful to look at some of the data for us around vacation. And we don't take very much vacation. And when we do, we actually work. Like this morning, I actually have already seen four patients in tele visits. God help us. So even though I'm on vacation, I'm still working. And I bet many of you do that the same way. 

So, in this survey. 60 percent of us as physicians, we're only taking 15 days or fewer per year. That's terrible. With 20 percent of us, one in five, taking only five vacation days a year. And most of us, when we're on vacation, like me right now, 70 percent of us work every day of a typical vacation. We do something. We check email; we do something while we are on vacation. And a third of us will spend more than 30 minutes a day on work while on vacation. 

Now, looking at subspecialties, oncologists are a little bit better because 60 percent of us were taking about three to four weeks of vacation. But you get more vacation than that!

Is Relaxation Worth Sacrificing RVUs? [00:03:46]

I know as well as you know that we're disincentivized to take vacation, right? Because we are RVU-driven, and every week I'm not getting RVU's, I'm actually getting less money. So, if I take vacation, I'm actually making less money.

Now, the other thing that sort of started happening more recently is this concept of paid time off PTO, right? Didn't used to be called that. It used to be called vacation. If you're in a business where when you're on vacation, you're paid, you're supposed to call it PTO. For those of us who don't have that sort of tracking system, we call it vacation. but it still makes me feel guilty, I guess.

Are Your Patients and Staff Mad When You Go on Vacation? [00:04:32]

Now, one other perspective that I learned the hard way when I took my sabbatical is just how angry patients get when we're on vacation. Our staff also is angry at us when we're on vacation because we're not immediatel