Latest / Becker’s Healthcare Podcast / Treating a Broken System: Fixing Physician Burnout and Healthcare Access with Dr. Neil J. Farber

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Treating a Broken System: Fixing Physician Burnout and Healthcare Access with Dr. Neil J. Farber · Becker’s Healthcare Podcast

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  - The strategic agenda facing hospital and health system
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  - So join us November second through the fifth
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  - at the Hyatt Regency in Chicago and come
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  - Register on our events page at beckershospitalreview.com
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  - This is Scott Becker with the Beckers Health
• 1:00
  - Care Podcast.
• 1:01
  - We're thrilled today to be joined by a
• 1:03
  - brilliant leader, doctor Neil Farber. I'm gonna ask
• 1:06
  - doctor Farber to talk to us first about
• 1:08
  - himself and his career and what he leads
• 1:10
  - today,
• 1:11
  - and then what trends he's watching and a
• 1:13
  - lot more. Doctor Farber, we're so thrilled that
• 1:16
  - you're with us. Can you take a moment
• 1:17
  - and introduce yourself to the audience and and
• 1:19
  - tell us about yourself?
• 1:20
  - Sure. Be glad to. I'm a retired
• 1:24
  - professor of medicine,
• 1:26
  - in general internal medicine. I retired seven years
• 1:29
  - ago, and I had a forty year career
• 1:31
  - in general internal academic general internal medicine. So
• 1:35
  - seeing patients,
• 1:37
  - doing research mostly about
• 1:40
  - how patients and physicians interact with each other
• 1:43
  - and then also
• 1:44
  - teaching along with the patient care and research.
• 1:49
  - I live
• 1:50
  - on the West Coast in San Diego.
• 1:53
  - I've had many hobbies.
• 1:57
  - Right now, I have hobbies replicating to space.
• 1:59
  - I'm a docent
• 2:01
  - at the San Diego and Space Museum and
• 2:04
  - a NASA solar system ambassador.
• 2:06
  - Those have happened ever since I retired.
• 2:10
  - And I just recently
• 2:12
  - wrote a book which is coming out in
• 2:14
  - October
• 2:15
  - about the health care crisis that we can
• 2:17
  - talk more about.
• 2:19
  - Tell us about the book and the themes
• 2:21
  - in the book. Give us some of your
• 2:23
  - thoughts on the health care crisis. Maybe help
• 2:25
  - divide it for us and tell us, what
• 2:27
  - you're seeing
• 2:28
  - and and what can we do about it?
• 2:30
  - That's a really good question.
• 2:32
  - You know, when I
• 2:34
  - as I went along in my career, at
• 2:36
  - the beginning of my career,
• 2:38
  - we had lots and lots of time with
• 2:40
  - patients.
• 2:41
  - Usually, it was twenty minutes or thirty minutes
• 2:43
  - for a follow-up patient and
• 2:45
  - anywhere from forty minutes to an hour with
• 2:47
  - new patients.
• 2:49
  - And and that amount of time was totally
• 2:51
  - devoted to the patient,
• 2:53
  - but there were changes that occurred in medicine.
• 2:56
  - For example, the electronic
• 2:59
  - health record
• 3:00
  - and then patient portals.
• 3:02
  - And and those were all designed to improve
• 3:06
  - health care for the patient as well as
• 3:08
  - to
• 3:09
  - improve the physician's
• 3:11
  - sort of office life.
• 3:14
  - And
• 3:14
  - initially they did, but then
• 3:17
  - there became
• 3:18
  - sort of insurance
• 3:20
  - got a hold of it
• 3:21
  - and decided that this would be a good
• 3:23
  - way of doing
• 3:24
  - preventative health care so they wouldn't have to
• 3:27
  - give out money for
• 3:29
  - patients who were ill.
• 3:31
  - And so more and more, there were things
• 3:34
  - that had to be checked
• 3:35
  - on the electronic health record
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  - on a daily basis anytime the patient came
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  - in.
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  - And then
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  - it came so that by the time I
• 3:44
  - retired,
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  - out of a twenty minute visit that I
• 3:47
  - had with the patient, over half of it
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  - was spent
• 3:51
  - with the nurse checking off things that needed
• 3:53
  - to be checked. So it left me with
• 3:55
  - only ten minutes
• 3:57
  - to have with the patient and I I
• 3:59
  - saw this occurring
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  - when I saw this occurring and, you know,
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  - it disturbed me and
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  - then I
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  - realized
• 4:07
  - when I became a patient
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  - myself
• 4:10
  - two years ago,
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  - that that basically I, as a retired professor
• 4:15
  - of medicine,
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  - couldn't get appointments that I needed, and I
• 4:18
  - realized if I couldn't,
• 4:21
  - what are the average patient?
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  - What's the average patient doing in terms of
• 4:25
  - trying to get appointments?
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  - And so I started doing some research and
• 4:30
  - realized that
• 4:32
  - this is
• 4:33
  - a phenomenon that's occurring across the entire country.
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  - The other thing I noticed is
• 4:40
  - that communication with patients has gone through
• 4:43
  - sort of different phases. Initially,
• 4:46
  - when I was in medical school,
• 4:49
  - we were,
• 4:51
  - given
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  - one
• 4:53
  - one hour
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  - of
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  - communication skills. And and and the communication skills
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  - were just to,
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  - here's the questions you need to ask of
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  - patients. Go go ask them. That's it.
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  - That changed
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  - as I went along because the fact that
• 5:11
  - I I had an interest in really,
• 5:14
  - communicating with patients and found a group that
• 5:17
  - that also
• 5:19
  - were interested.
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  - And
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  - the
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  - licensing
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  - commissions, the ACGME,
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  - the
• 5:28
  - graduate medicals
• 5:29
  - graduate education licensing,
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  - as well as the LCME,
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  - the medical school licensing,
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  - realized that basically communication skills were really important
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  - and so made it a mandate
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  - that
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  - students and residents be taught these skills.
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  - And so
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  - the the environment shifted
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  - so that most new physicians were learning how
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  - to actually
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  - communicate with patients.
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  - But then
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  - what happened towards the end of my career
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  - is physicians didn't have that kind of time
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  - to be able to do that.
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  - And and this is sort of the crisis.
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  - The crisis has occurred
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  - because physicians being under those kinds of pressures
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  - are either reducing their hours
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  - or going into concierge medicine where instead of
• 6:23
  - a panel of
• 6:24
  - 2,000 to 3,000 patients, they have a panel
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  - of 400 to 600 patients
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  - who are completely leaving medicine altogether.
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  - And this isn't only for physicians, it's for
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  - all health practitioners
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  - of any kind.
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  - Thank you. And this is something I mean,
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  - not not with any communication skills are part
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  - of it, but isn't so much of it
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  - just sheer supply and demand.
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  - We're now for example, I I watch an
• 6:50
  - oncology closely,
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  - 27,000
• 6:53
  - oncologists,
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  - two million new cancer diagnosis a year
• 6:57
  - isn't so much the problem, just a core
• 6:59
  - supply and demand
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  - problem. And and what you said is exactly
• 7:03
  - right. When the connected people find it harder
• 7:05
  - to get the access to where they need
• 7:07
  - to get to, then imagine how bad it
• 7:09
  - is for the rest of the 95% of
• 7:11
  - the world. You know, you're you're talking about
• 7:13
  - a long term physician, lots of relationships, lots
• 7:15
  - of connections, and even you have trouble finding
• 7:17
  - the right access when you do.
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  - And so imagine what that means for the
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  - rest of everybody exactly you said. So is
• 7:22
  - so much the supply and demand or could
• 7:24
  - it be fixed in other ways?
• 7:26
  - It it is supply and demand, but the
• 7:28
  - supply is decreasing.
• 7:31
  - And the supply is decreasing because physicians are
• 7:33
  - becoming burned out.
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  - And so they're finding ways to cope,
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  - which is to either decrease the number of
• 7:40
  - patients they're seeing or leaving medicine altogether.
• 7:45
  - So so that's part of the problem. And
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  - you're right, there is there is a demand
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  - increase
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  - in terms of
• 7:52
  - patients having more access to health care,
• 7:55
  - the average population getting older and having more
• 7:58
  - health problems, etc.
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  - So at a time when we need more
• 8:03
  - physicians and more physicians to step up and
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  - see more patients,
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  - Instead, they are leaving medicine or decreasing the
• 8:10
  - number of patients they're seeing.
• 8:12
  - Right. I mean, there's there's stats on something
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  - like twenty five percent of physicians are working
• 8:17
  - part time
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  - and also that we're in a situation where
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  - a huge majority of the doctors are 55
• 8:23
  - and older,
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  - and we're having 25,000
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  - doctors retire a year or 10 or 15,000
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  - retire a year.
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  - We only have 30,000 or so starting med
• 8:32
  - school and DO school a year. Those numbers
• 8:34
  - are really, really challenging from supply and demand
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  - perspective.
• 8:38
  - So, absolutely, trying to fix burnout and the
• 8:40
  - direction of people leaving the field
• 8:42
  - is so critical,
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  - but it strikes me that it's really a
• 8:46
  - losing battle
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  - unless we fix the capacity issue somehow or
• 8:50
  - another
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  - because, you know, I've we've always said, like,
• 8:54
  - in law firms, for example, or other businesses,
• 8:57
  - you could do all the things you want,
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  - but if you don't have enough capacity to
• 9:00
  - give you some freedom and some time
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  - to refresh themselves and to not burn out,
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  - there's only so much you could do, you
• 9:07
  - know, without capacity.
• 9:09
  - So is there anyone who fixes the supply
• 9:10
  - problem, or is that just so tied up
• 9:12
  - in the amount of residency spots and the
• 9:14
  - professional associations trying not to have more residents?
• 9:17
  - How how do we solve some of this?
• 9:20
  - That's a good question. And and, obviously, we
• 9:23
  - need more medical schools and more residency spots.
• 9:27
  - But the other thing
• 9:29
  - the other ways we can solve it is
• 9:31
  - by, for example, having
• 9:33
  - assistant
• 9:34
  - practitioners,
• 9:36
  - nurse practitioners,
• 9:37
  - physician assistants,
• 9:39
  - those kinds of things step up and and
• 9:41
  - be involved
• 9:42
  - and so one physician could have two or
• 9:45
  - three nurse practitioners, for example,
• 9:48
  - which would which would also help the supply
• 9:51
  - and demand issue. And then the physician only
• 9:53
  - would step in when somebody was more complex
• 9:57
  - or or needed more help.
• 10:00
  - A 100% and certainly see more or more
• 10:02
  - of that
• 10:03
  - where you've got I mean, 200,000 nurses are
• 10:06
  - graduating a year versus only 30,000 doctors or
• 10:08
  - so. And so just by demographics,
• 10:11
  - we're seeing a movement towards that model. And
• 10:13
  - if we don't
• 10:14
  - and we'd have to accelerate the option of
• 10:16
  - that model
• 10:18
  - to both avoid doctor burnout and to not
• 10:20
  - be so out of whack in supply and
• 10:22
  - demand.
• 10:23
  - It it does still seem for complicated diagnosis
• 10:25
  - is that
• 10:27
  - I don't see
• 10:28
  - easy solutions.
• 10:29
  - I almost view it as trust but verify,
• 10:32
  - doctor
• 10:33
  - Barber, that we
• 10:35
  - have more technology, more AI, more PAs, more
• 10:38
  - nurses,
• 10:39
  - but we also ought to verify
• 10:41
  - by trying to create
• 10:42
  - and educate more specialists
• 10:44
  - in a time frame that's quicker than we've
• 10:46
  - traditionally done. Certainly, in other countries, they do
• 10:48
  - it quicker than we do. It it it
• 10:50
  - just seems like there's a lot of ways
• 10:51
  - to try and staunch the bleeding,
• 10:53
  - but to really have impact,
• 10:56
  - we gotta do something on the spot on
• 10:57
  - the inside or we're gonna just change our
• 10:58
  - health care's delivered.
• 11:00
  - Yeah. I I I agree with that. But
• 11:02
  - the other thing is,
• 11:04
  - I I think there are ways of you
• 11:06
  - know, the part of the problem though is
• 11:09
  - if you look at it, it's not only
• 11:11
  - physicians who are burned out, it's nurse practitioners
• 11:14
  - and physician assistants and regular nurses who are
• 11:17
  - also burned out and
• 11:20
  - there's an increasing workload for everybody
• 11:23
  - and and that is
• 11:25
  - not only because
• 11:27
  - of people getting older and sicker in some
• 11:29
  - ways
• 11:30
  - but also
• 11:31
  - because of some of the things that are
• 11:33
  - required
• 11:34
  - for
• 11:36
  - institutions to make more money from insurance
• 11:39
  - and some of the aspects
• 11:41
  - that are inherent within the electronic health record.
• 11:45
  - But there are ways of dealing with that
• 11:48
  - and part of the problem I've seen
• 11:51
  - is that there's an increasing
• 11:54
  - incidence of
• 11:56
  - physicians joining unions
• 11:58
  - to try and make demands on institutions and
• 12:02
  - that is
• 12:04
  - not really gonna be very helpful. If you
• 12:06
  - have an adversarial
• 12:08
  - type of solution to this problem,
• 12:10
  - there's gonna be bitterness, untrust, and and more
• 12:14
  - physicians leaving the practice of medicine and that's
• 12:18
  - counterproductive,
• 12:19
  - basically, I think in the long run.
• 12:22
  - A 100%. And take a moment and tell
• 12:24
  - us about the title of the book
• 12:27
  - and when the book's coming out and where
• 12:29
  - people could find the book.
• 12:30
  - Right.
• 12:31
  - The the title of the book is Treating
• 12:33
  - a
• 12:35
  - A Physician's Cure for the Healthcare Crisis.
• 12:38
  - It's, published by Boyle and Dalton.
• 12:42
  - It's coming out October 5, I think, beginning
• 12:45
  - of October.
• 12:47
  - And it'll be available on Amazon,
• 12:50
  - Barnes and Noble, anywhere you have
• 12:53
  - books being sold.
• 12:55
  - Thank you so much. Doctor Farber, congratulations.
• 12:58
  - What an amazing career. Thank you for writing
• 13:01
  - the book. Looking forward to seeing it and
• 13:02
  - reading it. Thank you so much for joining
• 13:04
  - us today on the Becker's Health Care Podcast.
• 13:06
  - Just fantastic. Thank you so much. You're welcome.