Dr. MacDiarmid on combating the “crisis” of health care professional burnout

Scott A. MacDiarmid, MD, FRCPSC

In this interview, Scott A. MacDiarmid, MD, FRCPSC, discusses health care professional burnout, including how he came to be interested in the topic and what can be done to prevent burnout. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, NC, and the author of “Fist Pumps: The Prescription for Physician Burnout.” He is also co-leading a breakout session at the 2023 LUGPA Annual Meeting titled “Mobilizing Your Physicians and Staff from Burnout to Professional Fulfillment.”

Could you discuss your own personal interest in burnout and the motivation for your book?

It's funny; you don't know why you're driven to do certain things. It's almost like falling in love with another person; you can't put a finger on it. I'm Canadian; I did my fellowship at Duke in the early 1990s. I always say I'm a capitalist with a socialized heart. And when I was at Duke, I love being here, but medicine was more of a business relative to Canada. And especially with the educational system, I thought, they're kind of making this a commodity, and that may not work out well for the country. I've been in academics forever. I might be asked to give 5 or 6 talks at a review course on pelvic floor and incontinence. And they'd say, can I do one on health care, and I thought I'd save the world.I was trying to write a book on health care. The theme of the talk was, "When I die, you die: The fall the American health care system." We didn't use the term "burnout" then, but I remember some people, saying, "Scott, talk more about the provider part."And it was sort of my "aha" moment. That's when I switched and started writing my book. That's sort of been my mission since. I just know, whether it's this interview or that book or something else, if I can help create a world that lists up health care providers that serve this nation, count me in. That was my lofty goal. I do try to encourage people to begin the journey. What I mean by that is, the book, this interview, or whatever my voice is part of, what I'm trying to do is inspire and motivate people to begin their journey to their mountaintop of joy and fulfillment, and really equip them to say, "No, I'm not going to the valley of burnout." It's amazing. I try to encourage people; it's such a complex, difficult journey, in a sense. But if you can leave something you've heard, whether it's a song, this interview, something you read, and say, "I'm going to figure this out, I'm going to start practicing and living differently. I'm not going to do it like this for the next 30 years." That's probably one of your greatest decisions as a provider for you and your family.

Could you discuss your breakout session on burnout at this year's LUGPA meeting?

I think people have similar passions. For some people, it's prostate cancer, or maybe it's fishing. Jeff Spiers loves the topic [of physician wellness]. And so he and Scott Davis and Jonathan Henderson and I formed the physician wellness committee. And this is our launch. The agendas at these meetings are already full, but Jeff kind of snuck us in. We're bringing in Paul DeChant, an expert, and we're really just introducing in some breakouts to LUGPA that we want to get going on this, that we're going take it seriously. And I think we're trying to come up with tools and solutions and survival tactics. The LUGPA groups flourish by figuring things out as a whole group, or an individual group does something and shares it with everyone. We're trying to do that with burnout and do that with, what can you do as a group to have provider wellness, and then disseminate that. So this is really the announcement and then a sharing of ideas.

We're getting started. You need people. And that's nurses, administrators, physicians, that this is their thing; they want to come up with ideas. We need experts like Paul, maybe chief medical officers, CEOs of health care systems. Since I wrote my book, there's a lot of people that are really passionate about this topic. And they're not health care providers. But there are huge symposiums and things that they're setting up on this topic. We need people, we need experts, then we need tools, whether they're podcasts, books, CMEs. We need lectures, we need wellness booths. There are so many things that you can do to disseminate the messaging. There's no question you need partners, and I mentioned some. I think a perfect fit is the makers of drugs and equipment. If we can convince someone like that to help us disseminate [this], because let's face it, a lot of education in our country that's medical education, you need a sponsor. This meeting is not free. Right now, we really need a voice and to have Urology Times interested in this, don't underestimate how wonderful that is for us, because you really do need to get the word out, and be our voice.

Could you discuss the problem of health care professional burnout and its effects on urology practices?

If you think about it, costs are soaring out of control. Without getting in the weeds of it, I believe quality is going down as we've commoditized health care. And the providers—the nurses and the physicians and extenders—are checking out and burning out, which is affecting quality and delivery, etc. To me, it's a national health care crisis. If you look at the numbers, it's half a million physicians, 40,000 medical students, 60,000 residents, a third of our 3 or 4 million nurses. The prevalence has really led to the current nurse crisis, in my opinion. I was asked to speak at the AUA to the all the chairmen and program directors just before the AUA this last year. And it was on the critical shortage of urologists. The name of the talk was, "Houston, we have a numbers problem." We have about 10,000 or less urologists. The median age is about 55. Almost 30% are over 65. Now, that's not good. We're only graduating 300 a year, and currently small towns don't get urologists in general; everybody wants to go to the bigger cities. It's very difficult to recruit to a group, because it's so competitive. And then we've got the over-60 group that are really just hanging in there, that are, just based on the grind of call and burnout, etc, they're just sort of trying to get to the finish line. And so what happens is, the emotional burnout part is significantly impacting the functionality of the current number, which is not good, but sending this trajectory even more rapidly in the wrong direction. We're trying to survive as a small business. We serve our community, but we need emotional health as part of that. Yes, it's important to make decisions that improve or maintain the bottom line. But putting your provider wellness first or, in every decision you make, how is that impacting your own provider health as well as your nurses and your administrators? Because if you don't have that, it's not working out well. You can ask that to the hospitals now; they don't have enough nurses. And burnout really has impacted that. We need to be healthy.