Dr. MacDiarmid on the effects of physician burnout

In this video, Scott A. MacDiarmid, MD, FRCPSC, discusses the effects of burnout on physicians and practices. MacDiarmid is a urologist with Alliance Urology Specialists in Greensboro, NC, and the author of “Fist Pumps: The Prescription for Physician Burnout.” He also co-led a breakout session at the 2023 LUGPA Annual Meeting in Orlando, Florida titled “Mobilizing Your Physicians and Staff from Burnout to Professional Fulfillment.”

Video Transcript:

If you think about it, costs are soaring out of control. That's to the individual’s copay. The cost to the health care system and to Medicare, to small businesses like a LUGPA group trying to provide insurance for their staff. Costs are just going out of control. Without getting in the weeds of it, I believe quality is going down as we've commoditized health care. The providers–the nurses and the physicians and the extenders–are checking out and burning out, which is affecting quality and delivery. To me, it's a national health care crisis. If you look at the numbers, I'm stealing some of these from other folks–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 led to the current nurse crisis, in my opinion. I try to engage [my] audience [to think]–it may not be your passion; you may agree with it–but “I better do something about this”. I try to find something that will tweak their interest or get [them] to do something to engage them.

I was asked to speak at the AUA to the all the chairman and program directors just before the AUA this last year. It was on the critical shortage of urologists. They said, you can put burnout into that, how would you fit that into it. The name of the talk was, "Houston, we have a numbers problem." In fact, I'll show that slide on Saturday. We have about 10,000 or less urologists. The median age is about 55. Wow. This is AUA numbers. I keep going, "really?" Almost 30% are over 65. Now, that's not good. There's a lot over 60, and we're only graduating 300 a year. And currently, small towns don't get urologists in general. They're all going location, location, location–everybody wants to go to the bigger cities. But it's very difficult to recruit to a group, because it's so competitive.

Then the health care systems, as Evan [Goldfischer, MD] said, 65% are in health care, they're owned by health care systems that are employed by. So, it's hard to get people coming in. We've got the over 60 group that are really just hanging in there based on the grind of call and burnout. They're just trying to get to the finish line. What happens is the emotional burnout part is significantly impacting the functionality of the current number, which is not good, I just showed you, but sending this trajectory even more rapidly in the wrong direction. We're trying to survive as a small business and serve our community, but we need emotional health as part of that. What I try to direct my group­–I was the next man up, they say "you're the next president," so that's why I'm here today–is, yes, it's important to make decisions that improve or maintain the bottom line, but in every decision you make, how does that impact 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.

This transcription has been edited for clarity.