Doctors occupy a profession that is well-compensated, personally rewarding, and extremely meaningful to society. Why, then, is there a growing shortage of them around the world, leading to an increase of cases of physician burnout?
This question has been on the mind of healthcare leaders for over a decade, but it’s once again rising to the surface of mainstream discussion because of COVID-19, the quickly spreading coronavirus. In China, the dual challenges of coronavirus and doctor shortage have already merged, causing patients with other health issues — including very serious ones — to be literally turned away by hospitals for lack of care.
It’s not just a problem in China, though, and it’s certainly not just a problem in the context of coronavirus.
The Association of American Medical Colleges estimates that it would take an additional 95,900 doctors to optimize the availability of healthcare in the U.S. right now. In June of 2019, it was reported that there were over 11,500 vacant positions for doctors across England.
And while statistics show that the overall number of doctors in Europe has grown since 2010, they are distributed in extremely unequal fashion, with Greece, Germany, and Spain among the those with the highest number of physicians per capita, and England, Poland, and France having some of the lowest.
This has been a growing concern for quite some time. As far back as 2012, the European Commission created an “Action Plan for the EU Health Workforce,” and in it, estimated that the continent as a whole could be short of nearly a quarter-million doctors by 2020, a prediction of uncomfortable accuracy.
But why is physician burnout such a problem?
In order to answer that, you have to consider the backdrop to all of this: the real and growing crisis of physician burnout. From China to Estonia , everywhere that there’s a physician shortage (which is, well, pretty much everywhere), there is also a shocking amount of doctors with burnout.
Is it the long hours? Is it because of the time they’re forced to spend in front of computers instead of with patients? Or, in a catch-22 scenario, is it because a shortage of peers has them managing a too-stressful number of cases?
Maybe it’s helpful to answer another question first: what exactly is burnout?
It may not have a frightening name like “coronavirus,” but burnout is indeed a diagnosable medical problem. The diagnosis is made when a patient is “emotionally exhausted,” experiencing “depersonalization,” and has a “reduced sense of personal accomplishment.”
How big of a problem is it, really? According to some sources, as many as two out of three Chinese physicians suffered from burnout back in 2018. If that sounds like a lot, then brace yourself, because 78 percent of doctors in the U.S. reported burnout in that same year.
And lest you be convinced that the problem is contained there, international studies have concluded that burnout is “a common problem” in the physician community.
Returning to the question of “why,” a clear answer is still lacking. Depression and anxiety are frequently in the mix, but there’s not nearly enough evidence to sort out any semblance of cause and effect between burnout and mental illness.
The long hours are almost certainly a factor, with roughly 25 percent of doctors working 60-80 hours every week — and it’s not like they’re mixing margaritas, either — but again, there’s insufficient data to prove causality.
All this uncertainty leads us straight to the meat of the problem: what do we do about the growing shortage of doctors?
Some countries, including the U.S. and the U.K., have explored ideas relating to “fast-tracking” doctors’ education. But among the many issues with that plan is the obvious fact that if doctors all over the world are unsatisfied, churning them out faster is hardly a long-term solution.
Then there’s the possibility of reducing the pressure on physicians by relaxing the scope-of-practice restrictions on nurses and physicians’ assistants. There are some isolated bits of evidence to support the notion that this could help, but not nearly enough to hedge our bets on.
Some experts in the field advocate for simply walking back the mandate on doctors that has led to them spending 75 percent of their time away from patients. While that plan arises from good intentions, the answer here probably isn’t so much to reverse direction, but instead to double down on technology, using other forms of software to support the move to electronic record-keeping.
The reality is that each of these solutions — and the numerous others being proposed — would have needed to be implemented years ago in order to have much effect on the current situation. Becoming a doctor is a process that in most countries takes nearly 10 years, meaning that quick fixes simply don’t exist.
Whether it’s coronavirus, something even worse, or just normal, everyday health problems, the doctor shortage is poised to become a major crisis point in the global economic landscape. Add in a population that’s increasingly older — and whose health problems are more specialized — and you’ve set the stage for a very big problem indeed. Hopefully, leaders in the healthcare field, policy-makers, and innovators can come together to find a solution while there’s still time.