Pain Specialists Show Increasing Burnout – and so do their patients
This was reported at the 2014 annual meeting of the International Anesthesia Research Society (abstract S-114).
The high rate of burnout among pain specialists found in a recent study may be a wake-up call to the specialty, as it places these physicians at risk for substance abuse, interpersonal difficulties and suicidal tendencies, and also increases the risk for medical [workplace] errors. The investigators called for preemptive measures to help pain specialists before burnout sets in.
The risks of physician burnout listed above are similar to the warnings given about taking opiates. It strikes me that most of what’s said in this article accurately describes the stress we pain patients feel as well.
In addition to determining the incidence of burnout, the study aimed to nail down the relationship, if any, between demographic and psychosocial characteristics of the job that predict burnout.
The Maslach assesses burnout in helping professions through three subscales:
- emotional exhaustion,
- depersonalization and
- personal accomplishment.
The Job Content Questionnaire measures the social and psychological characteristics of jobs. “There are three major scales:
- decisional latitude,
- psychological demands at work and
- social support,”
“Most of the adverse reactions of psychological strain occur when the psychological demands are high, the workers’ decisional latitude is low and they have low social support.”
The above is also a good description of the situation many pain patients find themselves in.
266 surveys were completed between June and November 2013. It was found that on the Maslach Inventory,
- 61.3% (n=141) of respondents scored high in emotional exhaustion,
- 35.6% (n=82) scored high in depersonalization and
- 42.6% (n=98) had low scores for personal accomplishments
—the three essential indicators of burnout. “Almost 43% of pain physicians had low personal accomplishment scores,” he said, “compared with 12% in a national sample of physicians.”
When asked why there seems to be such a high rate of burnout among pain specialists recently, Dr. Kroll did not hesitate. “Because of recent FDA regulations, primary care physicians refuse to prescribe narcotics,” he said.
“So these [pain] patients are all coming to pain physicians, and they can be challenging and demanding. It really does create a tremendous psychological demand on the pain physicians. I think we need to create programs to mitigate and prevent burnout in our field.”
Charles Argoff, MD, professor of neurology and director of the Comprehensive Pain Center at Albany Medical College, in Albany, N.Y., commented that physician burnout appears to be a growing experience in many fields. “It would not surprise me if it continues to affect a greater number of pain specialists for a variety of reasons, including
- increasing obstacles to patient care created by the insurance industry;
- increasing reluctance by non–pain specialists to manage people in their practice with chronic pain;
- greater regulation by state and federal authorities of pharmacologic approaches to pain management; and
- increasing difficulties in receiving appropriate reimbursement for the complex care that pain specialists provide to their patients.”
Most of the above problems are just as stressful for the patients–in addition to their physical pain. Trudging through the arduous process of getting sufficient and effective pain medication, we patients feel the same”tremendous psychological demand” for the same reasons:
- having to argue with insurance companies over access to treatments and medication
- trying to find doctors able and willing to treat our pain
- taking great care not to run afoul of DEA regulations.
- increasing difficulties in paying for the treatments
“This may appear corny or trite, but focusing on the interpersonal relationships that develop between the provider and the person in pain—as well as the rewards of helping a person in pain suffer less—holds great value in reducing burnout,” he said.
“Focusing on being your patient’s advocate and helping your patient to be his or her own advocate also help to actively combat certain obstacles standing in the way of best practices in pain management.
There is no clear solution to this, and as long as non-practitioners continue to have the upper hand in how and what care will be allowed, burnout will continue to occur.”
All these rules and restrictions are pitting doctors who fear prescribing “too much” against patients who fear getting “not enough”. If we were given time and opportunity to develop that recommended interpersonal relationship with our doctors, we could tackle these obstacles as allies instead of adversaries.
An initial step we patients could take would be to approach our pain docs with compassion, validating their suffering as we would like them to validate ours. To prevent the complete takeover of pain care by non-practitioners, we and our doctors must join forces and work together.