Complicated Web of Healthcare System

Why are doctors burned out? Our health care system is a complicated web By Steven Adelman and Harris A. Berman – Dec 2016

“Your New Health Care System,” the utterly incomprehensible flow chart (above) created by the Congressional Joint Economic Committee in 2010.

It diagrams a complicated web of interrelationships that crisscross between hundreds of government offices, departments, and programs in a maze of boxes, circles, triangles, and other assorted shapes.

The chart gains additional complexity when we layer in even more interrelated complex systems:

  • insurers;
  • medical and specialty societies,
  • state medical boards, and
  • medical examiners;
  • medical schools,
  • academic medical centers, and
  • graduate medical education programs;

along with a multitude of corporate players and constituents like the biotech, pharmaceutical, medical device, and health information technology sectors.

We recently surveyed 425 practicing physicians and health care leaders and executives, seeking their opinions on the importance of eight approaches to transforming health care.

Those who completed the survey agreed that a variety of proposed system-level changes were important to consider in combating physician burnout.

Here are the eight transformational approaches we asked about, in descending order of perceived importance and ease of implementation.

  1. Improving electronic health records and related technologies to enhance the experience of patients and their clinicians
  2. Restructuring physician work-life to promote better self-care and work-life balance, especially for physician parents in dual-career families
  3. Reorganizing the funding of medical education to diminish burdensome debt for early-career physicians
  4. Placing more emphasis on identifying emotional intelligence in medical school admissions
  5. Modifying systemic factors (e.g. reimbursement, medical malpractice) that impede genuine, multidisciplinary team-based care that will unburden physicians
  6. Rebalancing the funding and focus of graduate medical education to produce more primary care physicians and fewer hospital-based specialists
  7. Enhancing the reimbursement of physicians who focus on health maintenance and primary care
  8. Accelerating migration away from utilization-driven fee-for-service care to so-called “value-based care”



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