American doctors are rich and miserable

Look around a physicians’ car park in Dallas, Texas, and the rewards from years slogging away in training are evident. “It looks like a German-car dealership,” says Scott Yates, a doctor, from behind the wheel of his BMW. He reels off all the luxury-car brands he can see. Yet he worries that his peers are still unhappy. “We all went to medical school to practice medicine,” he says, “not to deal with insurance companies, not to fill out paperwork.” This burden lies at the heart of a confounding statistic: American family doctors are among the best paid in the world and also some of the most miserable.

In a recent international survey by The Commonwealth Fund, a think-tank, of 11,000 doctors, 43% of American respondents reported feeling burnt out, more than in any of the other nine peer-countries polled (see chart). In Britain, just over a third of general practitioners in the bedraggled NHS reported being “physically or emotionally exhausted”, despite earning about half of the $242,000 taken home by the average American primary-care doctor. “Burnout is sometimes like a dirty little secret,” says Revathi Ravi, an internist and paediatrician in Boston. The American health-care system has all “the ingredients for it”. Her own experiences of burnout were so intense she considered quitting.

Paperwork is the driving force behind this misery, says Celli Horstman, one of the Commonwealth study’s authors. “There are just so many administrative tasks—on top of spending time with patients—that US physicians are expected to do.” Ms Hortsman cites elaborate charting, in-boxes teeming with patient messages and fighting with insurance companies.

Doctors are particularly aggrieved by the rise of electronic health records. Studies show that family doctors spend, on average, just under an hour every day answering patient messages alone. The use of remote-contact and communication apps spiked during the covid pandemic, reports Tait Shanafelt, a doctor at Stanford who studies burnout, “leading to a tsunami of inbox messages for physicians”. Although he emphasises their potential for improved treatment, “it’s all just extra work.”

This angst is not just a problem for doctors. Burnt out physicians are twice as likely to make a mistake. They are also more likely to quit, which can produce staggering costs. One analysis from 2019 found that turnover and hours lost to burnout costs roughly $7,600 per employed doctor, or $4.6bn each year.

Some solutions to burnout are straightforward. Researchers point to Australia, which created a centralised platform for health bureaucracy, cutting down endless form-filling. Jen Brull, the chair of the American Academy of Family Physicians, a trade association, hopes that artificial intelligence might help too, especially for “routine tasks like charting, coding and note-taking”. “A decade ago, maybe people would have said, ‘the clinician should do more mindfulness practices’,” says Dr Ravi, the Boston physician. Now there is more recognition of the need to reduce workloads. In the meantime, she leads classes and coaches doctors to avoid and withstand burnout, just as she did. ■