For years I wondered why despite being a confirmed urbanite, I love camping. Then I realized that camping gives me full permission to improvise—to make creative use of the limited materials I have to get the job done. Hence, shirt tails are fair game for wiping coffee grounds out of measuring spoons.
Similarly, I am inspired by people and groups that use the resources we have at our disposal in health care in creative new ways. Like the first explorers, these folks are testing approaches to provide care that are more effective than the status quo. Given the escalating health care costs, we need to be looking for ways to make the available financial resources work better for us. And, studies have shown that health care delivery includes a lot of wasted time, resources, and supplies, due in part to use of higher-priced services with no health benefits over less-expensive alternatives.
At a recent meeting on patient safety, I heard about a novel way of using a previously untapped resource—emergency medical technicians (EMTs), those courageous first responders to 911 calls. I followed up with Matt Zavadsky, MS-HSA, NREMT, who is the chief strategic integration officer at MedStar Mobile Healthcare, which provides emergency medical services (EMS) in the Fort Worth, Texas area, to learn more about it. Here’s what he told me.
For decades EMS units have been paid only to respond to emergency calls and transport people to the hospital. If they were to transport a person who needed less intense care to a lower acuity setting, like a walk in center or a clinic, they would not be paid—representing overuse of higher-priced services. In addition, EMTs, especially those based in fire departments, often spend a substantial portion of their shift waiting for emergency calls—representing underutilized human resources.
It took me almost two decades to look back and try to understand the reasons I left medicine. Leaving was an incredibly painful decision and the residual shame I carried made me want to look the other way—until I learned about burnout. Before, I thought it was me, that I was the problem. It was freeing to learn the truth: burnout is a psychological response to stress that has defined symptoms: emotional exhaustion, depersonalization, and inefficacy. Its triggers are well-understood, including those that affect physicians.
In 2013 I finally mustered the courage to write about my personal experience with burnout and leaving practice. I was shocked when the article went viral. Clearly my story struck a nerve. Since then I have made it my mission to learn all I can about physician burnout—its underlying causes, its consequences, and potential fixes.
In the course of my work I’ve interviewed dozens of physicians, researchers, health care leaders, and experts in burnout. I’ve learned that it’s a big problem for many physicians (actually it’s a big problem for many other health care providers, but what I know best is its effects on physicians). I’ve learned that understanding the root causes of physician burnout requires that you untangle the underlying flaws in our health care system. I’ve learned that burnout is not about the “weakness” or sensitivity of individuals and it can’t be prevented through individual wellness solutions alone.