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Primary Care Doctors On Burnout, Job Stress

We've been talking about a lot of post-COVID burnout in the healthcare system. This includes staffing shortages and heavy workload.

This isn't just inside the hospitals, but it's inside primary care offices too.

News10NBC spoke with a local doctor who recently resigned from her job, working for a major local health employer in the area.

Dr. Kerry Graff described why she decided to work in primary care, in the first place.

"I loved working with kids, I liked working with adults, working with whole families, I liked delivering babies," Graff said. "Family practice allowed me to do a little bit of everything, which I really liked."

She said the industry has changed over the years, and the pandemic worsened it. Graff said about 75-80% percent of the patients who came in, had three or more chronic medical problems. That percentage used to be significantly lower.

"So you're seeing a lot fewer patients, but you're dealing with a lot more problems," Graff said.

On top of that, a 60-hour work week is considered normal, she said, and her employer required a patient panel size of over 2,000.

Graff worked for a major hospital system in the area, at a family practice. She recently resigned to work for a telehealth company, and said the move came after realizing the work expectations were too high.

"When you're working for a hospital system, and 70-some percent of physicians now are working for big hospital systems, we've really given up a lot of our control for what our practice looks like," she said.

She said another trend right now, is doctors leaving practices for concierge medicine. That's where patients pay a monthly or annual subscription to get easier access to a provider, and the provider has fewer patients. There's no monthly insurance premium.

Dr. Michael Mendoza, primary care doctor and Monroe County Health Commissioner, explained: "That person may have more time, more availability to answer your concerns — to some patients, to a lot of patients, that is desirable."

It happened at the Linden Medical Group in Penfield a few weeks ago, when five doctors left the group suddenly. A few of those for concierge medicine. None of those doctors have agreed to an interview.

Mendoza doesn't believe this will become a larger trend, but said he isn't surprised doctors are exploring alternative options.

"In our healthcare system, to get all the things we need to get done, as patients and consumers, we just don't have enough primary care doctors in this country," he said. "As things change, we adapt as best as we can, we all just want to do a good job for our patients. I think that's the bottom line."

For Graff, it was not an easy or painless choice to make.

"I had to let go of doing primary care, and I have patients I had to let go of, from 27 years — that's heartbreaking," she said.

Mendoza said while the healthcare system is seeing major staffing shortages nationwide, Rochester has an efficient system compared to other cities he has worked in, such as Chicago and San Francisco.

Caring For The People Who Care For Our Patients

As we begin a New Year, I reflect upon the exceptional dedication of staff, physicians and volunteers across Ontario hospitals who spend time away from their families every holiday season to ensure patients receive the care that they need. At a time when many hospitals are continuing to recover from the impacts of the pandemic, it's more important than ever that we take care of those who take care of our patients. 

While senior health executives juggle many priorities, I have no doubt that one near the top of every hospital CEO's list is staff and physician health and wellbeing. It certainly is for me. Our people are the heart of our hospitals and the recent pandemic served as a stark reminder that we need to be doing all we can to support team members in the workplace. A healthy and engaged workforce is not only critical to the delivery of safe, quality patient care today, but a catalyst for growing the health care workforce of tomorrow. 

As hospitals work to address the impacts of health human resource challenges being felt across the province, the question on everyone's mind is, what steps are we taking to retain the valued health care professionals that are currently working in the system, while also encouraging a new generation to commit to the professions we need in the future? 

At Osler, we're looking ahead and addressing this priority in several ways through enhanced wellness programming, growth opportunities, formal and informal recognition programs, strategic partnerships, and thoughtful recruitment campaigns. Other strategies include providing development and sponsorship opportunities for staff, developing pathways for clinical externs, implementing alternative models of care, and enhancing processes that help improve the flow of patients through our hospitals. To date, staff and physician response has been positive, reinforcing that we're moving in the right direction, and we're confident that the cumulative effect of these strategies will have a positive impact. Moving forward, it is imperative that we continue to listen to the voices of our staff and physicians to help ensure we are nurturing and supporting them in this truly noble calling.  

What we're doing outside our walls to support team members is just as important as what's happening inside our walls. As a family physician, I'm proud of the growing partnerships we continue to nurture with primary care and our Ontario Health Team partners. Our community care colleagues play such a significant role in supporting wellness in our communities, and in preventing unnecessary hospital visits and admissions. Working together, we can ensure patients are receiving the best care in the right place at the right time, and by the right caregivers across the entire system. 

As we work to address the wellness needs of our team members, we are focused on providing inspiring work experiences for those entering the health care profession. As Osler partners with Toronto Metropolitan University to open a new School of Medicine in Brampton in 2025, we're acutely aware that we have an exceptional opportunity to ensure this new workforce is inspired to pursue their careers in our hospitals and in our communities. Osler's Academic Practice Partnership with Humber College is also advancing nursing education, scholarship, and research between the two institutions.

Our health system is as good as the people who work within it. Let's do everything in our power as senior leaders to ensure we're taking the necessary steps to sustain the valued talent within our hospitals, communities, and schools so that Ontarians continue to receive the best care today and into the future.

Dr. Frank Martino is President & CEO, William Osler Health System. 

Can Family Doctors Deliver Rural America From Its Maternal Health Crisis?

CAIRO, Ga. — Dr. Zita Magloire carefully adjusted a soft measuring tape across Kenadie Evans' pregnant belly.

Determining a baby's size during a 28-week obstetrical visit is routine. But Magloire, a family physician trained in obstetrics, knows that finding the mother's uterus and, thus, checking the baby, can be tricky for inexperienced doctors.

"Sometimes it's, like, off to the side," Magloire said, showing a visiting medical student how to press down firmly and complete the hands-on exam. She moved her finger slightly to calculate the fetus' height: "There she is, right here."

Evans smiled and later said Magloire made her "comfortable."

The 21-year-old had recently relocated from Louisiana to southeastern Georgia, two states where both maternal and infant mortality are persistently high. She moved in with her mother and grandfather near Cairo, an agricultural community where the hospital has a busy labor and delivery unit. Magloire and other doctors at the local clinic where she works deliver hundreds of babies there each year.

Scenes like the one between Evans and Magloire regularly play out in this rural corner of Georgia despite grim realities mothers and babies face nationwide. Maternal deaths keep rising, with Black and Indigenous mothers most at risk; the number of babies who died before their 1st birthday climbed last year; and more than half of all rural counties in the United States have no hospital services for delivering babies, increasing travel time for parents-to-be and causing declines in prenatal care.

Sarah Jane Tribble / KFF Health News

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KFF Health News

Kenadie Evans with her 3-year-old, Khloe Johnson, at their new home in southeastern Georgia. Evans is pregnant and says she intentionally chose Dr. Zita Magloire to manage her delivery.

There are many reasons labor and delivery units close, including high operating costs, declining populations, low Medicaid reimbursement rates, and staffing shortages. Family medicine physicians still provide the majority of labor and delivery care in rural America, but few new doctors recruited to less populated areas offer obstetrics care, partly because they don't want to be on call 24/7. Now, with rural America hemorrhaging health care providers, the federal government is investing dollars and attention to increase the ranks.

"Obviously the crisis is here," said Hana Hinkle, executive director of the Rural Training Track Collaborative, which works with more than 70 rural residency training programs. Federal grants have boosted training programs in recent years, Hinkle said.

In July, the Department of Health and Human Services announced a nearly $11 million investment in new rural programs, including family medicine residencies that focus on obstetrical training.

Nationwide, a declining number of primary care doctors — internal and family medicine — has made it difficult for patients to book appointments and, in some cases, find a doctor at all. In rural America, training family medicine doctors in obstetrics can be more daunting because of low government reimbursement and increasing medical liability costs, said Hinkle, who is also assistant dean of Rural Health Professions at the University of Illinois College of Medicine in Rockford.

In the 1980s, about 43% of general family physicians who completed their residencies were trained in obstetrics. In 2021, the American Academy of Family Physicians' annual practice profile survey found that 15% of respondents had practiced obstetrics.

Yet family doctors, who also provide the full spectrum of primary care services, are "the backbone of rural deliveries," said Julie Wood, a doctor and senior vice president of research, science, and health of the public at the AAFP.

In a survey of 216 rural hospitals in 10 states, family practice doctors delivered babies in 67% of the hospitals, and at 27% of the hospitals they were the only ones who delivered babies. The data counted babies delivered from 2013 to 2017. And, the authors found, if those family physicians hadn't been there, many patients would have driven an average of 86 miles round-trip for care.

Mark Deutchman, the report's lead author, said he was "on call for 12 years" when he worked in a town of 2,000 residents in rural Washington. Clarifying that he was exaggerating, Deutchman explained that he was one of just two local doctors who performed cesarean sections. He said the best way to ensure family physicians can bolster obstetric units is to make sure they work as part of a team to prevent burnout, rather than as solo do-it-all doctors of old.

There needs to be a core group of physicians, nurses, and a supportive hospital administration to share the workload "so that somebody isn't on call 365 days a year," said Deutchman, who is also associate dean for rural health at the University of Colorado Anschutz Medical Campus School of Medicine. The school's College of Nursing received a $2 million federal grant this fall to train midwives to work in rural areas of Colorado.

Nationwide, teams of providers are ensuring rural obstetric units stay busy. In Lakin, Kansas, Drew Miller works with five other family physicians and a physician assistant who has done an obstetrical fellowship. Together, they deliver about 340 babies a year, up from just over 100 annually when Miller first moved there in 2010. Word-of-mouth and two nearby obstetric unit closures have increased their deliveries. Miller said he has seen friends and partners "from surrounding communities stop delivering just from sheer burnout."

Sarah Jane Tribble / KFF Health News

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KFF Health News

Deanna Buckins holds her sleeping infant, Hayden. The boy's birth was handled by the family's primary care doctor and was "by far the best delivery ever," says Buckins, who has three older children.

In Galesburg, Illinois, Annevay Conlee has watched four nearby obstetric units close since 2012, forcing some pregnant people to drive up to an hour and a half for care. Conlee is a practicing family medicine doctor and medical director overseeing four rural areas with a team of OB-GYNs, family physicians, and a nurse-midwife. "There's no longer the ability to be on 24/7 call for your women to deliver," Conlee said. "There needs to be a little more harmony when recruiting in to really support a team of physicians and midwives."

In Cairo, Magloire said practicing obstetrics is "just essential care." In fact, pregnancy care represents just a slice of her patient visits in this Georgia town of about 10,000 people. On a recent morning, Magloire's patients included two pregnant women as well as a teen concerned about hip pain and an ecstatic 47-year-old who celebrated losing weight.

Cairo Medical Care, an independent clinic situated across the street from the 60-bed Archbold Grady hospital, is in a community best known for its peanut crops and as the birthplace of baseball legend Jackie Robinson. The historical downtown has brick-accented streets and the oldest movie theater in Georgia, and a corner of the library is dedicated to local history.

Sarah Jane Tribble / KFF Health News

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KFF Health News

YaSheka Shaw (left) celebrates losing weight during a checkup with medical student Kaniya Pierre Louis (center) and Dr. Zita Magloire.

The clinic's six doctors, who are a mix of family medicine practitioners, like Magloire, and obstetrician-gynecologists, pull in patients from the surrounding counties and together deliver nearly 300 babies at the hospital each year.

Deanna Buckins, a 36-year-old mother of four boys, said she was relieved when she found "Dr. Z" because she "completely changed our lives."

"She actually listens to me and accepts my decisions instead of pushing things upon me," said Buckins, as she held her 3-week-old son, whom Magloire had delivered. Years earlier, Magloire helped diagnose one of Buckins' older children with autism and built trust with the family.

"Say I go in with one kid; before we leave, we've talked about every single kid on how they're doing and, you know, getting caught up with life," Buckins said.

Magloire grew up in Tallahassee, Florida, and did her residency in rural Kansas. The smallness of Cairo, she said, allows her to see patients as they grow — chatting up the kids when the mothers or siblings come for appointments.

"She's very friendly," Evans said of Magloire. Evans, whose first child was delivered by an OB-GYN, said she was nervous about finding the right doctor. The kind of specialist her doctor was didn't matter as much as being with "someone who cares," she said.

As a primary care doctor, Magloire can care for Evans and her children for years to come.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

Copyright 2023 KFF Health News. To see more, visit KFF Health News.

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