He began thinking twice, he says, when a patient slapped him for not giving someone pain medication, and he was recently "punched and kicked" by a patient in the ED, a patient who he'd treated many times, but who had never paid his bills.
Asked if he wasn't trained to expect that in an emergency room setting, he said, no. "You were always taught that Medicare, Medicaid, and insurance companies would pay you a fair amount." Now regulations and insurance companies and legislation – "everyone seems to be coming down on us," he says.
David Bronson, MD, president of the American College of Physicians, says the study represents "a call to action to address the issues that are driving doctors away. Internal medicine is a great life and a great career."
"But the main reasons internists are dissatisfied and burned out has to do with reimbursement and limits on how much time they can see patients.
"Practice hassles and paperwork, are a lot greater than they were," Bronson says. But he sees a "glimmer of hope" in new payment models specified in the Patient Protection and Affordable Care Act.
"The patient-centered medical home model, if administered properly and done in the way it should, will bring rewards back to medicine," he says.
West says the study findings produced a kind of "fear factor" among himself and his co-authors. "None of us think it's acceptable that nearly half of the physicians across the country might be suffering from burnout. It can't be good for patient care or the health of the profession. And it's very concerning that these burnout problems could get worse.