San Francisco Marin Medical Society Blog

Burnout and Empathy by President-Elect Candidate Peter N. Bretan, Jr., M.D., FACS

We have an epidemic in our profession of medicine as > 400 physicians commit suicide each year. While this number is staggering, it is not surprising as 11.2% of doctors have depression and 30-65% suffer from burnout. Burnout is a complete physical and emotional collapse. The process (Freudenberger) and metrics (Maslach & Jackson 1981) have long been established, but we as a profession are just beginning to approach this rampant malady. Burnout is an individual response to a systemic problem; thus it requires both individual and organizational strategies to deal with it. Currently studies support that organization interventions are more effective than individual ones, however, there are no published studies using both to solve the problem and that is a major dilemma. Physicians need to have a greater awareness of burnout as it is not just bad for us, but also for our businesses and patients.


The many factors that contribute to burnout are actively being addressed through new initiatives. It was inspiring to hear at the 2018 NEPO meeting of the new effort by the CMA to reinvigorate clinicians with the joy of the practice of medicine. The American College of Surgeons also this year launched the campaign "Stop overregulating my OR" to reduce the administrative burden to surgeons and their practices. As President of the California Urological Association, it was directly evident to me that as a specialty several years ago we were suffering the highest reported burnout rate of >60%. My colleagues and I worked to ease the pressure from MOC by organizing to replace it with a more beneficial CME program called LLL (Life Long Learning). As a result, burnout has dropped almost 20%, supporting that just one organization change can significantly affect physician wellness. The APA, AMA, Stanford Medical Center, Permanente Medical Group, Oregon Med Centers Wellness, and Suicide Prevention have started needed programs, thus we must all work proactively to protect our profession from these organizational causes of burnout.


As these efforts evolve forward, it will be essential to address the rate of rising of the overall cost of healthcare delivery. We should be proud that California physicians provide outstanding care at one of the lowest healthcare delivery costs in the country. Inadequate access to care for Medi-Cal patients remains a significant driver for inefficient primary care. This makes a compelling argument to continue to increase Medi-Cal reimbursements (as was accomplished through Prop 56) and to develop a structure for sustainable healthcare access.


My experiences in and out of CMA for the past 18 years in leadership have helped me forge relations to work closely with our Executive committee, the Board of Trustees, the component medical societies and the Presidents Forum to fulfil these goals. My experiences directly with numerous State and federal legislators, as I have come to know them personally as my guest lecturers to the many pertinent parts of our healthcare policy course for medical students enables both students and colleagues to directly question our elected officials. But my humble beginnings have given me the most important asset of my leadership, that of empathy for my colleagues. With this brings an open mindedness and a commitment to be available at all times for access to all members of the HOD to discuss new issues that must be considered and vetted in this rapidly changing environment of healthcare for our profession of medicine. This is why I am running for CMA President Elect and humbly ask for your vote.


Peter N. Bretan M.D., FACS
Bio Video:

Twitter: @BretanMD

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