I just finished putting together the materials for a speech I am giving this evening to a group of estate planners. I was asked to speak about the current issues in healthcare and decided to focus on the issue of affordability, thus titling the speech, The Cost of Caring. I have some wonderful charts ready, highlighting how much more we spend on healthcare in the US compared to other nations. I am ready to talk about the types of healthcare costs and what drives them. Did you know that the rate of increase in hospital prices year over year has been decreasing since 2006? While that may surprise them, I’m sure the fact that on average Americans take 2.2 prescription drugs on a regular basis, nearly double that of other nations in the study won’t be a shock.
So the speech is ready, it is completely on point with what I was asked to do, but I don’t think I am going to use it. Every time I think about the title, my mind takes me to a much different place, one without charts and graphs. Those who are or have been caregivers know that the true costs of caring are not measured in dollar signs. These non-financial costs linger long after the care is provided. After years of caring for my father, my mother upon his passing continued the social isolation that she had become accustomed to as a caregiver. A woman who organized dinner parties, planned outings now preferred to remain alone in her home. Careers are put on hold, homes are mortgaged to pay the bills and vacations become a faint memory for those family members who find themselves caring for an ill parent, child or spouse. The health of the caregiver becomes a secondary priority resulting in higher rates of cardiac disease, lower preventive health efforts, and higher mortality rates than peer groups who are not caregivers (https://www.caregiver.org/caregiver-health).
While it is understandable that individuals thrown into the role of caregiver without the appropriate training due to family circumstances would struggle with the task. But our professional caregivers, physicians, nurses, and other clinical professionals choose the health profession and were well trained in how to function effectively within it. Or were they? Did you know that the profession with the highest rate of stress and burnout is the medical profession? We lose 400 physicians a year to suicide, notably more than the rate in the general population. The stress and burnout associated with the profession begins in medical school and continues throughout the career of the practicing physician. Workloads, administrative burdens, feelings of powerlessness, facing human tragedy on a daily basis and yes the weight of coping when things don’t go as planned are all contributing factors. Depression and burnout are not limited to physicians, nurses’ struggle with ever increasing demands, patients who are not at their best and can often be difficult to manage and the reality of patient loss.
As we struggle as a society and industry to address the affordability question, we often look first to how the payment models impact behavior. Pay the physician per procedure and they will do more procedures. Pay the hospital a single sum for the entire length of stay and they will discharge the patient sooner. Pay the health system a fixed rate per person and they will manage the care to keep the person out of the high cost settings. Add quality metrics to the payment formulas to assure “value”. Never in my experience have questions such as how do these payment models impact the individual provider from a psychological perspective been asked. Will the drive to reduce the hospital length of stay increase the pressure on the bedside nurse? Is the incentive for a primary care physician to see more patients per hour causing them to feel rushed and inadequate in their care delivery? Are the IT systems implemented to enhance quality actually adding extra burden to the caregiver, further reducing their ability to care for the patient as they would deem appropriate?
While the reality of our need to address the costs of healthcare in our society likely require the type of changes that will negatively impact our individual providers’ emotional wellbeing, that doesn’t give us the license to ignore those consequences.
The conclusion of my speech to the estate planners will focus on the fact that while the US spends more than other developed nations on healthcare, it woefully underspends those same countries on social care. The question that I hope they will ponder as they leave is not whether we are spending too much, but are we spending it in the right way?
Those of us working within this complex health system need to ask ourselves the same questions, are we spending our limited resources in the right way? Our clinicians are carrying a heavy burden and we must prioritize the resources to support them. No easy solutions exist although some leading organizations, such as the Mayo Clinic Center for Physician Well Being, are studying the issue to identify effective interventions. In August of 2016, the UNC School of Medicine officially adopted the Quadruple Aim, adding improving provider work life, to the well-recognized Institute of Healthcare Improvement’s Triple Aim (http://news.unchealthcare.org/som-vital-signs/2016/aug-4/unc-school-of-medicine-officially-adopts-quadruple-aim).
At the very least, we can start by acknowledging that clinician burnout is a serious issue and that it is happening within our own organizations. We can begin by providing our staff with a safe environment to come forward for help.
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I'm busy working on my blog posts. Watch this space!