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SAN ANTONIO
MEDICINE

Resilience is our ability to overcome ventures. We need that time to replenish and moral injury, the betrayal by the system that
hardship. As physicians, or a healthcare refocus our energies as we return to our de- is supposed to allow us to give our patient the
provider such as a Nurse Practitioner or manding profession. Without these outlets best care we can. The care that we have so dili-
Physician Assistant, we have all spent long we risk the development of burnout. How- gently trained for and so desperately want to
hours to get our degrees. Completing med- ever, having these other activities is not administer.
ical school, internship, residency (and in enough to avoid burnout. There is number
some cases fellowships) we have endured nu- three of my analysis. How did we get here? One possible ex-
merous hardships to get where we are today. planation is the increasing regulatory laws
So, I would say that most of us have a healthy Control of the workplace is a challenge that are well meaning but short-sighted. A
dose of resilience and self-motivation that and it starts on the day we see our first pa- PubMed search for the number of healthcare
empowers our ability to be the physicians and tient. For most of us, we spent almost a laws created over the last few decades re-
caretakers that we are. However, over time decade of training for this moment and our vealed a steady increase in their number. In
some of us might incur an illness, physical or training was all about developing a doctor-pa- the decade of the 1970s, we have a total of
mental, that could wear on our resilience. tient relationship. Then, on that first day of seventy laws passed dealing with healthcare
Chronic pain or depression can and does im- seeing our patient, we are confronted with nu- policy. Thereafter, the number of healthcare
pede our ability to continue treating patients merous barriers between us and the patient. policy laws increase steadily and exponen-
successfully. And of course, there is age to One, insurance companies that restrict testing tially. In this last decade, from 2010 thru
consider. With aging comes slower response have limited the resources for the patient in- 2019, there were 1,271 laws passed. The
rates and less energy. Most of us who are cluding a limited list of providers in their net- curve for the number of healthcare policy
older just cut down our hours in clinic or find work and, if it’s an HMO, a delay in treatment laws passed matches the curve of the number
another job that is less demanding to avoid on the day of the office visit. Two, an EMR of articles written about burnout. The con-
the frustration of not staying on time with (electronic medical record) that will oblige trol of our work place has been systemati-
our clinical load. For my younger readers, I you to become more proficient with its use in cally striped from our hands and passed into
hope there are many, many years ahead of you order to see the required number of patients the hands of administrators, law makers, in-
before you can possibly (and never do) relate needed to pay for your overhead and your surance companies and PBMs. We, who
to what I just wrote about aging. If we lose salary. Three, regulatory demands for docu- take care of our patients, have lost control
our resilience, I believe burnout is imminent. mentation in order to bill an acceptable level. and therein lies the consequential burnout
As an FYI, our medical society provides a free The number of metrics and type of metric are for some.
personal consultation for members who wish and continue to be a work in progress. The All three of these areas, resilience (self-mo-
to discuss, in confidence, a personal matter metrics are redundant in their need to be doc- tivation), life balance, and control of the
with a licensed medical psychologist by link- umented at each office visit and all too often workplace are equally important and, in my
ing to LifeBridge on our website. arbitrary and superfluous to the actual care view, require examination if we recognize
needed for that visit. Four, the dreaded prior- burnout in one of our colleagues. Regaining
Life balance speaks to our ability to find authorization (PA) required by the pharmacy control of our doctor-patient relationship is
other outlets for our mental and physical benefits managers (PBMs). PBMs are the a must and we should all feel obliged to de-
well-being. For some, it’s raising a family “unchecked” entities that profit the most velop a relationship with our policy makers.
and enjoying the time going to soccer games, from the kick-backs, termed as rebates, they I hope this “thought analysis” of burnout in
talent shows and other activities. I’m always get from the pharmaceutical companies. our profession will lead to a broader conver-
intrigued, but no longer surprised, to hear Based on their rebates, they create a formulary sation on this very important topic.
about our talented physicians that enjoy unique and profitable to them and restrictive
painting, playing an instrument, composing to our patients. PAs have been shown to delay Rodolfo (Rudy) Molina MD
music, writing, hiking, bicycling, traveling, or deny treatment and increase the adminis- MACR FACP is a Practicing
etc. The list of activities outside of medicine trative time and cost to providers. These four Rheumatologist and 2021 Presi-
that my colleagues enjoy is long and, for me, intrusive barriers can be and are a frustration dent-elect of the Bexar County Medical Society.
gratifying to hear of their endeavors and ad- we confront on a daily basis. Herein lies the

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