Burnout term is burning out…replaced with Moral Injury or “F Factor?”

I have been reading a lot about burnout and moral injury. Why is this issue important? Depression is on the rise within medicine and the physician suicide rate is nearly 2x that of the general population and even higher when compared to the military.  This is absurd and appalling to me and we should not tolerate suicide in anyone. It is heart breaking to know that fellow colleagues are suffering along this potential continuum. We need to help everyone along this path. As a veteran myself, moral injury should not be used in this context of physician burnout, but it is a better phrase than burnout. I think most of us know what the problems are and disagreeing on what term to use is not as important as the solutions. Once we get beyond this et terms, we should use a new term, the “F Factor,” or Fulfillment Factor. As physicians, we sacrificed many years of our lives because we care about patients, driven to learn, and have a desire to be give back to others. We need to focus on a Physician’s “F Factor.”  Irrespective of the term we use, we need to simply define what we are speaking about-conflict by the physician to put the patient first with other competing priorities- self interest and company interest.

Our first priority is to our patients. Physicians are second and anything the physician needs to enhance the physician-patient relationship, then it needs to be honored and respected. Do you need a scribe, then get a scribe. Do you need a stapler at your desk or a scanner or a printer, then get one. Arguments about adding a printer would be too expensive is where the problems are made worse.  A printer at the physicians desk or in the exam room needs to happen if that is what will increase the physicians “F factor.”  Albeit this is a simple example, create a list of issues that impede patient flow and limit time with the patient. Prioritize what will enhance the patient experience and increase your “F Factor,” and start addressing each one. Partner with your administrator to implement these solutions. 

Next, move to the larger system within your practice. Do you have enough technicians, do you need a scribe? Are there too many do’s and don’ts from upper management that interfere with your clarity of thinking about the patient first. Are you driven more by economics than what the patient needs? Obviously, be mindful of the economics, but do not be driven by them! 

Finally, focus on advocating for your patients at the national level by meeting with your legislators. Reduce burdens on physicians. The system focuses on physicians clicking too many times within their EHRs while ignoring the person, the patient. This reminds me of when I worked in the grocery business in high school and college where I saw customer service decline and more burdens were placed on the customer. We moved from manual cash register to scanners. We moved from serving the customer to the customer serving themselves by having them unload their own cart. Now, there are self check out stands, although it can be easier, it still requires a learning curve. The airline industry is doing the same thing, making the customer check-in on their own to print the boarding pass to even placing the sticker tag on the bags. The customer in this case is the Physician. We are burdened with so many bureaucratic lists. We have had to become coders, billers, clicking to oblivion to improve so-called quality of care, and we know that meeting MIPS standards does not equate to higher quality. This is merely a “C average” mentality which is contradictory to our mindset as physicians. We have strived to be far above a “C average” mentality. Standards should be set by physicians when it comes to the physician-patient relationship. I want all administrators to ask physicians, what resources do you need to be successful? Give them those resources and determine whether the “F Factor” increases, efficiency improves, morale is boosted, and most importantly, the patient’s and staff’s happy factor increases.

I know we can make a difference! We need to make sure we as individuals are doing our very best and practice self-awareness and avoid being a victim, but rather step up and voice our concerns and demonstrate leadership. We need to improve our EHR systems too by creating voice to text and improving communication across so many different platforms. Voice your concerns with your partners, practice, and larger systems. Own it.

Change will occur if we speak up as leaders.

Rob Melendez, MD, MBA

A must see video and references below:

Video by ZDoggMD: (Offensive language)



What is Moral Injury

Published by drrobmelendez

Eye Surgeon (Ophthalmologist) with Eye Associates of NM. I love performing eye surgery to help patients see better and live more fulfilled lives. I am married with 3 children and love helping others. I volunteer with the American Academy of Ophthalmology, Presbyterian Healthcare Foundation Board, and the Univ. of New Mexico School of Medicine. I serve on several boards and enjoy helping others. I have interest in educating and mentoring. I am a veteran where I served in the NM Air National Guard as a flight surgeon and a Lt Colonel. I also helped start a foundation named after my mom who was diagnosed with Retinitis Pigmentosa called The Juliette RP Vision Foundation. I enjoy playing tennis and music.

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