AAO 2023: Ophthalmology’s resilience amid physician burnout concerns

Peter J. McDonnell, MD, sat down with Sheryl Stevenson, Group Editorial Director - Eye Care, to discuss his presentation on physician burnout in the context of ophthalmology at this year’s AAO meeting.

Video Transcript

Editor’s note - This transcript has been edited for clarity.

Sheryl Stevenson: We are joined today by Dr. Peter McDonnell, who is our co-chief medical editor with Ophthalmology Times and who also is presenting at this year's American Academy of Ophthalmology. Really curious about the title of your talk, Thinking and Rethinking Ophthalmology. Tell us about your talk.

Peter J. McDonnell, MD: Well, you've seen the newspaper and radio and TV articles, no doubt, about the issue of physician burnout. One of the consequences of this COVID pandemic surveys of physicians showing somewhere in the ballpark of 50% to 60% of them showing substantial amounts of burnout using these questionnaires that are used to test for that. And, amazingly, or shockingly, up to 20% of American physicians indicating that they are seriously considering leaving the profession of medicine in the near future, which would obviously have a dramatic impact on the US healthcare system. So it's an issue that I think we need to give some careful consideration to.

It turns out that we ophthalmologists chose the best subspecialty. The worst burnout is in primary-care areas, emergency medicine, internal medicine, family practice, [and] pediatrics, and the least burnout—one of the least fields with the least burnout at only about 5%—is ophthalmology. That's about one-tenth the amount seen in those primary-care specialties that I mentioned.

The good news is that ophthalmologists, by and large, love being ophthalmologists and don't usually want to retire or give up medicine until pretty quite far along in their careers.

You might say, well, ophthalmology should have a lot of burnout. We were in the top three specialties at risk to be infected with COVID, probably because so much of our work is in front of the face of people. So we were definitely at high risk to get infected. And, of course, the famous doctor in China [Li Wenliang, MD] that first alerted us to the presence of this virus was himself an ophthalmologist and died from the disease. So you might think that ophthalmology would be at the bad end of the spectrum.

But my belief is that being able to help people see and getting that positive feedback from people, when you operate on someone and restore their vision, and the next day, you take the patch off, and they hug you and thank you for being a doctor and taking care of them. I think a lot of doctors don't get that kind of positive feedback in their practices.

If you give someone a statin and you lower their cholesterol by 20 points, they don't even realize really that you've done anything and you tell them their cholesterol is better. But they're having some muscle aches from the pill and they don't like taking medicines and I don't think they give the hugs and the feedback to the primary-care doctors that we ophthalmologists get. I think most ophthalmologists that I know are like me. They love what they do and they love their patient interactions.

Stevenson: Yes, absolutely. What are some of the ramifications across all of medicine or physicians considering this physician burnout in terms of patients and a shortage of doctors?

McDonnell: Yeah, a little data. So there's a big study from the Mass General Health Care System where they showed it had more impact on women physicians than men. And we've worked hard to increase the number of women physicians in this country to now in our medical schools there's roughly parity. And to lose a lot of those women physicians would be unfortunate, particularly in specialties where women's health is a priority like ob/gyn. So it would have a substantial impact.

Some of the things that seem to exacerbate the problem are things like the electronic medical records. There are doctors that spend more time typing away on their computers than they spend talking to their patients. And doctors do not like that. We didn't go to medical school so we could type in our computers. We went to medical school, so we could interact with our patients and help them.

And one thing that has been tried and turns out, apparently not to work, is giving financial incentives. Financial incentives it seems do not treat the burnout. Giving a doctor extra money for doing his electronic records well does not improve physician satisfaction. And a lot of physicians say they would accept less compensation if they could get rid of some of the bureaucratic and administrative burdens that are being placed upon physicians.

It's a very interesting topic to look at. And I think it's very important for the future of medicine that we give careful consideration to how we can address these issues. Because if medicine becomes less attractive for our best and brightest college students as a career path, or as the surveys suggest, if 20% of our doctors were to quit practicing medicine, the impact would be tremendous, tremendously negative.

Stevenson: Absolutely. Is there anything else you'd like to add that we haven't touched upon?

McDonnell: Well, some physicians are thinking maybe I should re-do my career and work in a hospital as an administrator or work in industry or be a chief medical officer for a company that's trying to develop a new medication or a new intraocular lens, let's say, and be involved in clinical trials and things. And, you know, one thing that I would say is, if you think there's no stress working in industry, you're wrong. There definitely are stresses; there may be different stresses.

But I would encourage doctors that are considering that option to maybe dip a toe in the water and get involved let's say in clinical trials or start doing consulting work for companies, perhaps 1 day a week and see what they like about it. See if it's a good fit. See if they enjoy it and find it rewarding. Some doctors might find maybe 5 days a week of seeing patients is just too much for me. And if I spent 1 or 2 days a week doing something else, like consulting or being involved in clinical trial design, or being involved in administration, maybe that would by changing things up a little bit, maybe would make it a little more fun for people and more enjoyable and they would be able to continue mostly in their medical career, but also have something else to stimulate them intellectually.