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David Ruef, a group exercise instructor and personal trainer, leads an aqua aerobics class at MUSC's Wellness Center on Wednesday, August 28, 2019, in Charleston. MUSC is opening classes to physicians and students to help with burnout. Gavin McIntyre/Staff

Work, gym, dinner, family time and sleep. 

And then it starts all over again the next day. 

While employees across all sectors juggle obligations to strike the perfect work-life balance, physicians say they are increasingly struggling to limit the amount of time they spent at work and avoid burnout. 

“I think we all agree that it is a significant issue in health care," said Dr. Peter Zwerner, chief medical officer for the physicians group at the Medical University of South Carolina.

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Gail Pilgram participates in an aqua aerobics class at MUSC's Wellness Center on Wednesday, August 28, 2019, in Charleston. MUSC is offering classes such as this one to help employees and students cope with work-related stress. A 2019 Medscape survey found 44 percent of physicians reported feeling burned out. Gavin McIntyre/Staff

Recently, MUSC announced it was ending all the youth programs at the on-campus wellness center. One of the reasons was to expand the number of programs for MUSC staff, students and the adult community. Zwerner explained programs like these feed into MUSC's goal of building resilience among doctors. Wellness is an important part of that. 

The American Academy of Family Physicians describes burnout as a condition shaped by exhaustion, lack of effectiveness and compassion or emotional energy. 

In a 2019 survey, Medscape found that 44 percent of physicians reported feeling burned out, a 2 percent increase from last year. Nearly 50 percent reported exercising as their method to cope with burnout. 

The top three contributing factors to physician burnout include extensive paperwork or bureaucratic tasks, long work hours and increased work related to electronic health records. 

“We physicians like taking care of people," said Dr. Rex Morgan, an internal medicine physician with East Cooper Coastal Family Physicians. “Spending hours in an office over a computer doesn’t give you joy.”

After each visit with a patient, most doctors now find themselves spending hours inputting data, Morgan said. Some of the data ensures that medical information related to the patient's visit is recorded properly for health insurers. 

Sometimes it's just making sure billing codes are correct. A lot of times, Morgan said, it is recording metrics for insurers. In some cases, he said, doctors end up mostly facing a computer screen during a patient's appointment.

"It just makes the day long," he said. 

In his experience, Zwerner has heard physicians compare these responsibilities to feeling like a cog in the wheel. There is a loss in autonomy, he said. These obligations take time away from doctors who want to spend more time with patients. And Morgan agreed. 

“It’s gotten much worse," Morgan said.

The Annals of Family Medicine found that 30 percent of primary care clinicians don't work in the same system two to three years after reporting burnout. 

Morgan said some doctors are turning to concierge medicine to rid their practices of the health insurance industry altogether. Under the concierge model, patients pay a yearly fee to a physician and all of their care is covered. For the physician, they completely avoid any additional health insurance-related paperwork. 

Morgan emphasized that this model mainly benefits patients who are financially affluent. 

“Everyone can’t afford that," he said.

Other doctors can't find a way to cope with the stress. Medscape estimates that 300-400 physicians die by suicide in a year.

“Physicians commit suicide at about two or three times the rate of the general population," said Dr. Rick McEvoy, a pathologist with Roper St. Francis Healthcare. 

A study presented at the American Psychiatric Association's 2018 annual meeting found that doctors had a higher suicide rate than any other profession. A separate analysis by the Centers for Disease Control and Prevention found that men who worked in construction had the highest rate. For male health care practitioners, the ranking was eighth highest.

“I think that all facilities need to have a discussion about how they are currently supporting physician wellness," said McEvoy, who helps lead a team to develop a wellness program for all staff members with Roper St. Francis Healthcare. “There truly is no one size fits all.”

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David Ruef, a group exercise instructor and personal trainer, leads an aqua aerobics class at MUSC's Wellness Center on Wednesday, August 28, 2019, in Charleston. Exercise classes are one way MUSC is trying to address employee burnout. Doctors in Charleston say the health care industry needs to figure out how to address this important issue. Gavin McIntyre/Staff

The local physicians advised that doctors should find more activities, such as exercising, to relieve stress. And they explained doctors should try to avoid taking paperwork home.  

They all agreed that the health care system should lift the burdens of heavy paperwork and data entry that fall on doctors. Morgan said he hopes that in the future they will be able to delegate tasks to administrative staff. 

Experts agree that the risk of not taking this issue seriously will mean fewer doctors treating patients.

"The onus is on the health care system," Zwerner said. 

Reach Jerrel Floyd at 843-937-5558. Follow him on Twitter @jfloyd134.

Jerrel Floyd is an Alabama raised reporter who covers health & wellness for The Post and Courier.

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