Social epidemics and the role of physicians

In the first blog, I discussed infectious epidemics and the recent social epidemic of loneliness. In this second blog, I will briefly mention the burnout epidemic, which has received ample attention in our literature and professional meetings. I will discuss the epidemic of social media toxicity and its impact on our children.

The burnout epidemic

I hear physicians asking questions that I have been heard in surgical lounges and medical dining rooms. Some of these questions I've frequently heard include:

• Did I choose the right profession?
• Would I recommend a medical career for my children?
• Should I make a career change?
• Is it time to retire?
• Should I have stayed in private practice instead of being employed as a physician?

These are just a few questions indicating that medical practice blahs impact many of our colleagues.

Burnout can have many negative consequences for physicians. Burnout can lead to depression, anxiety, chronic stress, irritability, decreased self-esteem, and even increases the risk of suicide. It is noteworthy that the suicide rate among physicians is greater than in other professions and also higher than in the general population. It is also of interest that there are higher rates of alcohol use among physicians experiencing burnout.

Burnout can lead to decreased job performance, increased absenteeism, and decreased enjoyment of our practices. It can also lead to increased medical errors and increase the risk of a malpractice suit. This will ultimately affect patient satisfaction and can impact our online reputation. This decrease in enjoyment also motivates physicians to leave the practice of medicine at an earlier age.

Finally, burnout can also negatively impact our health and well-being. Burned-out physicians are at an increased risk for cardiovascular disease (Appels and Schouten, 1991; Toker et al., 2012; Toppinen-Tanner et al., 2009) and other health consequences, including hypercholesterolemia, type 2 diabetes, coronary heart disease, hospitalization due to cardiovascular disorder, musculoskeletal pain, fatigue, headaches, gastrointestinal disorders, and respiratory problems. (Salvagioni et al., 2017).

Suggestions for beating back burnout

We can start small and make micro-adjustments that will improve our attitude towards our practices and make our situation more tolerable. For example, if you are a middle-aged physician and entering data in the EMR is daunting or emotionally painful, consider asking for a scribe to do the data entry. Now, we have software programs that use AI to convert voice to text, which may eliminate the need for scribes.

If we are having difficulty starting our office clinic at 9:00, we should consider negotiating different work schedules so we can start and end our day on time.

If working 60-plus hours a week is difficult, consider opting out of evening and weekend calls. Of course, this will reduce compensation.

Another suggestion is to leave your comfort zone and the boredom accompanying burnout. A personal example from my practice occurred after I performed my 3000th penile implant. I found I was bored with the operation and not having that dopamine rush which usually follows a successful operation. I changed my focus from men's health to female sexual dysfunction, which is a condition in its infancy. I attended lectures and meetings on the subject. This shifting of gears allowed me to leave my comfort zone and reduce my boredom.

A final suggestion is to consider a career change. Change can be challenging, exciting, and rewarding. When I speak to doctors who have changed careers, I often hear a response after six months in the new career: "I should have done this sooner!" For physicians considering a career change, I recommend reading Sylvie Stacy's 50 Unconventional Careers for Physicians.

Epidemic of social media

In the previous blog, I mentioned that Attorney General Vivek Murthy issued a report identifying loneliness as reaching epidemic proportions. In the spring of 2023, United States Dr. Murthy released an advisory called Social Media and Youth Mental Health, in which he said there is growing evidence that social media is causing harm to young people's mental health. The American Psychological Association (APA) issued its health advisory in 2024 requesting that the surgeon general place a warning label on social media platforms about the health hazards of excessive use of social media. This could be similar to the label required on cigarette packages warning about the dangers of smoking.

Social media use among young people is nearly universal now, based on surveys from the Pew Research Center. In 2022, up to 95% of teenagers surveyed (ages 13 to 17) reported using social media, and more than a third use it almost constantly.

Pew has also tracked which social media platforms (or "apps") teenagers use. In 2023, it found that the majority of teenagers—9 out of 10 for ages 13 to 17—use YouTube, followed by TikTok, Snapchat, and Instagram.

There are indicators that social media can cause profound mental health and physical harm to teens using social media. Murthy's advisory was based on a review of the available evidence. His report stresses that the brain is going through a highly sensitive period between 10 and 19 when identities and feelings of self-worth are forming. According to the report, frequent social media use may be associated with distinct changes in the developing brain, potentially affecting such functions as emotional learning and behavior, impulse control, and emotional regulation. The issue is the amount of time adolescents spend on platforms, the content they are exposed to, and how their online interactions disrupt activities essential for health, such as sleep and physical activity.

Over the last decade, increasing evidence has identified the potential negative impact of social media on adolescents. According to a research study of American teenagers 12-15, those who used social media over three hours each day faced twice the risk of having adverse mental health outcomes, including depression and anxiety symptoms. Although the minimum age most commonly required by social media platforms in the U.S. is 13, nearly 40% of children ages 8–12 use social media. That signals how difficult it can be to enforce these rules without parental supervision

Eating disorders are yet another concern. A review of 50 studies across 17 countries between 2016 and 2021 published in PLOS Global Public Health suggested that relentless online exposure to largely unattainable physical ideals may trigger a distorted sense of self and eating disorders. This is a particular problem among girls.

In addition, people who target adolescents—for instance, adults seeking to sexually exploit children, to financially extort them through the threat or actual distribution of intimate images may use social media platforms for these types of predatory behaviors.

According to Murthy's advisory, excessive social media use can harm teens by disrupting important healthy behaviors. Some researchers think that exposure to social media can overstimulate the brain's reward center and, when the stimulation becomes excessive, trigger pathways comparable to addiction.

Excessive use has also been linked to sleep problems, attention problems, and feelings of exclusion in adolescents—and sleep is essential for the healthy development of teens, according to the advisory.

The role of physicians in curbing use of social media

The American Academy of Pediatrics (AAP) offers a free digital tool called the Family Media Plan to help parents create a customized media use plan for their family. In addition to setting the age at which you plan to start giving your kids phones or internet access, this plan can be used to establish rules and educate children and teens about being careful about privacy settings, avoiding strangers online, not giving out personal information, and knowing how to report cyberbullying. Most pediatric experts agree that elementary school-age children should not have internet access using a device with all the social media apps.

One strategy is to make a social media plan for your family before the teenage years. Parents might consider starting with a dumbphone, or a cell phone that doesn't have email, an internet browser, or other features found on smartphones. The experts suggest delaying full access to smartphones for as long as possible. Go slow and start with a device allowing parents to add more apps as their child matures.

Experts suggest educating patients about the dangers of social media and steps they can take to control their children's use of it. This includes setting clear age-appropriate access limits, maintaining open communication, monitoring screen time, keeping devices out of bedrooms, and discussing online safety practices. Parents should also model responsible social media behavior themselves.

Experts are still debating the ideal age for a child to join social media, so parents should carefully consider their child's maturity level before granting access.

Responsible parents should set limits on screen time, designated social media hours, and specific platforms allowed.

Parents should discuss online safety, cyberbullying, privacy concerns, and responsible digital citizenship openly with their teens.

It is important to regularly check a teen's online presence but do so respectfully without invading their privacy.

Consider encouraging parents to keep phones and other devices out of the bedroom, especially at night, to promote healthy sleep habits. Research shows a relationship between social media use and poor sleep quality, reduced sleep duration, and sleep difficulties in young people. For teens, poor sleep is linked to emotional health issues and a higher risk for suicide.

According to the Surgeon General's report, on a typical weekday, nearly one-third of adolescents report using screen media until midnight or later.

Parents should try to create a culture at home where all phones are turned off by a certain time and at least one hour before going to bed. In my home, I had a policy that phones were not permitted at the dinner table or when the family went to a restaurant.

Parents should practice responsible social media use to set a positive example for their teens. For example, parents should not use cell phones at dinner time, and if they must take a call, it is polite to get up and walk away from the dinner table to talk.

Bottom Line: The healthcare profession has done an admirable job controlling infectious epidemics, including the AIDS virus, and creating vaccines for COVID-19 in a record six months. Now, we need to move on to social media epidemics: loneliness, burnout, and social media epidemics are as dangerous as infectious epidemics. Physicians need to take an active role in identifying these issues and discuss loneliness and social media use with patients and their families. Finally, physicians need to be concerned with their own mental health and find solutions for burnout in their own lives, which ultimately impacts the care we provide our patients.

_________________________

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.

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2025 offers a remarkable opportunity for concierge physicians to thrive

In health care change is inevitable, but for independent and employed physicians already facing financial headwinds that threaten to topple their medical practices, and the uncertain direction of a new administration, 2025 may feel particularly daunting. You don’t need a crystal ball to predict challenges ahead, but it may require a different kind of vision to see the ever-shifting regulatory, reimbursement and technological landscape as a path to genuine transformation. Almost five decades of experience advising physicians on career strategies has reinforced my view that chaotic times can bring enormous opportunity. Here’s why I believe converting to a concierge medicine practice offers physicians one of today’s (and tomorrow’s) most viable ways to remain or become independent, autonomous and empowered to practice their best medicine.

Challenge: Rising costs, declining reimbursements

There’s tremendous urgency for change as the environment grows increasingly unfriendly for doctors in private practice. Now representing just 22% of all practices, (Physicians Advocacy Institute Report 2022-24) the independent physician is in real danger of disappearing altogether. The combination of increased costs to operate a traditional practice and continual cuts to Medicare reimbursements have contributed to an overall 29% downward slide in Medicare compensation over the last two decades, according to the American Medical Association (AMA).

Reform may lie in the fate of multiple bills now in Congress. As I write this, the proposed 2.8% cut in the 2025 Medicare Physician Fee Schedule is set to go into effect on January 1st, 2025 unless the Medicare Patient Access and Practice Stabilization Act is passed, eliminating the cut and introducing a 1.8% increase. Additionally, bills to implement site-neutral payments have been proposed to remove one of the major financial incentives driving hospital consolidation, and much-overdue conversations are beginning to enact permanent inflationary payment updates to Medicare reimbursements. Commercial payers, caught in a harsh spotlight emphasized by December’s tragedy, may feel pressure to follow suit with measures to help relieve the financial burdens felt by physicians and patients. But will it be too little and too late?

I believe a better solution is offered through concierge medicine. In the more than two decades since its inception, this model has protected doctors from the tightening vise of declining reimbursements on one side and perpetually rising operating costs and inflation on the other. It has defined economic and professional freedom for our physician clients by providing them with a reliable, predictable, and most importantly, sustainable revenue base of membership fees. The pandemic offered further evidence of the model’s undeniable success, enabling our affiliated doctors to provide personalized care and prompt attention to their smaller patient panels without financial concerns from the sharp reductions in office visits and procedures. Post-pandemic, their practices have continued to grow, frequently necessitating the addition of a new physician to the team to meet increased patient demand.

Challenge: Restoring physician satisfaction

Reported levels of burnout have thankfully fallen below 50% for most physicians in the latest Medscape and AMA surveys, but as everyone agrees, there is still much work to do. Of particular note is that doctors involved in front line primary care, such as internal medicine, family medicine, pediatrics and OB/GYN are still experiencing higher rates of burnout. All physicians, however, including specialists in cardiology, endocrinology, rheumatology, neurology and pulmonology, continue to face ongoing financial, professional and personal pressures, and limited options for change. They can seek employment by a hospital system, join a larger multi-specialty group, leave medicine altogether - or convert to an alternative practice model.

At Specialdocs, we’ve long championed the concierge medicine solution, proudly bearing witness to its lifesaving impact for our affiliated doctors across the country. Whether a beleaguered physician mom struggling to achieve work-life balance, a discouraged midlife doctor reluctantly preparing for early retirement, or a young doctor frustrated with the impersonality of practicing in a large hospital system, conversion to our model has ushered in a new era of unparalleled career satisfaction.

Challenge: Adapting to rapid developments in technology

Technological practice advances have been a decidedly mixed bag for physicians over the years, bringing the success of remote monitoring for chronic conditions and convenience of telemedicine, but leaving the universally disliked imprint of cumbersome EHRs. It’s understandable that artificial intelligence, still in nascency, is alternately viewed as friend or foe in health care.

In 2025, the power of AI will likely increasingly be deployed to ease the administrative burden by streamlining tasks such as coding, scribing, and management of prior authorizations and reimbursement denials. With the ability to process and analyze information far more quickly than the human brain, AI’s potential to enhance diagnoses and treatments certainly feels exhilarating. But we must proceed with caution as being too early an adopter is frequently tantamount to being wrong. Hence, the imperative for well-defined guardrails around AI will become even more imperative in 2025, as well as a firmer understanding of what cannot be achieved– chief among them, replacing the sacrosanct physician-patient relationships built over a lifetime.

Challenge: Delivering value-based care

Since 2010, the shift from fee-for-service to value-based care has been widely promoted and pursued. However well-intentioned, value-based care may be the latest example of health care programs that overpromise and under deliver to all its constituents. A recent survey illustrates patients’ rising dissatisfaction with the U.S. health care system: for the first time in Gallup’s two-decade Annual Healthcare Poll, more than half of Americans rated the quality of health care as subpar, with 31% saying it is “only fair” and a new high of 21% calling it “poor.” Further, more than 7 out of 10 Americans believe the health care system has major problems or is in crisis.

I have long maintained that concierge medicine is the only model that really delivers on the pillars of value and quality in health care by benefiting physicians, patients, payers/employers and the health care system. Our physician clients treasure the rare gift of time to truly personalize their care; their patients value timely appointments and being seen before a serious illness develops; payers see fewer claims from concierge patients because of shorter hospital stays and decreased readmissions; and everyone benefits from the dramatic reduction in visits to the ER or urgent care facilities.

2025 can be a year of progress, action and optimism if you seize the opportunity for change.

______________________________

Terry Bauer is the CEO of Specialdocs Consultants, a pioneering company dedicated to transforming physicians’ professional lives since 2002 with a change to its industry-leading concierge medicine model. 

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