Dr. Henry Paul, MD

Psychiatrist, Author and Educator

PHYSICIAN BURNOUT

January 15th, 2016

“The number of U.S. physicians who say they are suffering “burnout” has jumped to more than half of doctors as the practice of medicine becomes more complicated and millions more Americans gain health coverage under the Affordable Care Act.” FORBES, 12/23/15

A disturbing trend is facing the medical community as we kick-off 2016. A recent report by the MAYO Clinic says, “doctor’s work life balancing is worsening”. The new study says the percentage of physicians who say they are suffering burnout rose to 54% in 2014 from 45% in 2011.

The report doesn’t specifically address the Affordable Care Act as the problem, but it does attribute the situation to more people getting healthcare and more paperwork involved with the new healthcare regulations. Where we were seeing a doctor shortage before the Affordable Care Act, this is only going to make that situation worse.

I wrote in October about the shortage of psychiatrists and how the profession was experimenting with telepsychiatry. Long before there was a national shortage of psychiatrists, there was a dire shortage of psychiatrists in rural areas of the country. That trend led the profession to experiment with new ways to treat patients. Hence online sessions with patients. But that has raised its concerns particularly with HIPAA, which requires the protection and confidential handling of protected health information.

Now, the trend we have seen in the psychiatric profession is bleeding over to the entire medical profession as a whole. In March 2015, The Washington Post reported by 2025 the doctor shortage in the United States could be as high as 90,000.

In a statement to Reuters News Service, lead author Dr. Tait Shanafelt, of the Mayo Clinic in Rochester, Minnesota said, “Things are unfortunately getting worse for physicians.”

“Of the 6,880 doctors who responded to the 2014 survey, about 47 percent reported high emotional exhaustion, about 35 percent felt depersonalized or saw less value in their work and about 16 percent felt a low level of personal accomplishment,” Reuters reported on the study.

What is scary about the shortage is that it will create a critical need for specialists to treat an aging population that will increasingly live with chronic disease. According to The Washington Post, the report by the Association of American Medical Colleges says, “the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.”

“An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand,” Darrell G. Kirch, the AAMC’s president and chief executive, told reporters during a telephone news briefing.

So what does this mean for the future of medicine? It will create longer wait times to get appointments, and most likely you will be traveling farther to see a specialist. More patients will be seeing physician assistants, too. For psychiatry, as well as many other medical professions there will be an increased use of concierge medicine, and you will have to get used to telemedicine for diagnosing and treatment.

LINKS
The Doctor Can See You Now – On Your Computer!
U.S. faces 90,000 doctor shortage by 2025, medical school association warns
The Complexities of Physician Supply and Demand: Projections from 2013 to 2025

TREATING OPIOD ADDICTION UNDER OBAMACARE

December 31st, 2015

There has been a movement afoot by physicians, social workers, and consumer advocacy groups to require all healthcare plans on the federal exchange to cover medications that are used to treat people addicted to painkillers.

The federal government has declared opioid addiction a “public health crisis,” and the Centers for Disease Control and Prevention (CDC) reported that more than 28,600 people died in 2014 due to overdoses from prescription painkillers, other opioids, and heroin. From Congress right down to local government officials everyone is trying to find solutions to handle the growing opioid and heroin epidemic. To turn this around is going to take a lot of education, compassion and better treatment options for those addicted, and support and guidance for those family members, friends, and loved ones who are trying to help.

It certainly would be a wise choice to cover the cost of the medication-assisted treatment. For so many addicts relapse is more common than you’d think. To begin with, it is hard to get into a treatment program due to the lack of inpatient and outpatient treatment programs, and if you do get into a program, once you’re through the cost of staying drug-free can become a burden too.

Drug addiction treatment has been shown to reduce associated health and social costs by far more than the cost of the treatment itself. According to Drugabuse.gov, the average cost for one full year of methadone maintenance treatment is approximate $4,700 per patient (2012 statistic). That is a lot less than incarcerating someone at a cost of nearly $24000 a year. And let’s face it, many of those addicted to painkillers are never going to get the necessary treatment in prison to deal with their addiction and turn their lives around. Jails are not, and never will be, appropriate treatment centers for addicts. I don’t believe that prison is an alternative to a drug treatment program. We need more treatment centers, more programs and more money to fight this epidemic. Call your elected officials and let them know that you want medication-assisted drugs covered under the healthcare bill.

LINKS
Opioid addiction treatment argued as ‘essential’ insurance benefit
Is drug addiction treatment worth its cost?
Drug Overdose Deaths by State, US 2013 and 2014

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

HEAD-ON – CONCUSSIONS, KIDS AND THE ALL-AMERICAN PAST TIME

September 30th, 2015

Very sad news this past weekend as yet another high school athlete has died from injuries sustained while playing high school football. This time, it was football. It has been reported by several news outlets that quarterback Evan Murray, a senior at Warren Hills Regional High School in New Jersey, died Friday night. He was just 17 years old.

More than one million high school students in the United States play football each year. And, although other sports have seen their fair share of deaths and life-threatening injuries it seems that football raises the most concerns. And why not? The NFL has put a lot of focus on concussions making it a top priority for protecting their athletes.

Here are some basic facts on concussions from the CDC:

All concussions are serious.
Most concussions occur without loss of consciousness.
Recognition and proper response to concussions when they first occur can help prevent further injury or even death.

The CDC is taking a proactive position on dealing with concussions and has developed an online program called Heads Up to help ensure the health and safety of young athletes. The HEADS UP Concussion in Youth Sports provides coaches, parents, and athletes important information on preventing, recognizing, and responding to a concussion.

Other organizations, including the NFL, are also exploring safer ways to tackle. The Seattle Seahawks put out a YouTube video on “Hawk Tackling” that focuses on tackling with the shoulder.

The bottom line is that how to tackle is going to be debated for some time. Whether “Heads Up” or “Hawk Tackling” are better will be a matter of time before anyone can tell. The hope is that by teaching the young kids that begin to play to keep their heads “out of the tackle” that over time the game will become safer. The Chicago Tribune ran a story last week (see link below) that looked at the pros and cons to teaching the different styles of tackling to kids.

While the debate rages on, I think that tackle football should be banned. High school football should be played as touch football. I know this is a lot less exciting, but it is also less fatal. Another fact to consider with school-age children playing tackle football is the lack of education, equipment, and money that many schools have to run a safe program.

As much as I would like to see touch football the reality is that tackle football is what is being played right now. That being the case, coaches and parents need to know the inherent dangers of hard hits leading to concussions and other serious back, neck and internal organ damage. Parents and players need to know how to properly perform a concussion evaluation and should be familiar with the school’s and the league’s injury and concussion policies. Below are some links to help educate parents, coaches and students about concussions.

LINKS:
Chicago Tribune: New tackling methods aim to make football safer, but proof still lacking
CDC facts on concussions
CDC Heads Up Concussion in Youth Sports
CDC Heads Up Youth Sports Online Training – 3o minute online class.
CDC Concussion Information Sheet

PLUMPED UP LIPS AND BIGGER BUTTS –TEENS ARE DRIVING PLASTIC SURGERY

August 26th, 2015

“THE CELEBRITY DRIVE FOR PERFECTION IS TRICKLING DOWN TO THE MASSES, AND EVEN TEENAGERS ARE GETTING PLASTIC SURGERY IN RECORD NUMBERS.” New York Post, August 23, 2015

Eighteen-year-old, Kylie Jenner has heads turning. She is one of the top ten most followed people on Instagram with over 33 million followers, and she is the number one most viewed person on Snapchat. So when Kylie Jenner admits to having plastic surgery – teenagers listen and want it too!

Although Jenner has only admitted to plastic surgery for her lips, there is speculation that she has done other surgeries including on her breasts and butt. With the social media following she commands, Kylie Jenner is a marketing machine. If Kylie uses it most likely so will the rest of young America. One simple Tweet or Facebook post from Kylie and millions listen. She is a trendsetter.

So this week in the New York Post it was not a surprise to see that teenagers are behind the spike in plastic surgeries. In 2013, according to The American Society of Plastic Surgeons, nearly 18,000 teen’s ages 13 to 19 got a form of Botox.

According to the article, “The 2014 Annual American Academy of Facial Plastic and Reconstructive Surgery Survey blamed “the rise of the selfie,” and there may be something to that.”

Look, there may be something to that. Many people aren’t into selfies or for that matter being in pictures at all. But this is a whole new generation. A young generation that photographs everything and posts it immediately for the world to see. With that comes much self-examination of one’s physical attributes and the need to make them better, or as many say to “correct” them.

So what should parents do when their teen wants plastic surgery?

Parents should think long and hard before giving the okay for plastic surgery and so should the surgeons. Unfortunately, they often do not. Surgery is a major decision with some physical risks, even serious ones. But on a psychological level surgery can also be risky. What I mean is that the motives for surgery can often be low self-esteem or anxiety about identity. Surgery will not cure that. As a matter of fact having surgery can often make these issues worse as they hold out the illusion that there are quick cures (in a quick cure culture) and the disappointment reactions are often disastrous. What’s worse is that the teenager misses out on learning that working on personal problems is a more difficult task but a more rewarding avenue to feeling better. Our society has moved more and more towards superficial cures for almost everything. Old fashioned hard work, slower but more rewarding efforts and a slow build-up of lasting self-esteem still outrank the quickie interventions. Just ask any drug addict who went for a quick cure for the pain that was being suffered and I think it will be obvious that there is no short cut.

HEADING OFF TO COLLEGE AND THE EMPTY NEST

August 25th, 2015

Each year about two million students go to college. Certainly attending college has real benefits: a typical college graduate earns from a half million to one million dollars more in their lives than students who don’t go to college. Despite the enormous expense of college, parents often see it as the most important investment they are going to make in their children’s lives. It is an enormous investment, but its success doesn’t depend on the prestige of the institution. A teen can be just as successful going to a state university as an Ivy League school.

As your child leaves for college this fall, there are some anxieties that you and your teen will go through. Even if it is a local school that your teen attends while living at home, it still represents a major, if not final, separation children make from their parents.

For parents who were actively involved in their teen’s life, this is a difficult time. The “empty nest syndrome” is a scary thought. As a parent, you will no longer play the role of primary caretaker or be the major figure in your child’s life. Parents who live through their children vicariously will have a more difficult transition. There is a fear of becoming unimportant in their child’s life. Many parents who have focused most of their lives on their children have avoided attending to other things such as their marriage, a career and their health. This is a great time for parent’s to reconnect with one another, pursue new (or return to) hobbies and activities, get into an exercise class, or return to work or make a career change.

Parents who worry that they will suddenly become unimportant in the lives of their new college student will soon find out that this is far from the case. This is not only because of the financial support most parents offer, but because of the help that this now “young adult” will need through any number of social, academic, and personal challenges that come along with teenagers transitioning to adulthood.

When your child leaves for college, encourage them to have reasonable expectations and to be prepared for new challenges. Many teens feel great anxiety when going off to college, even if they hide it. Many parents also fear the separation. For parents take this opportunity to enrich other areas of your life. It can be a very rewarding time. Remember, though, your child will still need you! As much as the everyday has changed you are transitioning into a whole new relationship with your child. Embrace it – the best may be yet to come!

MENTAL ILLNESS AND THE ADA

March 31st, 2015

Did you know that Mental Illness is among the illnesses and disabilities covered by the Americans with Disabilities Act? Not many people know it. The United States government covers a lot under the ADA. It includes mental health disorders that fall within the guidelines of the ADA but it does not list specific mental illnesses.

Under the ADA, a person has a disability if they have a physical or mental impairment that substantially limits one or more major life activities, a record of such an impairment, or is regarded as having an impairment.

It is great that the ADA can cover mental illness, but the scary part is that you have to tell others that you have it. Telling your co-workers or your boss can be the hardest. There is no right or wrong answer about telling your boss or others that you have a mental disorder. Although, if suddenly you are unreliable, your work drops off, and you no longer are the team player you used to be, then your boss will notice.

The ADA protects you from being fired from your job or rejected for employment. It also provides accommodations at work. Again, this is helpful, but you have to be willing to reveal your diagnosis. It most likely will depend on the overall benefit to you at work. Some people with mental health impairments will have a disability under the ADA and some will not.

The World Health Organization predicts that by 2020, mental illness will be the second leading cause of disability worldwide, after heart disease. Right now major mental disorders cost the nation at least $193 billion annually in lost earnings alone, according to a new study funded by the National Institute of Mental Health, and the direct cost of depression to the United States in terms of lost time at work is estimated at 172 million days yearly.

Here is a list of the possible mental disorders that could fit under the ADA. Notice I said “could” because the decision is based on your symptoms and the effect they have on your ability to do your job.

I want to see a national dialog about mental health that helps employers to understand the importance of having an employee who is both physically and mentally well. In order for employees to benefit from the ADA they have to be willing to share their diagnosis. Sadly, it is still a reality in America today that people with mental illness are somehow labeled or looked upon differently. I am proud to say that we are making strides in this country to change those stereotypes. I only wish it could happen faster. Putting mental health problems on an equal footing with physical illnesses will, in the end, benefit all.

Click here to read one woman’s struggle to decide to reveal her Bipolar Disorder diagnosis.

Disclaimer
This blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.