Jeremy Olson's excellent article about doctor burnout (" 'Medicine has become factory work," May 24) covers the stresses involved. But the folks quoted as recommending breathing deeply or calling a friend at 3 a.m. miss a serious problem. The medical workforce has been speciously demonized as the medical system's cost culprits.
The government-HMO corporation self-proclaimed mega "payers" make three evidence-free claims. First, that medical cost inflation is due to poor and profligate care by culprit clinicians driven to ignoble avarice by an evil fee-for-service (FFS) system. Yet FFS pay does not cause inflation in any other economic sector. Second, that costs could be contained by transferring the mega-corporation gatekeeping role to mini-clinicians at the bedside by fixed capitation payments ("payment reform") for servicing corporation and public-sector populations. Third, that physician gatekeepers could gain redemption, when their avarice is enlisted at the bedside in the more noble cause of conserving society's scarce resources, i.e., mega-corporation and government agency money.
Gatekeeper bonus pay contingent on restricting patient access to medical care is simply profiteering wrapped in noble-cause sophistry. It creates a patently corrupt financial conflict of interest between gatekeeping doctor and patient.
Burnout is one symptom of a corrupt cost-control system.
Dr. Robert W. Geist, St. Paul
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Burnout among physicians is nothing new, but the increased prevalence and new causes are the story largely missed in the May 24 article. Health care is always intense, but new requirements for documentation underlie the increasing epidemic. "Documentation" means complying with requirements from the Legislature, the Department of Health and insurance companies for evermore data on patient care in the specious name of "quality improvement," which is largely unproven, and "cost reduction," which is likely to be the opposite in reality. This year, legislators failed to come up with even a partial solution; shame on them.
The article portrayed some stress-reduction activities like a relaxed breathing exercise for docs — how pathetic. Our state needs more-effective strategies to stem this epidemic by reducing bureaucratic harassment of physicians.
Dr. Richard Morris, Maple Grove
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The text of the article states that paperwork was the most common stressor in the Vital WorkLife Survey. However, the graphics provided show the most frequent source of doctor stress/burnout was health care reform (48 percent), which merited not a single word of discussion in the body of the article. Was the graphic in error? Or will there be a follow-up article that addresses the contribution of health care reform to doctor burnout? Or am I left to assume there is an underlying bias involved in neglecting to address the top source of stress identified in the survey?
Dr. Jean Lewis, Rochester
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I believe physicians are just the tip of the iceberg for stress and burnout in today's health care arena. Consider all those professions and services across the continuum of health care, in any setting where health care is provided. The demand for the dollar, changing policies and culture of our health care delivery systems, and complexity of needs in patients served are certainly simplified etiologies of the identified stress and burnout. What and where are the solutions? One has to start someplace. Who is sitting at the table to determine and initiate necessary steps to ease stress and burnout without another agenda? Where is "do no harm?"
Susan M. Carolan, Blaine
The writer is a retired public health nurse.
SCHOOL SUSPENSIONS
I'd like to learn more about how teachers' gender matters
Two details jumped out at me from the May 24 article "Minneapolis school suspensions soar." One was the statement, in the context of the number of suspensions of students of color, that said, "In Minneapolis, the majority of teachers are white women and in classrooms with students of color," attributed to an advocate for reducing suspensions. Not knowing how editors direct reporters, I wonder why the reporter didn't follow that statement with a question as to how the gender and race of the classroom teacher figure into suspensions, particularly since earlier the article had established that Minneapolis teachers are highly trained with regard to these issues. Beyond being "white" and "women," these teachers have degrees and many hours of professional development, much of it focused on work in diverse classrooms.
The second detail was in the second paragraph, where the reporter cited the number of times that "[t]eachers sent students home." In the school where I work, the decisions about removing students from instruction and sending students home are made by teams of administrators, support staff and behavior specialists, not teachers. Again, all of these personnel are chosen for their qualifications, all are highly trained, and all in my experience, whether I have agreed with them or not, care deeply about ensuring the best service for the student.
Thomas Odendahl, Minneapolis
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Why is there such an uproar about suspensions? Students must respect authority and be at school to learn, without disrupting the teacher or other students. Suspensions are straightforward — obey authority and obey rules, or be suspended. Schools are full of loving, caring staff and should be given the credit they deserve.
Peggy Jantscher, Plymouth
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To the Minneapolis school administration, is it just about numbers? Have we fallen to that simplistic concern rather than the underlying causes for bad behavior? This is the same focus police get over their arrest figures. This parallels the University of Minnesota issuing "campus alerts" to crimes but being unwilling to list key suspect data. (The fear was that the public would think negatively about an entire race.) Similarly, we have learned that people of color experience a disparity in transportation time and distance. That is to be expected if you travel long distances between work and home, no matter the race. Have we lost our ability to think clearly? I think the readers know the answer. The solution isn't pre-K either; it's better parenting. Let's put our efforts in the right direction rather than creating a false narrative.
Joe Polunc, Cologne
AGING INFRASTRUCTURE
Design flaw or not, I-35W bridge deterioration was not addressed
In what universe does a gusset plate not age simply because it was "a design flaw"? ("About that aging-bridge example," D.J. Tice column, May 24). The fact of the matter is the plates on the Interstate 35W bridge aged at a faster rate because they were underdesigned and not up to the task. We also know there were other structural elements in the bridge that aged faster due to that design flaw.
For some reason, we have this belief that only ravages of nature can take down a man-made structure of this magnitude. In truth, it was humanity that sped the aging and decay of the I-35W bridge. It started with the under-designed gusset plates. It continued for years with inspectors who either didn't understand that deficiency or underestimated the stress it caused. It was subjected to increased traffic and heavier vehicles over the years. Finally, it ended with a contracted firm that advised changes to add support to the structure and a government so focused on cutting spending that it kicked the can down the street.
