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Matt Katz: Welcome to The Takeaway. I'm Matt Katz in for Melissa Harris-Perry today. Thanks for spending some time with us during this holiday week. It's no secret that healthcare workers are burnt out. More than two years of being on the front lines of a global pandemic have stretched nurses, therapists, hospital transporters and doctors to their breaking point, but this crisis did not begin with the pandemic.

Doctor 1: It's an infuriating system that we practice in.

Doctor 2: I don't think most doctors get burnt out by doctoring. It's everything else that comes along with it.

Doctor 3: In many ways, we will look in this era as a dark age of medicine. As amazing as the advances are in technology, we're failing in our ability to recognize our humanity.

Matt Katz: These are doctors who spoke with NBC News' documentary unit Left Field back in 2019, a year before the pandemic even began. Healthcare industry's long hours, low pay and convoluted service structures meant that the burnout crisis we're now seeing was long in the making. Then in 2020, the Association of American Medical Colleges projected that the US would face a shortage of up to 55,000 primary care doctors over the next decade. In many areas, the shortages are already here.

When doctors are overworked, patients suffer. A new survey from the research firm Commonwealth Fund has found that a majority of primary care doctors across 10 high-income countries, including the US, are burnt out and stressed, and it's affecting the quality of care they're able to provide. I spoke with someone who knows the demands of primary care doctors inside and out.

Dr. Blumenthal: David Blumenthal, president of the Commonwealth Fund.

Matt Katz: Prior to his role at the Commonwealth Fund, Dr. Blumenthal was a primary care physician himself. He gave us an inside look at a day in the life of a practicing family doctor.

Dr. Blumenthal: Being a primary care physician is an incredibly rewarding, but also an incredibly taxing. It is wonderful to have relationships with people who are also patients. I had patients who were-- I took care of their great-grandparents, their grandparents, them, their children and their grandchildren, and that was an incredibly gratifying experience. There's lots to recommend primary care, but one of the things that doesn't recommend primary care is the hamster-like treadmill that you're on.

You tend to see a patient every 15 minutes, maybe half an hour for a new patient. You know that your waiting room will fill up if you're late. Patients bring their problems. They want to talk, but life has to keep going. You don't want your waiting room filled with patients who are angry at you for being late. It doesn't pay very well. Day in and day out seeing patients for 9, 10 hours a day and then taking calls at night every 15 minutes, no stopping, recording your visits or writing them out between. It is absolutely exhausting. It is under-compensated in the American healthcare system.

Matt Katz: If a physician is under-compensated, exhausted, potentially burnt out, how does that affect patients?

Dr. Blumenthal: Well, it means you stop tuning in, you stop empathizing. You stop having the emotional energy that you should have for feeling what your patients are going through and what they need. You just want to get on to the next one because you want the day to be over. I think that isn't what we went to medical school to feel like, and it's not what it feels like when it's feeling good, when it's going well. It can happen, especially after 20 or 30 years, keeping empathy and emotional energy alive is a challenge.

Matt Katz: I'm curious how physicians in the United States compare to those elsewhere. In your report from the Commonwealth Fund on primary care provider burnout, how did the US stack up compared to other countries?

Dr. Blumenthal: Well, let me start with the context that the US primary healthcare system is really deficient compared to most other countries. We don't have enough of them, they are not valued, they don't get paid adequately compared to other specialties. That is not true in many other countries. Now, every country is a little different, but almost every successful healthcare system has a vibrant primary healthcare system, a functional primary healthcare system in which patients relate first and foremost to a family physician, and then, only then move on to see specialists. That is often not the case in the United States.

Some countries like England, for example, have historically had a terrific primary care system, but have begun to play with it in ways that aren't very helpful. In contrast to that, the Netherlands has a really terrific one, which showed up, by the way, in our cross-national surveys. The United States has less adequate primary care than virtually any other country that we would want to compare ourselves to.

Matt Katz: You found that in nearly all the countries that you studied in the report, younger primary care physicians were more likely than their older peers to be stressed out, to report emotional distress. What accounts for that, and why is that consistent from country to country?

Dr. Blumenthal: This was a survey that we did of 9,500 primary care physicians in 11 countries during COVID, and was focused on the effects of COVID. Younger primary care physicians are disproportionately women. That is true across the developed world. During COVID, women, as we know, in many parts of our economy had a particularly stressful time. They were taking care of children at home, homeschooling them, worried about the safety of their children, having to not only provide childcare, but basically be full-time parents.

I think that was one of the most important factors, or at least an important factor, in seeing that across the developed world, younger physicians, who are disproportionately female, were much more likely to be stressed and burned out. There are other reasons why younger physicians, male and female, would be stressed and burned out. They also, males and females, are establishing their careers, and don't see retirement, don't see light at the end of the tunnel.

I can imagine that if you're 10 or 12 years into a practice, and you think this is going to be my life for the next 30 years, that could be emotionally very difficult. Whereas if you're 60, 65, you know you're at the point where there is a limit. There's a time when you are going to get out, regardless of whether COVID continues or not.

Matt Katz: I think many of us have this impression that becoming a doctor is really prestigious and highly-compensated. It's the job that every parent wants to brag about that their kids have. Given what we're talking about, and given the grueling nature of being, specifically, a primary care physician, is that simply no longer the case?

Dr. Blumenthal: I don't think that we're in danger of losing medicine as a profession to attractions to other fields. There is a kind of rhythm to the rate of applications to medical schools. When the economy is booming and they're seeing lots of other options for earning a great income, medical school tends to be a little less attractive. During harder economic times, it tends to be somewhat more attractive.

I do also think that there has been, in the United States, an increasing sense that medicine is not as rewarding a career as it used to be because of the administrative and regulatory pressures that now affect the daily practice of medicine. However, if we continue to expand medical schools, we would still be able to fill them.

Matt Katz: Who takes care of the caretakers? What do we know about how doctors prioritize their own mental health care, especially as they experience this kind of burnout that we've been talking about?

Dr. Blumenthal: Well, our survey showed that very few physicians who were experiencing emotional stress actually sought help. It's hard to generalize about this, but my impression from watching my colleagues and being part of the medical community is that physicians are not any more likely, or maybe less likely, than the average person to seek help when they're stressed.

I think that your training encourages you to see yourself as stronger, and more resilient, and more capable of managing stress than the average patient that you see, and that being strong and seeming strong is even part of your role in giving patients confidence in your ability. I don't mean to say that all physicians are resistant to psychological or psychiatric care or behavioral health interventions, but I do think that there is no greater sympathy or comfort with that than there would be in the community at large.

Matt Katz: Is there a shortage of primary care physicians in many communities throughout the United States, and does that in turn contribute to the stress that some of these physicians feel in places where there might not be enough doctors to go around?

Dr. Blumenthal: Absolutely, there is. I live in Boston. Boston is a huge medical center and magnet for talent. The single biggest question I get as a health professional is, can you help find me a primary care physician? We then get into the business of begging people we know, who have closed practices, to take on another patient. It is very hard to find primary care, even in a medical center like Boston. If you go to rural America, primary care physicians are next to almost non-existent. I think they're rare almost everywhere. We have done this to ourselves by, year after year, refusing to do meaningful interventions at the policy level, at the professional level.

Matt Katz: What are those solutions? What do we do, Dr. Blumenthal, about this shortage, about this stress? What are the long-term policy ideas that you may have to make primary care a viable profession and health care more equitable for patients and providers?

Dr. Blumenthal: First and foremost, we need to pay more. We need to give primary care physicians the sense that they don't have to see 10, 20 patients a day in order to have a viable income. I think primary care physicians should have ready opportunities to work in integrated care settings, where they have access to specialists, including behavioral health providers, so that they can provide good care to their patients. So that their patients can be treated for their psychological problems quickly and easily, and physicians can devote themselves to the tough problems that primary care has to deal with. The patients who have multiple chronic conditions, where there's a huge amount of judgment and wisdom required to balance the medications, and the lifestyle requirements, and the homecare requirements that those patients need.

Have some of the less complicated work be done by nurse practitioners, physician assistants, medical assistants, who can manage that very, very competently, and leave physicians more time to devote to the very sick patients, so that you have an hour with a sick patient rather than half an hour. That would give physicians a chance to devote themselves to the totality of the patient, to listen, and not to feel like they have to push the patient out the door before it's time.

Matt Katz: Dr. David Blumenthal, former primary care physician and current president of the Commonwealth Fund, thanks for your time today. Dr. Blumenthal, we appreciate it.

Dr. Blumenthal: My pleasure.

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