By Chuck Buck for ICD10 Monitor
EDITOR’S NOTE: Opinions expressed by contributors are their own.
Following the sea of knitted pink hats worn by some of the hundreds of thousands of women who took to the streets in cities across the country and around the world in January 2017 to stand up for women’s rights, a recent Doximity research report on the gender wage gap among physicians presented itself as one more thread in the national fabric of questions regarding the issue.
Was it an “a-ha” moment to some who read the report, which revealed an average national wage gap between male and female physicians of $105,000 per year? Was it old news to some? Or was it received with a silent acceptance of the status quo?
Is this pressure to keep wages lower among female physicians than their male counterparts being sustained by men who occupy the euphemistic “C-suite?” Or, as one female physician described it to me, “the good ol’ boys club?”
Regardless, this income disparity could also contribute to physician burnout: a diagnosis that is more frequently seen among female physicians than their male counterparts.
“The gender pay gap across all professions in the United States has been reported to be about 77.5 percent – in other words, women make on average just over three-quarters as much as men, when adjusted for all other factors,” said Stephanie Thompson, an activist and writer. “In the most recent surveys available, women’s earnings were lower than men’s earnings in all states and the District of Columbia, according to the Census Bureau.”
In 2017, the national gender gap for physicians increased, as female doctors earned 27.7 percent less than their male counterparts – an even bigger gap than the national average.
The rallying cry for women’s rights continues to grow. There has even been movement toward reviving the Equal Rights Amendment (ERA), with the Nevada legislature last year becoming the first to ratify the ERA after the expiration of the original deadline – 45 years after Congress submitted the amendment to the states. New ERA legislation is currently pending in several other states.
“This news (the wage disparity) comes at a time when the topic of women’s rights, both in and out of the workplace, has never been more volatile, and women’s voices are being heard as never before,” Thompson believes. “The results of the Doximity study are especially notable when compared to other recent studies comparing patient outcomes, like one published in 2016 in JAMA Internal Medicine, that show patients cared for by female doctors fare better than those treated by men.”
According to Thompson, Harvard researchers were quoted as estimating that “approximately 32,000 fewer patients would die if male physicians could achieve the same outcomes as female physicians every year.”
Thompson also cited a Canadian study, published in 2017 in the BMJ, that determined that patients of female surgeons “tend to have lower death rates, fewer complications, and lower readmissions to the hospital a month after their procedure, compared to the patients of male surgeons.”
“Has the time come to acknowledge that women in healthcare might be treated worse than their male counterparts but still be achieving better results, on average – all while being paid significantly less?” asked Thompson. “And is that why burnout affects so many woman doctors?”
Burnout among coders is also occurring. And healthcare educator and consultant Laurie Johnson, herself a former coder, reports that it is can be experienced by those who seem to work 24/7. Johnson also cites a number of contributing factors associated with burnout.
“In the coding world, experience, flexibility, and expertise are sought,” she said. “When leaders recognize these attributes in coders, leaders tend to lean more heavily on these people.”
Overwork, which can be mandatory or internally driven, leads to coder burnout, according to Johnson. She said when overwork is paired with personal responsibilities, the effects can be physical as well as mental, but coders should also be alert to their susceptibility to burnout.
“Coders should assess how many hours they have worked at their full-time position, as well as any per diem positions,” Johnson advised. “They need to ask themselves, when was the last time that they laughed; how long has it been since they just relaxed?”
And, of course, there are ICD-10 codes for burnout – and each code represents a progression of the diagnosis.
“With regards to the ICD-10-CM codes, I think that the progression to coder burnout would be the initial mental and physical strain (Z73.3), then there would be the realization of the lack of relaxation (Z73.2). The next step could be work schedule pressures (Z56.3), then behaving in a type A pattern (Z73.1), until the coder is in full burnout mode (Z73.0),” Johnson said. “Of course, other issues may play a role in burnout, such as lack of physical exercise (Z72.3), inappropriate diet and eating habits (Z72.4), antisocial behavior (Z72.81), as coders are typically introverted, gambling and betting (Z72.6), or low income (Z59.6).”
ICD10monitor reported on burnout in its April 18, 2017 enews edition. In an article by Sarah Laird of Novant Health, Laird reported that coder burnout marks an opportunity for leadership to recognize and assist in its prevention.
“It is important for leadership to recognize the potential of burnout for their own staff and have plans to prevent it,” Johnson said.