I am VERY resistant to burnout solutions that focus solely on the individual, as these seem to imply that the problem originates in the affected person. This approach pokes at a sore spot, because of the years I spent secretly worried that the reason I left practice was personal weakness or inadequacy, something I lacked or failed to do.
When in 2013, I ran across the research on burnout, I learned otherwise. By definition, professional burnout is caused by workplace stress. It is not due to a personal weakness, and it can happen to anyone.
My presentations and the book I co-authored make this point—that while individual-based solutions like mindfulness and medication practice are very valuable, they must not distract a health care organization from dealing with the underlying causes of stress in the workplace: broken processes, disrespectful culture, inefficient electronic health records (EHRs), lack of team-based care.
A recent interview caused me to rejigger my thinking on the topic. Tom Jenike, MD, is chief human experience officer at Novant Health, an integrated health system in North Carolina. (Love the title.) He began our interview describing an initiative at his organization that focuses on building resiliency in clinicians. A dime a dozen, I thought. Yet another health system placating frontline physicians and nurses with stress reduction techniques.
But within the span of the call, I changed my mind about the relationship between individual and systems solutions. Why? Because of the results—not just the engagement and satisfaction outcomes, but the culture and systems changes that the initiative has catalyzed.
The prevalence of burnout among physicians is estimated to be more than 50 percent and has grown in recent years. This alarming trend is largely due to changing patient demographics, increasing cost constraints, new federal and state regulations, and other external factors that have reshaped the daily work experience of physicians. Too often today, physicians spend more time on data entry than in direct patient care.
Professional burnout, as it has been defined by researchers, is a response to stress in the workplace. It consists of three components: emotional exhaustion, depersonalization or cynicism, and a low sense of personal accomplishment in one’s work. It is caused by a “mismatch” between the worker and the workplace in one or more of six domains: workload, control, reward, community, fairness, and values.
Burnout among physicians has significant negative consequences, including effects on patient safety, quality of care, the patient experience, and personal costs to the individual physician: depression, substance use, suicide. It also affects health care organizations and our health care system as a whole, as physicians choose to cut back on clinical hours, retire early, or leave clinical practice for other careers.
Effectively addressing burnout requires an understanding of its true causes—just as an accurate diagnosis of respiratory distress is essential to effective treatment. Despite the fact that the cause is quite often systemic, frequently individual physicians and the health care organizations in which they work respond as if it were a problem solely within the individual. Too often, physicians and leaders “neglect the organizational factors that are the primary drivers of physician burnout.”
When I speak to groups or write about physician burnout, I often hear back from clinicians who are thankful someone is validating their experiences. As one young physician wrote me:
“I went into medicine for the right reasons, but find myself, after only six years, approaching burnout. I felt like I would be a failure if I were to ever actually say [this] out loud … I feel frustrated by the lack of support from the administration."
Her email reflects the sentiment of too many physicians today who feel their organizational leaders simply do not care about the inefficiencies and systemic issues that are a major cause of the widespread burnout among clinicians.
Indeed, a new athenahealth survey of more than 1,000 practicing physicians found that physicians who gave low marks to the long-term leadership abilities of their administrators were more likely to report low confidence in their ability to do their job well and more likely to exhibit low levels of engagement — as defined by their willingness to go above and beyond in their jobs and to recommend and stay with their organizations.
Read more here.