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.”
As my co-author, Paul DeChant, MD, MBA, and I stated in our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, “Rather than searching out systems issues, it may be tempting to think of the inherent stresses of practice, the traits and characteristics of physicians, mental health issues, and the effects of the culture of medicine as being the culprits. However, the widespread nature of burnout today indicates that clinicians with burnout are not ‘weak links’ but rather ‘canaries in the coal mine.’”
Why the instinctive focus on individual-based solutions? It may seem easier to create wellness programs and schedule mindfulness training to reduce stress than to identify and address the underlying problems in health care that fuel that stress.
Make no mistake, individual-based solutions are incredibly valuable. Practicing medicine is inherently stressful and that will always be true. All clinicians can benefit from strategies that boost well-being and stress resilience. However, relying on these strategies to “fix” burnout is short-sighted. It also fans frustration among physicians who are keenly aware of the system and workplace problems that hinder their daily work.
There’s another important reason to address the system and workplace problems fueling physician burnout. These problems affect others on the health care team and the most important person in the health care system—the patient. Fixing an inefficient scheduling system will reduce frustration for the physician and improve patient access and satisfaction. Developing a robust end-of-visit process will decrease the number of follow-up phone calls the physician needs to address and improve patient safety. An EHR with relevant reminders will reduce the cognitive load for physicians and improve the quality of care. Mitigating the documentation burden will allow physicians to spend more time speaking with patients and improve the patient’s experience of care. All these parameters are important performance metrics for any health care organization.
Addressing the system and workplace problems that are driving physician burnout is not a quick and easy task. It does take more time and effort than offering individual-level strategies. And there is no detailed guidebook on how to address these problems, because the answer varies across different clinical settings. A good place to start, however, is by querying clinicians about their top workplace frustrations.
Leaders can use surveys, focus groups, or one-on-one interviews to gather this information—or they can shadow physicians and nurses and see firsthand the issues and bottlenecks that are adversely affecting both clinicians and patients. Leaders can identify the most impactful problems—from the clinician’s perspective—and begin addressing them. Sometimes the fixes require large capital investments but quite often small, inexpensive changes, like rejiggering the daily clinic schedule to better accommodate documentation time, can have a big impact.
It’s true that fixing the underlying system and workplace issues is a more difficult nut to crack than providing individual-based support. But just as a bicycle needs both wheels to roll properly, burnout prevention requires both individual and system solutions. Clinicians need resilience support to be at their best, and they need a functional, efficient workplace in which to do their best work.
This post originally appeared in Worcester Medicine September/October 2017, published by the Worcester District Medical Society, a section of the Massachusetts Medical Society.