Physician Burnout: A Public Health Crisis?

Health care CEOs look for solutions

In a survey of U.S. physicians, more than half reported experiencing at least one symptom of burnout—a substantial increase over previous years—indicating that burnout among physicians is becoming a national health crisis, according to a Health Affairs blog. Leadership is needed to address the root causes of the problem and to reposition the health care workforce for the future, the authors contend.

Burnout is an experience of emotional exhaustion, depersonalization, and feelings of low achievement and decreased effectiveness. Although the focus of the blog was on physicians, the authors noted that burnout is also a serious problem for nurses and other health care workers.

According to the article, the spike in reported burnout is directly attributable to the loss of control at work; to increased performance measurement (quality, cost, patient experience); to the increasing complexity of medical care; to the implementation of electronic health records (EHRs), and to inefficiencies in the practice environment, all of which have altered work flows and patient interactions.

“The high level of burnout among physicians should be considered an early warning sign of dysfunction in our health care system,” the authors write. “Professional satisfaction for physicians is primarily driven by the ability to provide high-quality care to patients in an efficient manner. Dissatisfaction is driven by factors that impede this effort, including administrative and regulatory burdens, limitations of current technology, an inefficient practice environment, excessive clerical work, and conflicting payer requirements.”

One of the key contributors to burnout involves EHRs. While they have the potential to make a major contribution to patient safety and enhanced coordination of care, EHRs also have radically altered and disrupted established workflows and patient interactions, have become a source of interruptions and distraction, and are very time-intensive, the authors note.

Their blog suggests that “health care delivery organizations, organized medicine, payers, and other interested parties need to work with EHR vendors to improve their product offerings, which could reduce EHRs’ burden on physicians.”

In September 2016, the CEOs of 10 leading health care delivery organizations held a meeting at the American Medical Association (AMA) headquarters in Chicago, where they reviewed the extent of physician burnout in the U.S. and the consequences for health-care delivery systems.

During the meeting, the executives shared effective interventions and successful practices from their institutions. They acknowledged that each CEO needs to address the specific issues that contribute to burnout in his or her organization. At the end of the meeting, the CEOs made commitments to:

  • Regularly measure the well-being of the physician workforce at their institutions using one of several standardized, benchmarked instruments.
  • Where possible, include measures of physician well-being in their institutional performance dashboards along with financial and other performance metrics.
  • Evaluate and track the institutional costs of physician turnover, early retirement, and reductions in clinical effort.
  • Emphasize the importance of developing leadership skills for physicians and managers.
  • Understand and address more fully the clerical burden and inappropriate allocation of work to physicians that are contributing to professional burnout.
  • Support collaborative, team-based models of care in which physician expertise is maximally used for the patients’ benefit, with tasks that do not require the unique training of a physician delegated to other skilled team members.
  • Encourage the government and regulators to address the increasing regulatory burden that is driving inefficiency, redundancy, and waste in health care and to proactively monitor and address new unnecessary and/or redundant regulations.
  • Encourage and support the AMA and other national organizations to work with regulators and technology vendors to align technology and policy with advanced models of team-based care and to reduce the burden of EHRs on all users.
  • Support the AMA and other national organizations in developing further initiatives to make progress in this area by compiling and sharing best practices from institutions that have successfully begun to address burnout, profiling case studies of effective well-being programs; identifying efficient changes in task distribution; and outlining a set of principles for achieving the well-being of health professionals.
  • Continue to educate fellow CEOs as well as other stakeholders in the health care ecosystem about the importance of reducing burnout and improving the well-being of physicians as well as other health care professionals.
  • Use organizational research at their centers to determine the most-effective policies and interventions for improving professional well-being among physicians and other health care professionals.

Sources: Health Affairs; March 28, 2017; and Mayo Clinic Proceedings; December 2015.