The Complete Guide
Table of Contents
What Causes Physician Burnout?
Physicians have one of the most respected professions, not only in the United States but around the world. They have even taken an oath to solidify their commitment to helping people feel better when they’re sick, offering advice on preventing illness, providing recommendations for treating acute and chronic diseases and much more.
Accomplishing all this isn’t done quickly, though. Physicians work an average of 51 hours per week. In addition to focusing on patient care, they’re responsible for ordering and interpreting diagnostic tests, prescribing medications, updating medical charts, counseling on proper nutrition and hygiene and collaborating with other clinicians to ensure continuity of care. Most spend about 1.5 hours online daily conducting research because it’s crucial they’re informed about new or changing medications or treatments, procedures and diagnoses and educated on issues affecting the healthcare and insurance industries.
Not surprisingly, this heavy load of responsibility leads to burnout for a high number of physicians. Many doctors in the U.S. report burnout at rates two times greater than non-physician working adults. Studies show that, compared to other professionals, doctors disproportionately struggle with work-life balance and report symptoms of burnout and even severe emotional exhaustion.
The American Medical Association defines physician burnout as long‑term stress reaction characterized by depersonalization. With so many hours spent in the office and on-call, both day and night, doctors often take little time to focus on their well-being. Tragically, an estimated 300-400 physicians each year commit suicide.
A study surveying more than 3,700 physicians in nearly every specialty, work setting and region of the U.S. found that although more than half of respondents reported that their workload had impacted their mental health, only 17 percent have sought help, a mere 16 percent have considered meeting with a mental health professional and approximately 66 percent said they would not consider meeting with one at all. Individuals in this profession are less likely to seek treatment for burnout due to fear of licensure problems, the “physician personality,” a programming to cope alone, survival mentality and a “self-doubt, imposter syndrome.”
This problematic issue might be one of the reasons fewer Americans are going into the field of medicine. The Association of American Medical Colleges (AAMC) predicts a shortage of up to 105,000 doctors by 2030, including an estimated 43,000 in primary care.
Being a physician is a demanding job. It consists of long hours, high stress and very little room for error. No matter the specialty, even the most experienced doctors are encumbered with the pressure of numerous responsibilities that affect their patients’ physical and mental well-being. From negotiating a work-life balance and dealing with sometimes unsatisfactory leadership to handling an assortment of administrative tasks, these respected professionals face a wide array of issues that often contribute to physician burnout.
The Practice of Clinical Medicine
As Dike Drummond, M.D., an author, speaker and consultant on the topic of physician burnout, explained, “Our practice is the classic high-stress combination of great responsibility and little control. This stress is inescapable as long as you are seeing patients, no matter what your specialty.” As Dr. Drummond notes, the practice of clinical medicine is one of the only causes of burnout most physicians learn to cope with in their training
Some clinicians posit that nearly all physicians will experience burnout at some point in their career due to the profession’s inherently and overtly stressful nature. Others assert that the goals of the IHI Triple Aim won’t be achieved until a fourth one focusing on physician wellness is added. Neither argument is constructive to physicians if the primary causes of physician burnout are not addressed.
Doctors have 24-hour days and seven-day weeks. It’s a busy career with multiple roles and a high level of accountability. Add a personal life to the mix, and the result is more responsibility to fit into a jam-packed schedule.
Many physicians carry a heavy financial debt from medical school, are required to be on-call at least some evenings and weekends and must occasionally travel to medical conferences for continuing education. These duties are amplified during a natural disaster or disease outbreak such as COVID-19. Confronting sometimes unrealistic clinical productivity goals only adds another layer of stress.
Though physicians are probably one of the professions most in need of time off, the majority of them disclose that they sometimes or rarely have time for themselves. Generation X physicians and millennials report higher instances of rarely — or never — having time for themselves. Countless doctors don’t even get the recommended seven-to-nine hours of sleep per night, risking possibly harmful effects of sleep deprivation, including impaired language and math skills, impaired ECG interpretation and increased error rates in an intensive care unit.
Read more: 3 Ways for Physicians to Find Work-Life Balance
Although the transition to value-based care is designed to enhance financial and clinical performance through provider incentives, the guidelines and requirements that accompany it often add another layer of work for physicians. The approximately 1,700 Quality Measures implemented by the Centers for Medicare and Medicaid Services (CMS) for the goal of effective, safe, efficient, patient-centered, equitable and timely care require extensive documentation.
Combined with guidelines from incentive programs such as the Merit-based Incentive Payment System (MIPS) and regulations from the Health Insurance Portability and Accountability Act (HIPAA), physicians encounter excessive paperwork and multiple administrative tasks – all of which detract from time they spend with their patients. Almost half a doctor’s workday is spent on administrative work, while only 27 percent is spent on direct clinical care. For each hour of clinical face time they spend with patients, an additional two are filled with administrative and clerical tasks.
The following physician burnout statistics point to the seemingly disproportionate demand of administrative work on clinicians:
- U.S. physician practices spend an average of 785 hours per physician and more than $15.4 billion annually dealing with the reporting of quality measures.
- On average, doctors in the U.S. spend 2.6 hours weekly complying with external quality measures, enough time in an outpatient setting to see approximately nine additional patients.
- Eighty-one percent of physician practices disclose that the effort they spent on quality measures is increasing compared to five years ago.
- Forty-six percent of practices report that dealing with measures that are similar but not identical is a significant burden.
- Less than 30 percent of physicians believe current measures are moderately or strongly representative of quality of care.
- Almost 40 percent of doctors list regulatory and insurance requirements as one of the two least satisfying things about their jobs.
- The per physician time spent by physicians and staff-specific activities related to external quality measures translates to an average cost of $40,069 per physician per year; the average for family physicians is $50,468.
- Staff other than doctors spend 12.5 hours weekly per physician dealing with quality measures.
Another function physicians must fulfill is handling payer issues. Many payers require detailed documentation for reimbursement, and accurate documentation is necessary for full and timely payment. One study reported that approximately half of clinicians and healthcare executives want the emphasis of organizational interventions designed to decrease physician burnout to focus on documentation requirements from payers. Similarly, research published in the Annals of Internal Medicine maintained that enacting regulatory reform for fewer documentation requirements for doctors would improve accuracy, enable better use for research and help decrease overall physician burnout.
Technology has played an increasingly large role in the healthcare industry over the past couple decades and continues to offer a myriad of benefits to physicians and other healthcare professionals. Designed to streamline workflow, reduce administrative burden and improve patient care, it also may increase stress for physicians, especially when poorly designed.
Clinicians waste an average of 45 minutes per day by utilizing outdated communication technologies. This lack of interoperability and productivity costs hospitals in the U.S. more than $8.3 billion annually. In addition to physician burnout, it also results in waste and inefficiency. Electronic health record (EHR) systems specifically contribute to physician burnout as evidenced by these numbers from a study published by the Journal of the American Medical Informatics Association (JAMIA):
- Approximately 70 percent of respondents reported HIT-related stress, especially primary care physicians.
- Physicians who reported marginal time for documentation were 2.8 times as likely to suffer burnout as those reporting ample time.
- More than one-in-four respondents reported burnout.
- Doctors who spend large amounts of time on EHRs at home had a 1.9 times greater chance of burnout.
Many symptoms of physician burnout surface slowly, an accumulation of factors over months and years. Team members and other colleagues might not notice anything different, at least not immediately. However, symptoms of burnout in physicians can lead to some serious consequences in a profession in which mistakes can be very costly.
It’s important to remember that burnout can occur in other healthcare professionals, too. More than 15 percent of all nurses have reported feelings of burnout, and approximately 18 percent of hospital nurses exhibit signs of depression. The consequences of burnout among nurses include increased turnover rates, poor job performance and threats to patient safety.
Defined as a state of feeling worn-out and drained from an accumulation of stress from personal or work lives (or a combination of both), emotional exhaustion is a leading sign of burnout. It often consists of feelings of being overextended and having no more emotional and physical resources left to offer.
Numerous studies have shown that 25-60 percent of physicians across numerous specialties report exhaustion. Emotionally-exhausted physicians sometimes express a negative, cynical and/or hostile attitude toward patients and may treat them as objects instead of human beings. Note the following signs of emotional exhaustion in physicians, which can assist you in identifying it in team members:
- Your colleague is unable to recharge in between shifts or after a vacation and will start back to work still visibly drained.
- Professional demeanor increasingly goes by the wayside, replaced by short-tempered, irritable and/or argumentative behavior.
- Your colleague begins to express feelings of dread about the workday or describes his or her workload as insurmountable.
- Forgetfulness, poor focus or inattentiveness become more frequent, impacting job performance and making him or her more prone to injuries and accidents.
- Emotional exhaustion leads to physical fatigue that is, paradoxically, combined with insomnia. Listen for complaints consistent with this sort of “wired and tired” phenomenon.
- Emotional and physical exhaustion suppress the immune system. A stoic physician with no other outward signs of burnout may start to suffer illnesses more frequently or develop a chronic condition.
Individuals often select a physician based on online and word-of-mouth recommendations. A doctor known for his or her good bedside manner is probably going to procure more new patients than a one perceived as distant and impolite.
Encountering a physician with a negative, cynical or impersonal attitude toward patients, family, staff members and colleagues doesn’t necessarily mean that doctor is just plain rude. His or her behavior might be a result of depersonalization, a common symptom of physician burnout. Also known as “compassion fatigue,” it signals a void of emotional energy and is sometimes expressed as unprofessional comments directed toward co-workers, blaming patients for their medical problems or the inability to express empathy or grief when a patient dies.
Lack of Efficacy
A lack of efficacy, which is less common in men, refers to a feeling of incompetence or low sense of personal accomplishment. Physicians who lack efficacy often doubt the quality or meaning of their work, which contributes to a loss of self-confidence. Whether real or imagined, lack of efficacy also can negatively affect a physician’s productivity.
Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults age 18 and older. According to the journal JMIR mHealth and uHealth, the high demands and inherent uncertainty in the practice of medicine added to environmental causes and conditions may contribute to excessive worry, a core aspect of anxiety disorders.
A study published in the Journal of the American Board of Family Medicine — one of the few that have examined anxiety as a component of burnout — found that doctors who experienced increasing anxiety and withdrawal were more than three times as likely to report burnout compared to those who didn’t experience high levels of these issues. The study also noted that primary care physicians (PCPs) experience more burnout and anxiety than other healthcare professionals, which could likely worsen from the impact of the COVID-19 pandemic.
Depression is much more common among physicians than in other professions. The onset of depression starts early for physicians, as about half of medical students experience burnout and one percent experience suicidal ideation during school. Among residents training in general surgery, the rate of depression approaches 40 percent.
In the Medscape National Physician Burnout & Suicide Report 2020, about two-thirds of surveyed respondents reported “colloquial” depression. However, about one percent have attempted suicide, almost 25 percent reported thoughts of suicide and a large percentage have not spoken to anyone about their thoughts of suicide. About half of the respondents reported that depression gets expressed in some way in their interaction with patients.
Sleep Deprivation and Disturbance
Physicians are busy professionals. Their busy routine begins in medical school with rotating shifts, long hours and on-call duty. Therefore, physicians of any age or specialty may endure sleep deprivation, irregular sleep patterns and circadian misalignment.
Symptoms of sleep deprivation include slowed thinking, reduced attention span, worsened memory, poor or risky decision-making, lack of energy and mood changes. A persistent lack of sleep creates significant risks to physical and mental health, which could be fatal for physicians and their patients.
Sleep disturbance is a predictor of depression, and insufficient sleep may contribute to burnout. As noted in the Journal of Clinical Sleep Medicine, excessive documentation required for reimbursement increases work burden, limits sleep opportunity through longer work hours and increases the homeostatic drive for sleep related to prolonged cognitive demand.
Substance abuse has long been acknowledged to cause physician impairment. Compared to nine percent of the general population, physicians report rates of substance and alcohol abuse between 10-15 percent. Though the substance most commonly abused by the general population is alcohol, doctors have a higher rate of prescription drug abuse.
One study found that almost 70 percent of physicians abused prescriptions to “relieve stress and physical or emotional pain.” Multiple other studies reported there is a markedly higher risk of suicide and alcohol use disorder in physicians suffering from burnout.
What Physician Specialties Have the Highest Burnout Rate?
It’s probably not a stretch to presume that emergency department physicians experience high levels of stress on the job. Not only do they often work alternating day and night shifts and see patients with a large variety of injuries and illnesses, they also administer care to those whose conditions typically require more immediate treatment.
Approximately 6,000 emergency physicians contemplated suicide in 2018, and almost 400 attempted it. This was before the COVID-19 pandemic, during which many frontline healthcare workers were faced with long shifts, uncertain treatment plans and shortages of personal protective equipment. Nurses especially have had a relatively high prevalence of burnout during the pandemic.
Within just the past five years, multiple specialties have published review articles addressing burnout within their respective fields. For the past few years, Medscape has published a report highlighting survey information on both physician burnout and suicide. Over the past five years, specialties that have reported the highest level of physician burnout include critical care, emergency medicine, family medicine, internal medicine, neurology and urology.
According to the Medscape National Physician Burnout & Suicide Report 2020, the medical specialties in which the highest number of doctors disclosed symptoms of burnout include:
- Diabetes and endocrinology
- Family Medicine
The American Urological Association notes that the average urologist in the United States works 56 hours per week. A previous study suggests that the high burnout rate among urologists might be due to long working hours, the burden of the electronic medical record and pressure from competition to see an ever-larger number of patients.
Factors affecting radiologist burnout consist of turnaround time pressures, ever-increasing imaging volumes, declining reimbursements per study, isolation in the work environment, changes in the market and perceived livelihood threats from technological advances. Although nephrology is number three on the Medscape list, it increased from 32 to 49 percent over the past year.
The lowest rates of physician burnout were reported in the following medical specialties:
- Public health and preventive medicine: 29%
- Ophthalmology: 30%
- Orthopedics: 34%
- Psychiatry: 35%
- Otolaryngology: 35%
- General surgery: 35%
What are the Consequences of Physician Burnout?
The effects of physician burnout go far beyond exhausted and/or unhappy clinicians. If you don’t properly address the reason(s) for your burnout, personal and professional consequences may occur.
No matter the cause(s), physician burnout can be costly for the healthcare industry and even patients. It puts doctors at increased risk of motor vehicle accidents and near-miss events, even after adjusting for fatigue. It also has been directly linked to an array of problems, including decreased patient satisfaction and care quality, physician alcohol and drug abuse and addiction and high medical error rates, malpractice risk and physician and staff turnover.
Increased Medical Errors
Johns Hopkins University researchers estimate that medical error is the third-leading cause of death, accounting for 251,454 deaths in the U.S. per year. One nationwide survey found that most Americans are having positive experiences with the healthcare system, but 21 percent of adults have personally experienced a medical error.
There is an immense amount of evidence that suggests physician burnout is associated with increased medical errors. A study published in the journal Mayo Clinic Proceedings found that physician burnout, fatigue and work unit safety grades were independently associated with major medical errors. Another study, this one by the Stanford University School of Medicine, reported that physician burnout is at least equally responsible for medical errors as unsafe medical workplace conditions, if not more so. If you’re a doctor who reports signs of burnout, you are twice as likely to have made a medical error in the previous three months.
Higher Risk of Suicide
Pursuing a career in medicine puts you at an increased risk of suicide. Specifically, suicidal ideation has also been associated with occupation-specific factors, including:
- Practicing psychiatry or anesthesiology
- Increased workload volume
- Being evaluated as unfit to practice
- Perceived medical errors by surgeons
- Workplace harassment and lack of empowering leadership among postgraduate physicians in training
Mental health issues such as depression, substance abuse, self-destructive tendency and guilty self-concept are associated with physician suicide, but some research shows that burnout without depression does not increase suicide risk and can therefore be safely addressed outside of mental health care.
Inflated Physician Recruitment Costs
According to the American Medical Association (AMA), physician burnout costs the U.S. approximately $4.6 billion each year through physician turnover and reduced clinical hours: an average cost per employee of $7,600 annually and $500,000 to more than $1 million per doctor. It doesn’t, however, take into account the expenses and other resources necessary to recruit doctors and other clinicians or intangible costs like lost productivity, decreased quality of work and increased competition due to turnover from departing physicians. Although these factors might not seem to affect you personally, they negatively affect the healthcare industry as a whole.
Elevated Physician Impairment
If you’re a doctor who has felt unable to safely and effectively carry out the core responsibility of patient care, you’re not alone. Though the official term for is physician impairment, it’s an issue that’s not usually openly discussed due to stigma or fear of disciplinary, career-affecting consequences. Regardless, ignoring signs of impairment puts you, your patients and even your colleagues at increased risk for dangerous outcomes.
Physician impairment can be caused by burnout as well as exhaustion, mental illness or a decline in cognitive or motor skills due to age or disease, or substance abuse. Some doctors experience sleep-related impairment due to long work hours sometimes resulting in burnout and self-reported, clinically-significant medical error. The American College of Emergency Physicians (ACEP) recommends that any impaired physician proactively and voluntarily refrain from the practice of medicine. Colleagues who notice impairment in a physician should intervene to ensure that doctor doesn’t practice until no longer impaired.
Heightened Risk of Malpractice
If you’ve never been sued for malpractice, consider yourself fortunate. More than half of physicians have been sued for malpractice, with some specialties reporting a more than 80 percent litigation rate. Almost all doctors who practice in a high-risk specialty will be sued by the age of 65. It’s no wonder that physician burnout is associated with malpractice suits.
Most physicians sued for malpractice report major psychological and/or physical effects from the litigation. Enter Medical Malpractice Stress Syndrome (MMSS). Similar to post-traumatic stress disorder (PTSD), it’s the emotional and traumatic experience doctors endure when being sued. An aggravating factor in MMSS is the stigma associated with a malpractice suit, often resulting in anxiety and depression, fatigue and emotional exhaustion, difficulty concentrating, irritability, changes in appetite and libido, apathy, anger and feelings of shame and guilt.
Reduced Patient Satisfaction
It’s no surprise that patients who receive care from a physician experiencing burnout don’t typically report high levels of satisfaction with their doctor. Lower patient satisfaction is almost a foregone conclusion to poor quality of care. However, physician burnout also can affect your personal well-being as a doctor through low job satisfaction.
In research on the link between physician burnout and patient satisfaction, patients of doctors with high levels of exhaustion and depersonalization had significantly lower satisfaction scores and longer post-discharge recovery time. A major study published in JAMA Internal Medicine found that in addition to being three times more likely to receive low satisfaction ratings from patients, physicians with burnout are twice as likely to be involved in patient safety incidents and deliver suboptimal care to patients, owing to low professionalism.
Poorer Patient Outcomes
As a physician, you’re tasked with numerous responsibilities while under pressure to improve the quality of care you provide to your patients. You’re required to complete extensive documentation and perform other administrative duties, all while seeing patients. Additionally, the increased bottom-line pressure means patient visits are often brief. The problem is that the more stress you encounter on the job, the more that care is likely to suffer.
Physician burnout has been proven to result in overall worse outcomes, including twice the odds of involvement in patient safety incidents. When depersonalization leads to poor interactions with your patients, you’re apt to suffer from impaired attention, memory and executive function. Even if you know you’re experiencing symptoms of burnout and keep working, you’re more likely to have decreased work productivity, exhaustion and poor quality of care when compared to earlier in your career.
Multiple empirical studies have found that physicians with burnout are more likely to fail on critical aspects of professionalism that determine the quality of patient care, such as adherence to treatment guidelines, quality of communication and empathy. If you experience symptoms of depression along with burnout, you’re at risk for more pronounced safety risks.
What Type of Physician Burnout Solutions are Available?
Treatment for physician burnout doesn’t come in a one-size-fits-all solution. There are no interventions that immediately produce results. However, there are a myriad of small steps you can take to improve your well-being, even if it requires you to do some things differently.
As the AAFP notes, understanding the drivers of physician burnout informs the ongoing development of intervention models to prevent it as well as the support services to help you cope with the symptoms. Successful interventions — those that take into account the broad range of causes and incorporate a variety of different therapeutic tools — have been found to decrease overall burnout symptoms by 10 percent, emotional exhaustion by 14 percent and depersonalization by four percent.
No matter the reason(s) for your burnout, do not be hesitant to ask for help, whether it’s from a colleague, friend or professional. Even if you have to take seemingly simple actions such as scheduling time with friends and family or no longer working with a payer that causes you a lot of administrative stress, taking the first step in addressing the issue of burnout is essential to overcoming it.
Confronting burnout is not all the responsibility of physicians. Researchers have found that organizational interventions have the highest potential to ease burnout and that the organization by whom you’re employed and the environment in which you practice play critical roles in whether you remain engaged or burnout. Similarly, organizational interventions that address physicians’ workloads, schedules, supervision and job control have shown a larger benefit in overall burnout than those focused on the individual.
It is essential to acknowledge the existence of burnout in an organization and offer resources to assist physicians and other healthcare staff affected by it. The leadership behaviors of physician supervisors play a critical role in the well-being of the physicians they lead, so a lack of support on this level may result in unnecessary, exacerbated stress in doctors.
Conversely, positive effects occur if administrators allocate time for physicians to incorporate teamwork, mindfulness, sharing of workload through Patient-Centered Medical Home models and coaching for challenging experiences. Research has found increased job satisfaction among physicians when their department leaders:
- Keep them informed
- Support their career development
- Ask for their opinions on how to improve the work unit
- Recognize their good work
Some in the healthcare industry recommend implementing physician burnout as a top metric to monitor. Even if that’s not done, organizations should ensure support of proactive mental health treatment for their employees and not penalize them for experiencing burnout. As a physician, you should have access to comprehensive resources to address work-life integration, exercise/fitness, sleep habits, diet, personal financial health, relationships, hobbies and preventive medical care.
Social Activity and a Supportive Work Environment
If you’re a physician employed by a health system, hospital or large practice, you have a built-in support network with whom to discuss issues such as burnout and its causes. If not, it’s important to seek out peers or mentors you trust as for support.
If you’re concerned about a lack of privacy with colleagues, consider forming or joining an already established group of physicians who meet regularly to discuss issues affecting your career. The Mayo Clinic found that giving physicians a way to gather in small groups for semi-structured, private discussions in restaurants, coffee shops or reserved rooms results in measurably lower burnout and social isolation and higher well-being and job satisfaction.
Another readily available option is social media. More than 90 percent of physicians are involved in social media for personal or professional use. Connecting with peers on these platforms enables you to not only share expertise and solutions to ease stress but also learn from successful physician burnout solutions and programs that already have been implemented.
You can’t offer quality care to patients if you’re not properly taking care of yourself. As a physician, you already know the importance of exercise, a balanced diet and sufficient sleep. Whether or not you heed your own advice on these topics can make a noticeable difference in how burnout affects you.
Taking care of yourself also can come in the form of making time for your family and friends, participating in fulfilling hobbies such as golf or yoga or seeking counseling. It might involve utilizing breathing techniques to release stress or attending stress management training.
Multiple clinical trials have highlighted mindfulness as an effective treatment for burnout. The American Association for Physician Leadership defines mindfulness as a way of remaining in the present while processing unfolding events and feelings in a compassionate and nonjudgmental way. Studies have found that mindfulness training has resulted in sustained reductions in depressive symptoms, stress and burnout scores and increased physician well-being and patient-centered qualities.
Use of Technology to Streamline Workflow
Multiple technologies have been developed and implemented to make workflows more efficient, enable continuity of care and simplify the job of a physician. However, not all of them have achieved that; instead, they’ve added more administrative tasks to your already busy schedule. The result? Increased stress and burnout.
The best technology solutions should let you automate much of your routine processes, promote connected care and foster teamwork and collaboration. For example, mobile technologies allow you to easily access patient information and other data and discuss care plans with other physicians without being tied to a computer. Telehealth technology, used more often in 2020 due to the COVID-19 pandemic, helps improve workflows by reducing administrative tasks and providing access to clinical decision support.
According to the AMA, physicians who are satisfied with different applications of information technology were four times more likely to be happy with their medical practice. Eight out of nine studies found that changes to workflow redesign, including targeted quality improvement projects and separating workflows, had a substantial impact on physician burnout and job satisfaction. When developed with physicians in mind, technology improves quality of care, not hinders it.
Reduced Work Schedule
When you decided to become a physician, you knew you’d probably be working long hours. That doesn’t mean an excessive workload doesn’t negatively affect you.
No one can work long hours with little sleep and a lot of stress for months on end without experiencing some type of burnout. Half of the physicians in the Medscape National Physician Burnout and Suicide Report 2020 disclosed that they would give up at least $20,000 in annual income in order to reduce their work hours.
Setting realistic expectations of your role in providing quality care while maintaining a work-life balance is non-negotiable if you want to escape physician burnout. If you have any flexibility over your work schedule, use it. If not, consider employing a schedule where you begin or end your workday earlier to make more time for personal or family responsibilities or obligations.
Working in a multi-provider practice, hospital or health system should enable you to more easily implement a more flexible schedule. Attempt to delegate any non-physician tasks to support staff, especially administrative duties. Additionally, your employer should establish realistic and fair productivity targets, so you’re not burning yourself out only to attain some unrealistic metric.
Established Resources to Address Physician Burnout
Many physician associations and organizations offer a variety of resources on ways to reduce burnout. Most are free of cost to members of these groups. You might also consider joining a local chapter of one of these organizations to meet peers with whom to discuss issues related to physician burnout. Notable resources to assist physicians with burnout include:
- The Maslach Burnout Inventory (MBI): This tool measures burnout as defined by the World Health Organization (WHO). The MBI-Human Services Survey for Medical Personnel is derived from the Human Services Survey specifically for medical personnel.
- American Medical Association (AMA): Through its STEPS Forward program, the AMA offers an “interactive practice transformation series offering innovative strategies that will allow physicians and their staff to thrive in the evolving health care environment by working smarter, not harder.”
- American Academy of Family Physicians (AAFP): On its website, the AAFP has some articles focused on physician burnout that were published in its journal, FPM.
- American College of Surgeons (FACS): The Physician Well-Being Index is available to practicing surgeons and individuals completing surgical training programs and allows users to track their well-being over time, compare their scores to physicians nationally and access both local and national resources on multiple categories and topics.
- National Academy of Medicine (NAM): Its Action Collaborative on Clinician Well-Being and Resilience was created to improve baseline understanding of challenges to clinician well-being, raise visibility of clinician stress and burnout and elevate evidence-based, multidisciplinary solutions.
- Accreditation Council for Graduate Medical Education (ACGME): This organization’s Physician Wellbeing Initiative focuses on five key areas — resources, education, influence, research and collaboration — to support its ongoing commitment to physician well-being.
- American College of Physicians (ACP): The Patients Before Paperwork initiative is designed to “reinvigorate the patient-physician relationship by challenging unnecessary practice burdens.” The organization also has a page on its website with resources for physician well-being and professional fulfillment.
American Association for Physician Leadership (AAPL): With Mindfulness 101, AAPL offers an overview of how mindfulness is connected to physician burnout and provides some mindfulness exercises and meditations.
What is Nurse Burnout?
Physicians aren’t the only clinicians who experience burnout. Nurse burnout, defined as a chronic response to work-related stress composed of emotional exhaustion, depersonalization and personal accomplishment, costs the U.S. healthcare system $14 billion annually, which includes $9 billion for hospitals alone.
A reported 15.6 percent of all nurses have reported feelings of burnout, higher levels of which are associated with higher rates of both patient mortality and dissemination of hospital-transmitted infections. Nurse burnout often is due to understaffed hospitals, fatigue, a chronic lack of sleep and feelings of being constantly overworked but unappreciated.
The following statistics on nurse burnout identify some of its causes:
- Nurses with greater than a 1:4 nurse-to-patient ratio have a higher risk of burnout, with each additional patient raising the risk by 23 percent. For each patient added to that ratio, there was a seven percent increase in hospital mortality.
- A study by the University of Pennsylvania School of Nursing found that nursing shifts totaling 10 hours or greater were more likely to cause nurse burnout, nurse job dissatisfaction and discontent in care among patients.
- Emergency department nurses have the greatest rate of burnout, followed by ICU nurses.
- One of the highest sources of work stress for nurses is a lack of teamwork.
- Pay and supervisors are common stressors for nurses working in clinics, continuing care and home care.
If you’re a nurse experiencing burnout, attempt to practice self-care, maintain a regular exercise routine, eat a well-balanced diet, use paid time-off and vacation, foster strong co-worker relationships and regulate your shift schedule as much as possible to include work days of no longer than nine hours. Take advantage of any mental health services your employer offers, and don’t hesitate to seek outside professional help.
Dealing with Physician Burnout Caused by COVID-19
The COVID-19 pandemic in the United States is certainly doing nothing to quell the problem of burnout experienced by physicians and their staff members. Practices are dealing with decreased revenue due to fewer in-office patient appointments, and hospitals are filled to capacity. In the Medical Economics 2020 Physician Burnout Survey, 65 percent of physicians indicated that the COVID-19 pandemic has increased their feelings of burnout and contributed to a general feeling of helplessness.
Not only are you at a higher risk for COVID-19 infection than the general public, working in a pandemic affects your mental health. Quarantine and isolation often bring on negative side effects, including depression, anxiety and post-traumatic stress (PTS).
Common signs you’re feeling anxious about the COVID-19 outbreak include:
- Frequent worry
- Moments of fear and feeling helpless
- A change in sleep patterns
- Withdrawal from activities that you normally enjoy
- Feeling of frustration, resentment or anger
- Sadness and or tearfulness
Beyond keeping up with the latest tips and trends for treating COVID-19, it’s essential that you attempt to decrease your stress level and avoid unchecked burnout by following some of these tips:
For Healthcare Leaders/Administrators:
- Emphasize the importance of self-care as the center of the response.
- Allow employees to focus on immediate needs instead of less critical tasks.
- Ensure your organization has a detailed infection control preparedness plan for pandemics, including the novel coronavirus.
- Offer flexible sick leave policies that aren’t punitive.
- Encourage physicians to delegate non-clinical tasks.
- Recognize and reward employees for their actions during the pandemic.
- Create a culture of open communication and positivity.
- Ensure you’re following proper protocols for cleaning and preventing virus spread.
- Explore alternatives to face-to-face triage and visits (e.g., telehealth).
- Supportively discuss with family members protective planning for the home, protocols for routine arrival home after duty and the benefits of taking off shoes, removing and washing clothing and immediately showering.
- Limit your exposure to general news about COVID-19, especially on social media.
- Stay connected with family, friends and support networks – digitally, if necessary.
- Focus on what you can reasonably accomplish instead of everything on your to-do list.
- Attempt to take regular breaks to focus on a stress-reducing activity (e.g., reading, taking a walk, doing yoga).
- Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid alcohol and drugs.
- Focus on what you can control (e.g., preparing supplies in case you’re quarantined).
- Discuss with staff members details about covering for each other in the case of an absence in the office.
Finding a Solution
Physician burnout is – and will continue to be – an issue plaguing the healthcare industry. Looking beyond the impact of the COVID-19 pandemic, the growing physician shortage will only exacerbate the problem. The latest Association of American Medical Colleges (AAMC) study projects a shortage of 139,000 physicians by 2033. The study further projects a shortage of up to 41,900 specialists as the aging baby boomer population relies heavily on specialties.
These jarring stats reflect the status of the healthcare industry prior to the impact the coronavirus has had on untimely physician deaths as well as physician physical and mental health that impacts their ability to practice medicine. The ripple effects of the COVID-19 pandemic on physicians and medical staff will take years to evaluate.
While the AAMC study is primarily focused on what the future landscape of physician shortages will look like, Americans are already feeling the shortfall. According to a 2019 AAMC public opinion research study, more than 1 in 3 participants said they had trouble finding a doctor in the past two or three years. Just four years earlier, 1 in 4 participants responded stating they had trouble finding a doctor.
With many factors working against the healthcare industry, it will take a team approach between individual physicians, healthcare organizations and technology solutions to make a notable impact on reducing physician stress and burnout. From identifying the problem to implementing solutions, a balanced ecosystem of all three parties working together will be necessary to advance measurable change.
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