Physician Burnout on the Rise: Is Prevention Possible?

Despite growing awareness of physician burnout in recent years, the problem has continued to increase. Burnout affects medical students, residents, and practicing physicians, with an estimated prevalence of 30% to 68%, and the negative impact extends to patients, coworkers, healthcare systems, and clinicians’ family and friends.^1,2

Professional burnout is a “syndrome defined by the triad of emotional exhaustion, depersonalization, and low sense of personal accomplishment related to one’s work,” according to a review published in October 2017 in the Annals of Thoracic Surgery.³ John J. Squiers, MD, of the Heart Hospital Baylor Plano in Plano, Texas, and colleagues note that burnout is most commonly assessed with the Maslach Burnout Inventory, which includes self-report questions (answered on a 7-point Likert scale), such as “I feel fatigued when I get up in the morning and have to face another day on the job,” and “I feel I’m positively influencing other people’s lives through my work.”

Risk Factors and Consequences

Although burnout affects individuals across career fields, higher rates have been found among physicians compared with other working adults in the United States (38% vs 28%). Prevalence also varies across specialties: the highest rates have been observed among emergency medicine and primary care doctors (60% to 70% and 50% to 60%, respectively), while lower rates have been noted among dermatologists and pediatricians (30% to 40% for each).⁴

Burnout has been linked with depression and suicidal ideation among physicians. In a 2011 study of 7905 surgeons, 1 in 16 had experienced suicidal ideation in the previous year, which was shown to be significantly associated with burnout (odds ratio [OR], 1.910; P <.001) and depression (OR, 7.012; P <.001).⁵

The new review identifies factors associated with increased risk for burnout among physicians, including younger age, being a parent, chosen subspecialty, number of hours worked per week and number of nights on call, and billing-based compensation.^6,7 “Interestingly, seemingly positive character traits, including dedication, conscientiousness, responsibility, and motivation, appear to put physicians at increased risk for burnout, possibly because individuals possessing these characteristics may not experience work satisfaction that meets their idealistic and perfectionist qualities,” Dr Squiers and his colleagues note.

In addition to protecting physicians’ well-being, reducing burnout is critical for the delivery of appropriate patient care. A strong independent correlation has been demonstrated between increased burnout and higher risk for medical errors. In research published in 2013, more than 15% of surgeons with high levels of burnout reported at least 1 major medical error within the preceding 3 months.⁸

Current Solutions

Despite the related risks posed to all involved, much of the research to date has explored the prevalence of burnout rather than preventive or treatment solutions. Additionally, many initiatives designed to address burnout tend to place the burden on the physician to help manage stress — for example, by fostering “resilience” in physicians.

“Rather than simply enduring stress, a resilient individual uses ‘strategic stopping’ that allows for recharging rather than continuing to endure additional stress,” wrote Dr Squiers and colleagues. Factors that have been shown to promote resilience include: individual factors such as positive coping and physical fitness, family factors such as communication and closeness, organizational factors such as teamwork and positive command climate, and community factors such as belongingness and cohesion.⁹

Numerous healthcare systems now offer programs aimed at improving physician resilience and wellness, including those summarized below.

• At Baylor Scott & White Health in Texas, the SWADDLE (Staff Well-being Assistance During Difficult Life Events) program offers physicians individualized support by trained peers. The program “is also designed to support healthcare providers through unanticipated adverse events, including medical errors, traumatic patient outcomes, lawsuits, agency complaints, or mass casualties, many of which can also serve as a nidus for burnout,” the authors stated. Baylor Scott & White Health also offers prevention initiatives and wellness services.
• The Carolinas Healthcare System in North and South Carolina developed a program called LiveWELL (Work, Eat, Learn, and Live), consisting of on-site representatives and various web-based resources. Educational events focus on stress management through resilience techniques, and the Employee Assistance Program at Carolinas Healthcare System offers free, short-term counseling and monthly ewbinars pertaining to resilience and burnout. 
• WellMD, the wellness program at Stanford Hospital in California, is led by physician experts and “promotes resilience improvements and burnout reductions through a variety of initiatives and programs, including online resources, stress reduction and mindfulness classes, and a crisis hotline,” as explained in the review. “Importantly, the committee is committed to studying the efficacy of these programs as they are implemented across the Stanford system.”

Expanding the Focus

Along with the predominant emphasis on personal resilience, which Dr Squiers and colleagues argue is too limited, there should also be a focus on reducing exposure to stressful stimuli. They believe one major contributor to the increase in burnout is the growing burden of administrative tasks that diverts physicians’ time and energy from practicing medicine. Clinicians often spend more time doing administrative work than on direct patient care — for example, medical interns spend 40% of their working hours on the computer vs 12% on patient care, and practicing physicians perform administrative work up to one-sixth of the time.^10,11

Physician groups have begun to address this topic with proposals for broader solutions, such as the American College of Physicians’ position statement calling for a reduction in administrative tasks in health care, the American College of Radiologists suggestion that burnout be resolved by changing the work process rather than the physician, and the National Academy of Medicine calling for further research on the impact of organizational change on burnout.

“Although most efforts at preventing physician burnout are focused on improving individual physician resilience, healthcare organizations are failing to change the system that is increasingly asking doctors to perform tasks, largely administrative in nature, for which they have no passion,” Dr Squiers and colleagues concluded. “It is time to stop treating symptoms and redirect our focus to fighting the disease of burnout.”

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References

1. Rothenberger DA. Physician burnout and well-being: a systematic review and framework for action. Dis Colon Rectum. 2017;60(6):567-576.
2. Schrijver I. Pathology in the medical profession? Taking the pulse of physician wellness and burnout. Arch Pathol Lab Med. 2016;140(9):976-82.
3. Squiers JJ, Lobdell KW, Fann JI, DiMaio JM. Physician burnout: are we treating the symptoms instead of the disease? Ann Thorac Surg. 2017;104(4):1117-1122.
4. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-1385.
5. Shanafelt TD, Balch CM, Dyrbye L, et al. Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54-62.
6. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
7. Balch CM, Shanafelt TD, Dyrbye L, et al. Surgeon distress as calibrated by hours worked and nights on call. J Am Coll Surg. 2010;211(5):609-619.
8. Dyrbye LN, Varkey P, Boone SL, Satele DV, Sloan JA, Shanafelt TD. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358-1367.
9. Meredith LS, Sherbourne CD, Gaillot S, et al. Promoting psychological resilience in the U.S. military. Rand Health Q. 2011;1(2):2.
10. Block L, Habicht R, Wu AW, et al. In the wake of the 2003 and 2011 duty hours regulations, how do internal medicine interns spend their time? J Gen Intern Med. 2013;28(8):1042-1047.
11. Woolhandler S, Himmelstein DU. Administrative work consumes one-sixth of U.S. physicians’ working hours and lowers their career satisfaction. Int J Health Serv. 2014;44(4):635-642.

This article originally appeared on Medical Bag