January 10, 2018
A Health Affairs blog article co-authored this past year by 10 prominent health system CEOs describes the problem of physician burnout as a national public health crisis and “a matter of absolute urgency.”
The numbers support their contention. The Medscape Lifestyle Survey 2017 reveals that 51 percent of physicians report experiencing this energy-depleting affliction, characterized by cynicism, exhaustion, and feelings of inefficacy and apathy. Emergency medicine physicians, obstetrician/gynecologists, family medicine specialists and internal medicine specialists report the highest rates (59, 56, 55 and 55 percent, respectively). The survey of 14,000 physicians found that, overall, burnout has risen 25 percent over the past four years. The six most common causes of burnout in the 2017 study were too many bureaucratic tasks, too many hours, feeling like a cog in a wheel, increasing computerization (EHRs), insufficient income and too many difficult patients.
The co-authors of the Health Affairs piece urge hospital and health system leaders to recognize the gravity of burnout as a business issue as well as a personal and professional problem, and to take responsibility for working to mitigate it. The leaders put forth 11 recommendations for organizations and the sector as a whole. One of these is encouraging and supporting the American Medical Association 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 and efficient and satisfying changes in task distribution, and outlining a set of principles for achieving the well-being of health professionals.
The American College of Physicians, an association of 152,000 internal medicine specialists and the largest medical specialty association in the world, has responded to this charge with a new initiative called Physician Well-being and Professional Satisfaction. The initiative seeks to promote physician well-being by giving clinicians the tools they need to reduce the negative impact of a variety of major occupational stresses, including administrative burdens, poor work-life balance, patient overload and pressures to reduce health costs.
Among other things, the program will:
- Establish “wellness champions” in each of the ACP’s chapters through a trained team of ACP members who will provide coaching and support, and share strategies that have been shown to improve professional satisfaction and well-being. The teams will report on burnout levels among chapter members and facilitate physician support groups.
- Develop online educational resources for physicians exploring such topics as achieving better work/life balance, increasing practice efficiency to reduce administrative burdens, and engaging more effectively with patients.
- Advocate for systems changes to simplify and reduce unessential tasks that can detract from patient care and increase stress among clinicians through, among other efforts, its Patients Before Paperwork initiative, a program designed to build stronger relationships between patients and physicians.
In an article in ACP Internist, Susan Thompson Hingle, MD, MACP, chair of the ACP Board of Regents, said the problem of burnout has taken on new urgency with changing demographics as patients have grown older and sicker and physicians have also become older, with more nearing retirement age. At the same time, “fewer medical students and residents are choosing to go into internal medicine, especially primary care internal medicine, thus there is a worsening physician shortage issue . . . It is felt acutely by the spectrum of the medical system when each physician retires early or stops seeing patients out of frustration or exasperation. . . This is simply something we cannot ignore. We must face it head on with the same level of commitment as other systemic issues.”
The nationally recognized physician well-being initiative developed at Mayo Clinic, recommends the following nine strategies to help organizations tackle the issue of physician burnout:
- Acknowledge and assess the problem. Communicate to physicians that burnout is recognized as a problem at the highest level of the organization. Mayo Clinic uses face-to-face meetings, town halls, radio broadcasts, letters, videos and other communication vehicles. Once the problem is acknowledged, measure physician well-being as a routine organizational performance metric.
- Harness the power of effective leadership. Identify leaders with the ability to listen, engage and develop physicians. A Mayo Clinic study of more than 2,800 physicians found that each one-point increase in the leadership score (60-point scale) of a physician’s immediate supervisor was associated with a 3.3 percent decrease in the likelihood of burnout.
- Develop and implement targeted interventions. Not all departments or units will have the same severity or sources of burnout. Tailor interventions to local needs.
- Cultivate community at work. Mayo Clinic has created a dedicated meeting area offering free fruit and beverages for physicians and provides one hour of protected time weekly to allow physicians to meet with small groups of peers to build camaraderie.
- Use rewards and incentives wisely. Incentives such as greater scheduling flexibility or protected time to allow physicians to pursue meaningful aspects of work may be more effective than financial incentives, which can foster overwork and contribute to burnout.
- Align values and strengthen culture. Make sure your organization is living its stated values by periodically surveying physicians.
- Promote flexibility and work-life integration. Look for ways to give physicians greater flexibility in when and how they work, such as starting the day earlier or later, and give physicians the option to work less (with an adjustment in compensation).
- Provide resources to promote resilience and self-care. Give physicians objective information on how their well-being compares with physicians nationally and then link them with resources that can help them take the appropriate action. These resources should cover work/life balance, sleep habits, nutrition, hobbies, personal financial health, relationships and preventive medical care.
- Facilitate and fund organizational science. In addition to implementing efforts to reduce burnout, vanguard institutions have the added responsibility of developing evidence-based strategies that will be used by other organizations. “Given the profound effect of physician well-being on quality of care, patient satisfaction and access to care, such knowledge will be critical to the long-term health and viability of the nation's health care delivery system,” according to an article on the program in Mayo Clinic Proceedings.