To some physicians, the word burnout is a familiar one. It comes up in conversations with colleagues, it’s discussed more frequently in the media, and it may also be personal. So what do we actually know about it? And, more importantly, can it be avoided?
What is physician burnout?
On May 28, 2019, the World Health Organization (WHO) classified burnout as an occupational phenomenon, a reason for which people contact health services but that are not classed as illnesses or health conditions.
According to the World Health Organization's 11th Revision of the International Classification of Diseases (ICD-11):
Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
- reduced professional efficacy.
Burnout is a phenomenon that has been cropping up across the medical industry. Medscape’s 2019 National Physicians Burnout & Depression Report surveyed over 15,000 physicians and found that 44% reported that they felt burned out with 50% of women and 39% of men reporting being burned out.
At its worst, burnout is a partial explanation for the high rates of physician suicide—a persistent problem that has lasted for decades. One doctor commits suicide in the U.S. every day—the highest suicide rate of any profession. And the number of doctor suicides—28 to 40 per 100,000—is more than twice that of the general population, new research shows.
As our medical industry shifts to accommodate new findings and cutting-edge research, burnout is at the forefront of the medical industry’s mind.
What’s the cost of physician burnout?
The cost of burnout isn’t just limited to an individual physician’s well-being, though. The repercussions of this phenomenon are widespread enough to have a resounding financial effect on our health care system. A study published in the Annals of Internal Medicine dives into the true financial costs of physician burnout.
In the study, Joel Goh, an assistant professor of analytics and operations at the National University of Singapore, aided by a team of researchers from Stanford University, the Mayo Clinic, and the American Medical Association stitched together a mathematical model that could estimate the cost of doctor turnover and the shorter hours because of burnout.
“We found that at an organizational level, the annual burnout-associated cost was estimated at approximately $7,600 per physician per year,” Goh said to US News in an interview. “At a national level, the estimated cost ranged from $3 billion to $6 billion a year.”
These estimates are pretty conservative, since it only takes into account lost work hours and physician turnover. Burned-out physicians are actually more likely to make medical mistakes, have less satisfied patients, and get sued for malpractice, all of which have indirect costs that haven’t been factored into the $3 to $6 billion loss.
What is causing physician burnout?
For a widespread phenomenon to have such severe consequences on the industry, surely there are systematic reasons afoot.
Dr. Danielle Ofri, a doctor who practices at Bellevue Hospital in New York, penned a recent New York Times op-ed titled “The Business of Health Care Depends on Exploiting Doctors and Nurses.” In this piece, she accuses the system of taking advantage of healthcare workers’ empathy to milk every last drop of work from physicians. Dr. Ofri details how her friends and people often work in off-hours, spending extra time finishing patient records in the EHR at home. Burnout, she believes, is related to the hours of paperwork that physicians must file instead of working with patients.
Others echo her analysis. Dr. Lotte Dyrbye, a physician and professor of medicine at the Mayo Clinic in Rochester, Minn. who co-wrote the study analyzing the cost of physician burnout to the healthcare industry, told NPR that the research shows that doctors find meaning in helping patients but are taxed by systemic burdens they consider tangential to patient care.
Among the burdens contributing to physicians feeling like they lack autonomy: “cumbersome, inefficient” electronic health record systems; increased reporting requirements; and hectic, irregular schedules.
“There is a general sense of loss of meaning [to the work],” she told NPR.
In an editorial that accompanied the Annals of Internal Medicine study about physician burnout costs, Dr. Edward Ellison, co-CEO of Permanente Federation, pointed out that “physicians find practicing medicine harder than ever because it is harder than ever.”
When almost everything a health care provider does is being monitored, rated, and reported, and the time spent on paperwork and sitting in front of a computer is increasing disproportionately to the time spent with patients, how do we expect physicians to feel?
Physician burnout is just one of the growing pains of larger healthcare practices like hospitals.
Can physician burnout be avoided?
The reasons physicians end up feeling burnout are abundant and complex, but physicians who have managed to avoid it wield their own burn-out evading techniques. Perhaps there are ways to change the course of this increasing burnout trend.
In the Jewish Journal, Dr. Albert Fuchs MD responds to the NYT op-ed, explaining why he has never felt burnt out. While Dr. Ofri’s NYT op-ed looks to administrators to fix the system, Dr. Fuchs has a simpler suggestion to avoid physician burnout.
He writes, “Unhappy doctors and new trainees should go where the happy doctors are – into private practice. Our practice has three physicians, two employees and zero administrators. We three have chosen an EMR that we actually enjoy using (appropriately named Elation). We are in control of our own schedules. We balance our work and our lives. We are directly responsible for our patients.”
Drawing from his own experience. Dr. Fuchs suggests that medical training should also teach the basics of running a business as a solution to burnout.
“I quickly learned that running the business is integral to patient care. Hiring excellent staff, deciding on which insurance contracts to accept, making sure the appointments are long enough, and myriad other administrative details directly determine the care I deliver in the exam room,” he wrote. “I became an employee under the assumption that these details would be executed well, and that the administrators’, doctors’ and patients’ interests all aligned. I quit my job and went into private practice when I saw that this wasn’t so.”
The increasing attention on physician burnout comes at a time when the percentage of solo practice physicians are falling while employment grows at hospitals and very large practices, according to the 2018 AMA Physician Practice Benchmark Survey report. It isn’t a coincidence. Research studies have actually shown that physicians in solo or small practices are less likely to burn out and more likely to develop deeper relationships with their patients. A study published in the Journal of the American Board of Family Medicine found that only 13.5 percent of providers who work in small, independent private practices felt burnt out.
Maybe one solution to burnout simply to learn to work in smaller practices. While it isn’t an easy feat to run a small or solo practice, it comes with the autonomy that bigger practices simply can’t give. In smaller practices, for example, physicians can choose the EHR systems that align with the goals and processes of their practice. After all, the point of autonomy is to be able to make smart choices around technology, about the systems put in place to aid the work, about the people you work with, and how to optimize patient care.