When the National Academy of Medicine (NAM) released its comprehensive report in October, Taking Action Against Clinician Burnout, an estimated 40% to 54% of US physicians reported experiencing burnout.1 In light of this, burnout is increasingly being recognized as a crisis in healthcare.1-5

The NAM report found that physicians in private practice are at significantly higher risk for burnout (almost 30% greater) than physicians in university-based settings, and physicians in specialties with high patient contact such as medicine, family medicine, general internal medicine, and neurology reported higher rates of burnout than other disciplines.1

Burnout is thought to be the direct result of occupational demands that consistently outweigh the physical, mental, and psychological abilities of individuals suffering from it. While the problem has been well documented and studied since the 1990s, the scope of burnout has only increased over the past decade.1-4

Categories of Symptoms


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The Maslach Burnout Inventories, the most common tool used to assess burnout, identifies 3 main categories of symptoms associated with occupational stress.1-4:

  • depersonalization
  • emotional exhaustion
  • a reduced sense of personal accomplishment

Other descriptions have attempted to capture the distress of burnout. A 2017 review by DeCaporale-Ryan defined it as “the emotional manifestation of a profound mismatch between high expectations for one’s future and the reality of daily life.5

Burnout can occur in all phases of a physician’s career, from medical school to advanced practice.3 The consequences often extend to physicians’ personal relationships and can compromise their desire and ability to perform job functions, which can lead them to consider leaving their jobs and even the medical profession.1,2,4  In a 2017 study of 1289 physicians, a “sense of calling” was strongly associated with a high perception of meaning in life.6 Another study found that physicians with burnout were less likely to identify medicine as their calling.7

Factors Contributing to Burnout

The literature shows that the issues contributing to burnout are institutional and systemic, including excessive workloads, insufficient staffing, procedural inefficiencies, poor leadership culture, and lack of support for physician’s contributions and individual needs. These large-scale issues have a negative impact on physician satisfaction with their work and impede their ability to effectively perform their jobs.

Numerous occupational stressors have also been identified1-4:

Lack of Autonomy

Recent studies have pointed to high degrees of oversight by regulatory agencies and healthcare organizations and the restrictions posed by insurance companies as major contributors to physician burnout.2,4 Fred and Scheid observed that physicians may feel constrained in their decision-making abilities regarding time spent with patients, tests ordered, and treatment choices.2

Interrupted Workflow1,2

  • Demands to increase the number of patient visits per day
  • The need to answer electronic messages and queries in the patient portal
  • Documentation requirements
  • The need to master new technologies

Time Management Challenges1,2

  • Lack of work time allotted for continuing medical education (CME) and requirements for recertification
  • The requirement of training modules mandated by regulators (eg, patient safety, infection control, the Health Insurance Portability and Accountability Act [HIPAA], and protections for human subjects)

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Electronic Health Record

The requirement to maintain electronic health records (EHR) has been cited in the literature as a major stressor that affects all 3 Medicare Administrator Contractor Satisfaction Indicator (MSI) domains by depersonalizing the physician-patient interaction, extending the administrative functions physicians perform, and shifting the focus from the patient to the task.1,2 The NAM report stated that clinicians view administrative tasks as less meaningful work, and incomplete mastery of the system extends the time required to perform EHR tasks, which can increase frustration at work.1

Conclusion

Awareness of physician burnout has peaked in the past few years with many new investigations exploring its underlying systemic causes. However, while interest in burnout research has increased, changes to the way in which physicians practice are slow in coming. Until the culture of medicine begins to shift, clinicians will continue to be exposed to situations that set the stage for individual burnout.

References

1. Taking action against clinician burnout: a systems approach to professional well-being. National Academy of Medicine, 2019. http://nap.edu/25521. Accessed 10/30/19.

2. Fred HL, Scheid MS. Physician burnout: causes, consequences, and (?) cures. Tex Heart Inst J. 2018;45(4):198-202.

3. Dyrbye LN, Varkey P, Boone Sonja L, et al. Physician satisfaction and burnout at different career stages. Mayo Clin Proc. 2013;88(12):1358-1367.

4. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018;283:516-529.

5. DeCaporale-Ryan L, Sakran JV, Grant MBE, et al. The undiagnosed pandemic: Burnout and depression within the surgical community. Curr Prob Surg. 2017;54:453-502.

6. Tak HJ, Curlin FA, Yoon JD. Association of intrinsic motivating factors and markers of physician well-being: a national physician survey. J Gen Intern Med. 2017;32(7):739-746. 

7. Jager AJ, Tutty MA, Kao AC. Association between physician burnout and identification with medicine as a calling. Mayo Clin Proc. 2017;92:415-422. 

This article originally appeared on Medical Bag