There is a severe and worsening epidemic of physician burnout in the United States, which threatens the health of doctors and patients alike. What is burnout? How does it affect doctors? And, how can this affect patient care? Finally, what can be done about this issue, to breathe life and energy back into the field of medicine?
What does physician burnout look like?
Burnout among doctors is generally described in terms of a loss of enthusiasm for one’s work, a decline in satisfaction and joy, and an increase in detachment, emotional exhaustion, and cynicism. It manifests in disproportionately high rates of depression, substance abuse, and suicide. Annually, approximately 400 physicians take their own lives in the United States.
A 2016 study published by the Mayo Clinic showed a high and increasing rate of physician burnout. Of the almost 7,000 physicians who responded to the survey, 54.4% “reported at least one symptom of burnout in 2014 compared with 45.5% in 2011.” Satisfaction with work-life balance also declined, but this is no huge surprise given that, as a whole, physicians are working more and earning less. In other words, more than half of US physicians are experiencing at least some degree of burnout.
Moreover, many doctors are leaving medicine mid-career, which, among other things, causes patients to have to start all over again with a new doctor. Other physicians are cutting back their hours, which makes it more difficult for patients to obtain timely appointments. These developments are expected to worsen the projected shortage of physicians that our country will be facing over the next few decades, estimated to be up to 100,000 doctors by 2030, according to a study commissioned by the American Association of Medical Colleges.
Why are doctors so burned out?
The causes of physician burnout are complex, but have to do in part with increasing workload, constant time pressures, chaotic work environments, declining pay, endless and unproductive bureaucratic tasks required by health insurance companies that don’t improve patient care, and increasingly feeling like cogs in large, anonymous systems. Parasitic malpractice lawyers are always circling, which causes us to waste an enormous amount of time with defensive documentation. The transition from paper charts to electronic medical records, which seemingly were designed to maximize revenues instead of clinical care, has created a technological barrier between doctor and patient, and between doctors.
Physician burnout compromises patient care
There is good evidence that physician burnout results in more expensive healthcare and less satisfied patients. Demoralized doctors can suffer from impaired memory and attention, and poor decision-making. They can be distracted, and their communication with both patients and peers deteriorates. They feel less empathetic and engaged in the outcomes of their day-to-day decisions. Their bedside manner worsens. They can make mistakes, sometimes devastating. While this is a difficult phenomenon to measure, a 2014 study of intensive care doctors showed that emotional exhaustion among physicians predicted a higher mortality rate among the patients they cared for. And according to a research review in The BMJ from 2017, “there is moderate evidence that burnout is associated with safety-related quality of care.”
What can we do to address physician burnout?
Sadly, hospitals and other medical institutions have tended to address the problem of physician burnout merely by giving their doctors inspirational talks about “resilience,” patting them on the shoulder, and then sending them back into their deteriorating clinical lives with no material change in circumstances. Sometimes they throw in a yoga mat. The physician then continues to suffer in silence, leaves medicine, or encounters some other tragic endpoint.
Recently, there appears to be more awareness of, and concrete attention being paid to, this issue. Some medical schools and hospitals have started including physician wellness in their curriculums, and even dedicating some faculty time to help monitor and ensure the well-being of their staff physicians.
The problem of physician burnout is complex and there is no easy solution in sight. In my personal experience as a primary care physician over the last 20 years, the insurance companies won’t flinch at wasting a doctor’s time, even deliberately, if it will increase their profits. Hospitals will choose a medical record system that prioritizes their revenues, and which has the doctor facing the screen and pecking away, over one that allows for doctors and patients to speak with each other, comfortably, face to face. As with most things, it comes down to the bean counters, and the bottom line.
Addressing the human cost of physician burnout
The losers in all this, equally, are the doctors and the patients. If you are receiving substandard care from a seemingly burnt-out or distracted doctor, you obviously need to report it, and advocate for your own care. However, it is also critically important to remember that doctors are people too, not robots. As with most things in life, empathy is a two-way street. Doctors and patients need to put their heads together and try to find a way to regain what is being lost in terms of the once strong doctor-patient bond. We need to reclaim healthcare, for the good, and the safety, of us all.