Clinician Burnout

Clinician Burnout is defined as high scores on at least two of three subscales: Exhaustion, Cynicism, and Reduced Personal Efficacy. Most physicians report feeling overwhelmed and dissatisfied with their profession, and this feeling has increased over the past decade. 

This escalating issue, known as physician burnout, persists despite addressing it. Athenahealth’s study of over 1,000 physicians revealed widespread struggles.

The Severity of Clinician Burnout

According to the survey, 93% of physicians frequently experience burnout. 49% feel overburdened by their workload. Only 38% are confident in their practice’s financial health. The implications are profound. Many physicians are considering leaving their profession.

Physicians play a crucial role in our healthcare system. Yet, they are bogged down by regulations, paperwork, and operational changes. The survey highlights that 64% of physicians are overwhelmed by paperwork. 91% believe regulatory demands are intensifying.

60% say they are expected to be available 24/7. That is unsustainable. That level of availability often comes at the cost of their health. During the pandemic, three-fourths of physicians felt overworked, and half considered a different career.

Clinician burnout has escalated to crisis levels despite a decade of attempts to solve the problem. According to Dr. Robert Pearl, 71,309 doctors quit their profession in just one year. Doctor dissatisfaction is worse in America but is a worldwide problem.

According to the CDC, fatigue, depression, anxiety, substance use disorders, and suicidal thoughts are on the rise.

 

“Burnout among these workers has reached crisis levels.”

-Dr. Debra Houry (CMO @ the CDC)

The Impact on Nurses

A survey from January 2023 indicated a potential exodus among nurses. 85% of hospital-based nurses are contemplating resignation within a year. Nonetheless, the decline in nurses’ well-being remains a significant concern.

Trends in Clinician Burnout

• Early 2000s to 2014:
• Initial studies showed increasing burnout rates, with a notable rise in 2019.

• Pre-COVID-19 Era:
• Burnout was already a significant issue. Administrative burdens, work-life imbalance, and the emotional toll of patient care were damaging.

• COVID-19 Pandemic Impact:
• The pandemic worsened physician burnout. The AMA reported a peak burnout rate of 63% in 2021. Burnout was up from 38% in 2020. Mayo Clinic reported depression scores of 52.5% in 2021.
• AMA reported professional fulfillment scores fell from 40% in 2020 to 22.4% in 2021.
• Physicians who recommend their profession dropped from 72.2% to 57.5% that year.

• Recent Data (2024):
• The Medscape Physician Burnout & Depression Report showed high burnout and depression.

Contributing Factors

Clinicians have shifted much of their workday from dealing with acute issues to chronic ones. Chronic illness afflicts 60% of Americans. Obesity, diabetes, and chronic pain seem persistent despite clinician attempts to reverse them. 40% of Americans over 65 take five or more prescription medicines.

Those short visits need to deal with medical complexity. The severity and complexity contribute to exhaustion and overwhelm. Taking the time needed puts the clinician behind schedule. Running behind can lead to stress, missed lunch breaks, and working late. Taking shortcuts to keep moving results in the clinician feeling bad about their performance. Such “moral injury” increases burnout.

Staffing shortages worsened during the pandemic, increasing physician and nurse burnout. Meanwhile, many hospital networks are expecting higher productivity levels. More wRVU productivity is expected to help offset other financial losses. Doing more work with less staff is unrealistic and harmful. Clinicians feel the stress from having less autonomy in their workplace.

This shows the five main causes of clinician burnout.

First Do No Harm

One study showed that burned-out physicians are less productive. Employers can experience $80,000 less due to reduced productivity per burned-out physician. Those physicians are also more likely to leave within the next two years.

Burned-out clinicians make more medical errors, have lower quality scores, are absent more, retire earlier, and have lower patient satisfaction scores. Burned-out clinicians suffer from impaired attention, memory, and executive function.

Burned-out clinicians are more likely to leave.
Burned-out clinicians are more likely to leave.

Is There Hope?

Indeed, there is hope.

Improved staffing would help. Listening to clinicians about their daily struggles and how to overcome those would help. Implementing some clinician ideas would go a long way. Disciplining bad employees boosts the morale of those who work hard. Keep panel size reasonable. These changes can be cost-effective. Better pay for staff nurses would help. Those dollars can be taken from the excessive pay of travel nurses.

“Clinician-friendly” organizational changes can improve wellness and decrease burnout. Moving away from high productivity requirements and short time slots would help. Flexible and part-time work schedules help. Increasing autonomy and say over scheduling would help. Unfortunately, many national trends are in the opposite direction.

Leveraged technology may help some of the challenges faced by healthcare professionals.

How Technology Can Assist

Healthcare technology can reduce the burden on physicians. Billing management, electronic health records (EHRs), and patient communication have shown promise. EHRs can either increase or decrease a clinician’s workload. Ambient voice technology has the potential to help reduce typing into the EHR.

The Role of Artificial Intelligence (AI)

AI may help by automating routine tasks and simplifying complex processes. AI has the potential to reduce administrative workload, allowing more patient focus. Machine learning can potentially search complex medical reports to highlight important data.

Do you love being a doctor? Is your job satisfaction level a 9 or 10 on a 10-point scale? If not, continue reading.

 

“While burnout manifests in individuals, it originates in systems. Burnout is not the result of a deficiency in resiliency among physicians, rather it is due to the systems in which physicians work.” – Christine Sinsky, MD (AMA VP of Professional Satisfaction).

This shows five possible solutions to clinician burnout.

Love Being a Doctor

How much do you love your job (0-10)? Many doctors answer 6 or 7.

Younger folks had higher scores. It got me thinking. I scored 9 or 10 on the career satisfaction score when I started.

It may have dipped to eight or so for a decade. A few years ago, mine went to a 6 or 7 as I neared the end of my second decade of practice.

That pattern may be typical, but I wouldn’t say I liked it.

Clinician Burnout – in the Mirror

Where would it end? Am I required to endure this downward spiral?

Should I change to a different practice setting? I even considered early retirement in my 40s.

For me, the changes were gradual. I almost overlooked the lowering of quality of life over time.

I started reading about physician burnout. My colleagues needed help, and the more I learned, the more I could guide them.

It dawned on me that I was heading down that road.

I took a step back. My reading about burnout had a new purpose – to apply the ideas to my life.

Can Happiness Change?

Fortunately, about 50% of a person’s well-being is genetic, and mine is positive.

I needed to work on the other 40% (attitudes, ideas, habits, etc.) and 10% (externals like money, schedule, etc.).

Some of my changes may help you.

Online surveys, such as Myers-Briggs, DISC, and Strength Finder helped me learn more about myself. I then applied what I learned. For example, I learned that I’m an “objective thinker,” “an introvert,” and a “lover of learning.” Those insights allowed me to structure my day and relate better to others.

Conclusion

Physician burnout is a pressing issue that requires a multifaceted solution. We can better serve providers and patients by concentrating on physicians’ needs.

 

Articles

  • ama-assn.org – Burnout benchmark: 28% unhappy with current health care job
  • ahrq.gov – Physician Burnout
  • medpagetoday.com – Physician Burnout Tied to Job Disengagement, Worse Care
  • ncbi.nlm.nih.gov – Burnout in clinicians 

Books

The best book on the subject: Stop Physician Burnout by Dike Drummond, MD

 

One Comment

  1. “You completely missed the point. The EMR is the main driver of burnout. A shift to patient messages going directly to the doctor, anincreasing documentation workload, greater reliance on these faulty, EMR driven metrics, and eliminating the need for staff by putting more and more burden directly on the doctor shoulders. It is a huge problem Newtown is a solution to burn out. Ha.” –
    Christine Gourin (VIA E-mail)
    Christine,
    I hoped I didn’t completely miss the whole point. I do think you are making a valid point. Most electronic medical records are not set up to make the doctor’s life easier. Many menial tasks create more work. But if your employer is focused on physician wellness, they can help. Mine offers transcription, EMR training, ambient AI technology, MA, and front desk staff to receive and triage all notes and time carved out to catch up on charting. I find the EMR a valuable tool. I use order sets and macros to help me. I would never return to paper charting.

    March 19, 2024
    Reply

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