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Physician Burnout

Sigmund Freud got it right in stating: “love and work are the cornerstones of our humanness.” Yet, that hope is fading for physicians across the country. National data shows a 43.9% physician burnout rate1, higher than for other professions.

Growing Crisis in Physician Burnout

As burnout becomes a growing concern, the medical community is pausing to acknowledge the complex interplay between over-stressed physicians and their patients.

While burnout is important to physicians, it is also a major workplace concern impacting many employers. There are about 953,695 actively licensed allopathic and osteopathic physicians. Each of these physicians supports about 17 jobs for an estimated 12.6 million jobs in the U.S. likely impacted by physician burnout.2

Medical practices have changed significantly over the past decade. In 14 states, a health care network is the largest employer and in most states a healthcare entity falls within the top 5 largest employers.3 Gone are the days when physicians were mostly solo practitioners running small businesses.

The percentage of hospital-employed physicians increased between 5% and 22% in every region of the country between 2012 and 2016.4 The percentage of physicians who are employees in their practice increased from 41.8 percent to 47.1 percent during that same time period. Thus, not only was 2016 the first year in which the percentage of practices owned by physicians dipped below 50 percent, it was also the first year when there were an equal number of physicians as employees and practice owners.

Younger doctors and women physicians are more likely to be employees in a healthcare practice suggesting a progressively shifting landscape with more physicians as employees and less owning their practices. The stressors of being an employee are different than those physicians faced as practice owners. This may contribute to greater burnout as physicians lose control and autonomy in their daily practices.

There are personal and business-related issues associated with burnout. On the personal side are serious concerns with substance use, poor relationships, suicide, and depression. On the business side are concerns with costly turnover, reduced productivity, lower patient satisfaction, and increased medical errors.

The Business Case for Addressing Burnout

Turnover is costly with direct and indirect costs of replacing a physician estimated at between $500,000 and $1 million dollars.5 Also, physician burnout and turnover are thought to be contagious, so one burned out physician leaving an institution makes it more likely that other healthcare providers will leave too. An excellent calculator exists to help leaders understand the ROI in addressing burnout in their organizations.6

Moreover, burned out physicians see fewer patients making it more difficult for people to access care negatively impacting an organization’s bottom line. The Triple Aim -better care, better outcomes and lower cost for improving population health is undermined by physician burnout. It has been suggested that the Triple Aim be expanded to the Quadruple Aim adding work-life balance for health care providers.7

Beyond the business case, there are three additional compelling reasons to address physician burnout:8

  • the moral-ethical case of providers caring for people;

  • the tragic case of physician suicides; and

  • the regulatory case of accreditation requirements.

While the business case is compelling, leaders should also recognize that addressing burnout is simply the right thing to do. Good leadership improves burnout and physician satisfaction.

There are several ways to tackle burnout starting with a burnout assessment in the organization. These seven factors drive physician burnout and beyond healthcare, impact employees across most industries:9

  • Workload

  • Efficiency

  • Flexibility and control

  • Culture and values

  • Work-life integration

  • Community at work

  • Meaning in work

These factors should be addressed at four levels: national, organizational, work unit, and individual levels. Leadership plays a key role in addressing burnout at the organization and work unit levels. Burnout can be measured with scales such as the Maslach Burnout Inventory10, the freely available Stanford Professional Fulfillment Index11, and the freely available Mini-Z Burnout Survey.12 The scales assess the extent of burnout and the effectiveness of interventions to address it based on the seven drivers listed above.

The good news is that more national attention is focused on burnout. Multiple national organizations are collaborating on research, resources and best practices in effectively addressing burnout including the American Psychiatric Association, the National Academy of Medicine, and the American Medical Association.

Together, we can help bring joy and sustainability back to the medical profession to ensure optimal, compassionate care for people.

By: Gaurava Agarwal, MD, Assistant Professor, Northwestern Univ., Dept. of Psychiatry and Behavioral Sciences, Chair, Behavioral Health Section, American College of Occupational and Environmental Medicine, Advisory Council Member, Center for Workplace Mental Health.

References

  1. Shanafelt, T., West, C., Sinsky, C, et al., Changes in Burnout and Satisfaction with Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc., 2019.

  2. American Medical Association: Policy Research Perspectives, 2017.

  3. Comen, Sauter. The Largest Employer in Every State. March 2017.

  4. American Medical Association: Policy Research Perspectives, 2017.

  5. Butcher, Lola. The Business Case for Fighting Physician Burnout. April 26, 2019. Healthcare Financial Management Association, Leadership.

  6. Bodenheimer, Thomas and Sinsky, Christine. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine. November/December 2014, vol 12. no6. 573-576.

  7. Shanafelt, TD., Noseworthy, JH. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clin Proc. 2017 Jan;92(1):129-146. doi: 10.1016/j.mayocp.2016.10.004. Epub 2016 Nov 18.

  8. Id.

  9. Survey available in Article Appendix

  10. Mini Z Survey

More References

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