Articles of Interest for Healthcare Executives
PHYSICIAN BURNOUT: ITS INCIDENCE AND UNDERPINNINGS - John M. O'Brien, Ph.D. Senior Consultant, DocExecutive
Researchers continue to identify alarming increases in physician burnout year after year in the United States. Some experts are calling it the biggest public health problem facing our nation. Although the incidence of burnout varies based on physician specialty, the 2017 Medscape Report demonstrated that levels of burnout are consistently increasing year after year in all areas of medical practice.
Some hospital administrators and physician leaders are arguing that the main cause of physician burnout is the physicians themselves. These experts highlight data that show that doctors who are more burned out make a greater number of medical errors, placing patients at more risk. In a recent interview, Dr. John Noseworthy, head of the Mayo Clinic, argued that patients should fire their doctor if they suspect that he or she is burned out. Dr. Dike Drummond, well-respected expert on physician burnout, cogently called Dr. Noseworthy’s ideas and conclusions into question. If up to 60% of physicians in a specialty area are burned out and should not see patients, how is that a realistic solution to the growing physician shortage? In short, it is not.
Are physicians really to blame for their burnout? The 2017 Medscape survey identified the following elements of physician practice as the main causes of burnout: too many bureaucratic tasks, spending too many hours at work, feeling like just a cog in a wheel, and increased computerization of practice. As these factors indicate, organizational structures play a role in at least contributing to burnout levels in many doctors if not being the main causes.
Does that mean that individual doctors do not have any characteristics that cause them to burnout? Although it is not helpful or effective to BLAME physicians for their burnout, we can learn to identify what personality variables and behavior patterns may make physicians more vulnerable to stress and burnout. We will explore physicians, personality characteristics and burnout in a future blog. However, there is one personality characteristic that many physicians possess that underlies burnout: perfectionism.
Many doctors confuse an adaptive drive to excel with the maladaptive quality of perfectionism. Doctors learn in medical school that they must always have the answer, should always get the answer right and can never make a mistake. In short, they learn that they must be perfect and therefore not human. When they do make errors, do not know answers or are dealing with inefficiencies in the work environment, their perfectionism can crumble, sometimes leading to depression, anxiety, burnout and suicide.
Untreated depression and suicide is one of the most devastating effects of physician burnout. Until recently this phenomenon had not received significant attention. The important work of Dr. Pamela Wible has highlighted the tragedy of physician suicide and reasons for it. Physicians are #1 on the list of professionals that are most likely to kill themselves. Medical students are also at risk and can have up to two times the incidence of depression as compared to the general population.
There are a variety of factors that contribute to physician burnout. Both individual and organizational variables contribute to burnout and therefore can be effective targets of intervention. Organizations can change their structure and involve physicians more in problem solving ways to improve their work environments. In future blogs, we will explore changes that practitioners can make to adjust to stressors in their work environment as well as personality and its relationship to burnout.
WHAT HEALTHCARE ORGANIZATIONS CAN DO TO HELP REDUCE PHYSICIAN STRESS - Margaret Palmer, Ph.D. President, DocExecutive
No one, within medicine, disagrees that physician stress is presenting itself with increasing frequency and intensity. Greater work dissatisfaction, a gradual degradation of personal and professional relationships, depression, and, most alarmingly, the rapidly escalating incidences of physician suicide are being experienced from the smallest rural healthcare settings to the large, urban, trauma centers. Distressed physicians were the first iteration of those we singled out to receive special help. But, the phenomenon is growing rapidly with the need for more widespread support. Pamela Wible, M.D., reveals, in her shocking but realistic books, the true desperation that is being experienced in silence by those on whom Americans depend for our good health.
So many factors contribute to the rising and serious trend of severe physician stress, many of which are individual and personal and the responsibility of the physician to address. These are the same individuals, however, who we trained to put aside any sense of personal or professional vulnerability, and carry on, no matter what they might be experiencing inside of themselves. To say that physicians are masters of keeping their vulnerabilities secretly tucked away is quite an understatement. Most who do reveal their exhaustion and dissatisfaction with medicine are already in late stage levels of stress.
But, employing organizations can be more alert and ready to adjust some current practices that will produce immediate and long-term sustainable reductions in physician stress. According to a recent study in JAMA, (12/5/16), “Controlled Interventions to Reduce Burnout in Physicians”, organizational interventions can involve simple changes in scheduling and reductions in the intensity of workload, thereby creating institutional support for the fragile mental health of its providers. Additionally, the article points out that attending to improved team work within medical practices, changing the ways in which physicians are evaluated, and enhancing job control can contribute greatly to a sense of balance not currently felt. As physicians are invited into discussions that can alter their stressful work environments, there is a greater feeling of empowerment and control, somethings that physicians have lost, incrementally, since the advent of employment by healthcare organizations.
It is true that healthcare organizations must maintain a healthy enough bottom line to sustain the continued provision of contemporary and advanced healthcare, but acknowledging the increased expectations placed at the feet of the revenue producers is essential to providing support to an ailing population of physicians. Encouraging are the data that point to the efficacy of organizationally based interventions for reducing physician stress, and ultimately, burnout. “Organization-directed interventions were more likely to lead to reductions in burnout. Those that combined several elements such as structural changes, fostering communication between members of the health care team, and cultivating a sense of teamwork and job control tended to be the most effective in reducing burnout.” (Linzer, Grossman, et al., J Get Intern Med. 2015).
Healthy healthcare organizations are built around the longevity and commitment of their physicians to provide the high quality care that attracts patients to them. It makes perfect sense to tune into the simple organizational interventions that cost little to initiate but pay off hugely to all constituents involved in the delivery and receipt of quality medicine.