19 May 2016

The Physician Burnout Epidemic, Part 1: Root Causes of This Alarming Trend

Physician burnout is a huge – and growing – problem, not just for doctors, but also for the entire healthcare system and the population it serves. In a recent survey by Studer Group of more than 350 practicing physicians, a staggering 90 percent of respondents said they have experienced symptoms of burnout at some point in their career. And 65 percent of those who have experienced burnout said they have considered leaving medicine.

A Disturbing Trend With Serious Implications

Physician burnout has increased dramatically in recent years. According to a 2015 Medscape article that compared the responses of respondents to both the 2013 and 2015 surveys for the Medscape Physician Lifestyle Report, 46 percent of respondents said they suffered from burnout in the 2015 survey, compared to fewer than 40 percent of respondents in 2013. An analysis from researchers at the Mayo Clinic and the American Medical Association shows an even bigger jump: The percentage of physicians who said they are suffering burnout rose from 45 percent in 2011 to 54 percent in 2014. According to the report, “Burnout and satisfaction with work-life balance among U.S. physicians are getting worse. American medicine appears to be at a tipping point with more than half of U.S. physicians experiencing professional burnout. Given the extensive evidence that burnout among physicians has effects on quality of care, patient satisfaction, turnover, and patient safety, these findings have important implications for society at large.”

This trend is even more disturbing in the face of the growing physician shortage. Surgeon General Vivek Murthy, M.D., MBA spoke about the severity of this issue in a recent interview with MedPage Today. “The suicide and burnout rate is very high,” he said, “and this is concerning to me because we're at a point in our country where we need more physicians, not fewer; we need more people entering our profession, not fewer…I am particularly interested in how to cultivate emotional well-being for healthcare providers. If healthcare providers aren't well, it's hard for them to heal the people for whom they are they caring.”

What’s Fueling the Increase in Physician Burnout?

The causes are well documented, with regulatory burdens, lack of work-life balance, changes to payment arrangements and the increased computerization topping the list of complaints. Physicians responding to the Medscape Physician Lifestyle Report ranked “Too many bureaucratic tasks” as the most important cause of burnout, followed by “spending too many hours at work.” Changes to the healthcare system that affect doctors’ earnings also have taken a toll: 2015 respondents cited insufficient income as the third most important cause, up from fifth place in 2013. And increasing computerization of physicians’ medical practices jumped dramatically from ninth place in 2013 to fourth place in 2015.

A 2013 analysis by the American Medical Association (AMA) and RAND Health found that while doctors approve of electronic health records (EHRs) in concept and appreciate being better able to access patient information remotely, as well as the promise of improvements in care quality, the current state of EHR technology has significantly worsened their professional satisfaction. Most of their frustration stems from current EHR systems’ poor usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information because of interoperability issues, and degradation of clinical documentation. In a December 2015 article on WBUR’s CommonHealth site, former practicing doctor-turned-writer Diane W. Shannon, M.D., M.P.H. shared an internist’s explanation of frustration with EMR finally drove her to leave medicine: “If I took the time to actually talk with my patients, which is what drew me to medicine in the first place, it meant I fell behind and then spent hours and hours at home in the evening doing the required data entry.” In his inaugural address to the Connecticut State Medical Society’s House of Delegates last year, incoming president Henry E. Jacobs, M.D., J.D. wrote that “No study existed or exists today that demonstrates EMR decreases errors, increases efficiency, or lowers costs. Studies do show, however, that it has demoralized doctors and nurses and is a major component of job dissatisfaction and angst about where medicine is heading.”

Dr. Jacobs expressed doctors’ current frustrations in blunt terms. “The practice of medicine has become that of technician-bookkeeper-data entry clerk,” he wrote. “Government intervention into medicine has empowered insurance companies and CMS, using perverse incentives, bureaucratic regulations, and economic pressure, to force doctors to practice medicine their way…Clinical judgment was made an anachronism and guidelines morphed into mandates…Rigid adherence to protocols had some lethal consequences for patients. We are now serving under a cookie cutter paradigm.”

Physicians and practice managers who participated in the AMA-Rand Health study also cited the cumulative burden of externally imposed rules and regulations as a major source of frustration and professional dissatisfaction. Gerald A. Maccioli, M.D., Sheridan’s Chief Quality Officer, explained the scope of the problem: “There are more than 500 state quality measures in total, and only 20 percent cross over among states and medical specialties. Individual insurers and even health organizations often require their own metrics as well. This lack of standardization creates an almost unbearable administrative burden for doctors.” In February, the Centers for Medicare and Medicaid Services and the America’s Health Insurance Plans trade group took a first step in trying to standardize quality metrics, finally reaching consensus on how to measure physician quality in seven medical areas. But these initial seven “core measure” are far from comprehensive and won’t go into effect for years.

Doctors participating in the AMA-Rand Health study also expressed frustration that the increased demand for care (caused in part by the expansion of healthcare coverage to millions of previously uninsured Americans under the Affordable Care Act) limits the time they can spend with each patient, sometimes detracting from the quality of care they can provide.

Physician, Heal Thyself?

Focusing on personal wellness, such as a healthy diet, regular exercise, taking short breaks and practicing mindfulness meditation, can help and give doctors some tools within their control. The AMA’s STEPS Forward™ practice transformation series includes modules on improving physician resiliency and preventing physician burnout that focus on wellness activities and programs. But it’s hard for doctors to find time to exercise, eat well, meditate, take short breaks, and incorporate other wellness activities into their routines when they barely have time for themselves as it is. And most of the contributing factors are outside doctors’ control.

Sixty-six percent of the doctors who responded to the Studer Group survey said they don’t have the tools or resources to help themselves or their peers with this problem, and 54 percent said their leaders are not actively taking steps to treat or prevent burnout. More and more physicians are joining health systems, hospitals or large physician services companies as a refuge from the daunting administrative and legal burden of complying with government and carrier regulations and rules. Physician leaders have a responsibility, not only to doctors but also to patients and to health systems, to help relieve as much of this burden as possible so that physicians have the time and focus they need to provide high quality care.

Part two of this series will address the important role of physician leaders in combating the burnout epidemic.