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The current political climate has generated a lot of uncertainty regarding future healthcare developments, but the debate over national policy can sometimes overshadow issues affecting the frontlines of patient care. One growing problem is physician burnout, manifesting itself in a lack of enthusiasm for work, growing cynicism about patients or career, and a poor sense of self-worth. Physician burnout can lead to poor job performance and in serious cases, suicide. Even worse, feelings of burnout have become more prevalent over time, increasing two fold from 2011 to 2015, according to a Mayo Clinic study. While it may appear to be a problem best solved on an individual, case-by-case basis, administrators and healthcare researchers have been working to identify the root causes and manage burnout on an organizational level.
Workplace stress isn’t unique to medicine, but statistics suggest physicians suffer from it more severely. Studies have found that depression is more common among physicians than the general population, affecting about 12 and 19 percent of male and female doctors, respectively. It’s especially prevalent in medical students, with rates ranging from 15 to 30 percent. Burnout affects physicians of all specialties, but some are hit harder than others. According to a 2015 Medscape survey, critical care, emergency medicine, primary care, and general surgery had the highest reported rates of burnout. The least-affected specialties were dermatology, psychiatry, and pathology.
|Rank||Specialty||Percent Reporting Burnout Symptoms|
Source: Medscape Physician Lifestyle Report 2015
Burnout can negatively affect a provider’s mental state and overall career, but it can also impact patient care in a measurable way. Burnout is associated with higher rates of self-reported medical errors, according to most research. One study suggested a correlation between nurse burnout and incidence of urinary tract and surgical site infections, though it also corresponded to lower staffing levels. Other than quantifiable errors, patient access and experience can be affected, as physicians reporting stress are also more likely to reduce office hours and react negatively during patient interactions.
Researchers have identified multiple reasons for physician burnout. Some of it is attributable to the nature of the job, especially among providers who handle serious cases that may involve fatal injuries or illnesses. Indeed, high rates of burnout are not unique to the US, but affect doctors across the world. Other typical causes, according to physician surveys, are an excess of bureaucratic responsibilities not directly related to patient care, such as data reporting to state and federal agencies and medical coding, long work hours, and computerization, primarily entering data into EHR systems. A common complaint among physicians is that other responsibilities detract from the time they spend with patients. One survey estimated that the average physician dedicates two hours on administrative or reporting tasks for every hour interacting with patients. When doctors believe they are focusing more on regulatory requirements (compounded by poor workflow models) than actually helping patients, it’s not surprising they would become frustrated and bitter about the entire process.
|1.||Too many bureaucratic tasks|
|2.||Spending too many hours at work|
|3.||Income not high enough|
|4.||Increasing computerization of practice|
|5.||Impact of the ACA|
Source: Medscape Physician lifestyle Report 2015
Since healthcare organizations cannot simply ignore the growing list of mandated reporting and assessment procedures or sit back and hope that relief comes in the form of new legislation or reduced regulations, it’s up to health system, hospital, and physician leaders to proactively address provider burnout. So far, a two-pronged approach that seeks to prevent burnout as well as treat those already suffering from it has seen the most success. Prevention strategies can range from simple solutions such as allotting more scheduled time off and granting physicians control over their work hours, or major overhauls of clinical procedures. One study involving primary care providers found that “mindfulness” training, a brief series of courses designed to cultivate objectivity and compassion, produced sustained positive results over several months. Investments in staffing and clinical infrastructure can also help prevent burnout. Additional personnel can take over some of physicians’ administrative duties, while a reliable and intuitive HIT system can reduce some of the irritation many providers face when they enter patient data, for instance. However, such a solution may be out of reach for smaller or financially constrained organizations.
The above methods can alleviate burnout, but treating overstressed physicians isn’t always straightforward. Some doctors have said that mental illness among providers is rarely addressed or acknowledged because of social stigma. Doctors are held to high standards, by themselves as well as their peers, and often will not admit they have a problem. Organizations cannot force a cultural shift from the top down, but they can take a step in the right direction. Awareness or stress management programs can help physicians identify symptoms of burnout before they become a problem and foster a more supportive atmosphere for providers seeking assistance.
Burnout is on the rise, but there’s reason to be optimistic. The vast majority of physicians are still satisfied with their career choice, according to a new survey from the AMA. More than half would still recommend others to pursue medicine as a career, and three-quarters responded that the desire to help others was their primary motivation in their job choice. Today’s physicians aren’t tired of practicing medicine, but express frustration at specific aspects of it, aspects that can be adjusted in some cases through minor accommodations to daily operations. It’s a manageable problem, but keeping burnout under control will be an ongoing effort.
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