January 05, 2018 10:15 AM

Opinion: It’s Time to Treat Physician Burnout’s Root Causes

The medical community widely recognizes the stresses physicians face. Now it is time to take measurable steps toward changing the profession.

Practicing medicine is bad for your health.

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Mounting evidence shows that stress-related burnout is a significant and growing threat for doctors — and their patients. If there is a silver lining, it is that the medical community is beginning to acknowledge and address the complex factors at play, recognizing that good health care must include caring for caregivers.

Numerous studies reveal that physician burnout — generally defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment — is a major problem.

A Medscape survey found that 51 percent of doctors surveyed in 2016 said they experienced burnout, an increase of more than 25 percent since 2013. This dovetails with a 2015 paper published in Mayo Clinic Proceedings that reported a burnout rate of 54.4 percent in 2014, up from 45.5 percent in 2011.

It is a phenomenon found across all specialties in medicine, regardless of stress levels or time demands. For physicians, burnout rates are almost twice as high as those found in the general population.

A 2015 Mayo Clinic study reported that roughly 40 percent of physicians suffer depression each year and almost 7 percent had considered suicide within the prior 12 months. It is estimated that 300 to 400 doctors take their lives every year.

The pain and suffering those statistics only hint at is bad enough. But they are compounded by findings that burnout corrodes the doctor-patient relationship, resulting in lower levels of patient satisfaction, job satisfaction and productivity, as well as higher levels of medical errors and disruptive behavior.

Burnout is also connected to the decision to switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

There is no single cause of burnout, but long workdays contribute. Doctors work an average of 50 hours per week, 10 more than most other Americans. Other major contributing factors include the pressures caused by student debt (the average medical student owes about $190,000 in loans upon graduation); an inability to accomplish obligations outside of medicine; and the frustration that results from an inability to spend uninterrupted time with loved ones.

The challenges of balancing work-home obligations take a special toll on female doctors, whose burnout rates are twice as high as those of their colleagues, making them more likely to leave the profession.

"Medicine has long been hampered by the ancient myth of invincibility — the notion that physicians must never show weakness, always embodying grace under pressure. This is not only wrong, but also adds to the emotional toll on our physicians."
Marschall S. Runge, M.D., Ph.D.

The problem with paperwork

Physicians are subjected to very time-consuming administrative activities, much of this from regulations imposed by federal and nonfederal insurers. And perhaps the single most problematic of these is the time demand of electronic health records. It is no coincidence that the spike in burnout rates has come at the same time as the broad adoption of EHRs. Someday, EHRs may revolutionize health care by dramatically increasing our ability to share and review patient information. But today, EHRs are turning many physicians into clerks.

SEE ALSO: Study: Physicians Don’t Report or Treat Their Own Mental Illness Due to Stigma

It can take 32 clicks to order and record a flu shot. Some studies show that doctors now spend about two hours on paperwork and desk work for every hour they devote to patient care.

Personal contact is a major reason people choose careers in medicine, so it is hard to overstate how much this dispiriting lack of contact leads to the depersonalization and depression that are the hallmarks of burnout.

Perhaps the best evidence that practicing medicine is bad for one’s health are studies showing that medical students begin their training with stronger mental health profiles than their fellow college graduates. This advantage vanishes and a deficit emerges as they progress through their schooling, residency and professional practice.

As in medicine, we must identify the problem before we can treat it. A crucial step was taken in July when the National Academy of Medicine called on researchers to identify interventions that ease burnout. Many universities and academic hospitals have been exploring ways to address the problem.

At the University of Michigan, we established two groups last year: one to look for meaningful changes among our doctors and the second to focus on these same challenges among our younger residents. Although some comfort results from providing yoga or meditation classes at work and the like, in the big picture, these approaches are not treating the root problem. It’s like putting a Band-Aid on an inflamed skin lesion — it may help temporarily, but it does not address the core issues.

The next level is to make small, meaningful changes to help physicians achieve a better work-life balance, such as implementing more flexible scheduling that recognizes family commitments and better child care assistance. The use of “scribes” to handle some paperwork chores and drawing a sharper distinction between the care only doctors can deliver and that which physician’s assistants and other trained personnel can effectively provide would help, too. At Michigan, we will soon begin pilot programs aimed at creating this environment.

Above all, we must allow doctors to ask for help and provide them with the care they need without penalty. Medicine has long been hampered by the ancient myth of invincibility — the notion that physicians must never show weakness, always embodying grace under pressure. This is not only wrong, but also adds to the emotional toll on our physicians.

Physician burnout is a national crisis. Unfortunately, there is no quick fix. Medicine will always be a uniquely demanding profession, requiring years of training and long hours of service to be ready to make life-or-death decisions.

Fortunately, a broad consensus has emerged in the medical community that doctors cannot provide the best care for their patients if we don’t figure out how to take care of them.