The healthcare system needs to boost resilience in physicians, on whom it inflicts ‘unnecessary trauma,’ says one adviser.

Jan. 19—Physician burnout rates continue to trend upward, with the highest percentages seen among specialties where patients make first contact with the healthcare system: emergency medicine, obstetrics and gynecology, and family and internal medicine, according to Medscape’s annual physician lifestyle report.

Burnout has raised concern because it has been linked to increased staff turnover and decreased quality of care, patient satisfaction, and patient safety, according to a 2015 Mayo Clinic study. Symptoms include loss of motivation, feeling emotionally drained, feeling fatigued before work, and becoming irritated by routine work demands.

Almost half of physicians had either frequent or constant feelings of burnout, according to a survey released last November by the Merritt Hawkins physician-recruitment firm conducted for the Physicians Foundation. Feelings of burnout contributed to the high share of physicians, 46.8 percent, who reported that they were accelerating their retirement plans.

The Mayo study found that 54.4 percent of physicians showed at least one sign of burnout, an increase from 28.4 percent in 2011. The Medscape survey, which included responses from more than 14,000 physicians in more than 30 specialties, found a 59 percent burnout rate in emergency medicine. The rate was 56 percent among OB-GYNs and 55 percent for physicians in family medicine, internal medicine, and infectious disease specialties.

When asked to rate their feelings of burnout on a scale of 1 to 7, with 1 meaning burnout doesn’t interfere with their life and 7 indicating that burnout may cause them to leave medicine, the highest severity of burnout—a 4.6 rating—occurred among urologists. That was followed by otolaryngology and oncology, which both had burnout severity ratings of 4.5.

Medscape also inquired about “happiness” at work and outside of work. Urologists were the happiest outside of work, with 76 percent reporting being very or extremely happy when not on the job. The happiest at work were dermatologists, 43 percent; and ophthalmologists, 42 percent. The unhappiest were rheumatologists and nephrologists, with only 24 percent of both specialties being very or extremely happy at work.

Sixty-nine percent of male physicians were happy outside of work and 45 percent were happy on the job, compared with 67 percent and 39 percent for females.

Legislative Efforts

The various studies identify the same causes of physician burnout. In the Medscape survey “too many bureaucratic tasks,” “spending too many hours at work,” “feeling like a cog in a wheel,” and “increasing computerization of practice” topped the list. Other burnout factors include issues related to compensation, insurance, maintenance of certification, and threat of malpractice suits.

Congress addressed some of these in the recently passed 21stCentury Cures Act, which then-President Barack Obama signed Dec. 13. It requires the U.S. Department of Health and Human Services to set goals to reduce regulatory or administrative burdens—such as documentation requirements—for physicians using electronic health records (EHRs) and to develop a strategy to meet those goals. It also allows physicians to delegate documentation requirements for Centers for Medicare & Medicaid Services programs to non-physician scribes.

Resilience & Joy

While such steps can help, others urge system-wide changes to address burnout.

Liz Boehm, director of research at Vocera, a San Jose, Calif.-based clinical communications company, agreed that a multifaceted approach to mitigating and preventing burnout is necessary.

“Health care involves helping people who are sick, who are in constant pain, who are at the end of life,” Boehm said in an interview. “Physicians and other care-team members absorb some of that.”

Many times, these caregivers cannot help. For people who are trained to solve problems, not being able to help can be very stressful, said Boehm, who wrote co-wrote a Vocera report on “Elevating Resilience, Well-being, and Joy in Healthcare.”

The Vocera report cites a 2012 Journal of Infection Control study that linked nurse burnout to urinary tract and surgical site infections. The authors concluded that, at hospitals where nurse burnout was reduced by 30 percent, there were 6,239 fewer infections with corresponding annual savings of $68 million.

The healthcare system inflicts “unnecessary trauma” on its caregivers by adding layers of complexity on top of poorly designed operations that create unintended consequences, generate frustration, and take the focus off patients, according to Boehm.

In addition to focusing on physician and nurse well-being and restoring their “joy to practice,” Boehm also stressed the need for physicians and nurses to have a say in changes to their work processes and environment. Research backs her up.

Teamwork, participation in decision making, and change history “were associated with higher engagement and lower burnout among physicians and staff,” concluded a study by the Palo Alto (Calif.) Medical Foundation Research Institute published in 2016 in the Journal of Ambulatory Care Management.

While she applauded Congress for including the provision in the 21st Century Cures Act that allows physicians to delegate documentation tasks to scribes, Boehm said EHRs should automatically provide the needed documentation or be so intuitive in their interface that scribes become unnecessary.

“The most interesting solutions are those that recognize it’s a multifaceted problem,” Boehm said. “Let’s also strengthen individuals’ resilience to deal with dysfunctional systems.”

Health system leaders need to be mindful of how the process improvement systems they put in place may affect front-line caregivers, Boehm added.

An emerging strategy used by the Mayo Clinic and other organizations to address burnout caused by feelings of isolation involves hosting dinners and other social events where physicians get to better know their colleagues.

While these activities have been found to be helpful, Boehm finds it ironic that the discussions at these events often involve sharing work-arounds to deal with system dysfunction.

“You can host a dinner, but if you put people in a process where they’re not interacting with each other at work, are you really solving the problem?” Boehm asked.

A Comic Book Approach

Another burnout prevention strategy for clinicians is to take up an outside interest or revisit an old hobby that has gone by the wayside.

At the Ashley Women's Center in Gastonia, N.C., Sam Wilcox II, MD, said he has one medical partner who bikes and kayaks, another who spends time golfing, hiking or engaging in church activities, and another who enjoys fine food and travel. Wilcox did something entirely different. He started a business around his hobby, and this past November he opened Doc's Basement, a comic book store that also sells toys and video games.

"It definitely helps," Wilcox said in an interview. "It's just a release to go away to another realm."

People from all walks of life come to the store, including other physicians and their families. Wilcox said he met a pediatrician at the store the other day and, after learning about his store, other physicians have begun talking to him about their own interest in comics and video games.

"It's started conversations that never would've happened," Wilcox said.

Andis Robeznieks is a freelance writer based in Chicago. Follow Andis on Twitter at @AndisRobeznieks.

Publication Date: Thursday, January 19, 2017