How to address physician burnout (the right way)

Physician burnout has become a new hot research topic in medicine.

It’s a hot button issue for a variety of stakeholders, in part because it has such far reaching impact. Not only are physicians themselves affected, but so are health care institutions, insurers, the system as a whole and, of course, patients.

And it’s widespread.

A study in JAMA Network Open found that physician burnout increased from 40.6% in 2014 to 45.6% in 2017, along with increasing levels of exhaustion and cynicism.

A Geneia report earlier this year found 89% of physicians believe the “business and regulation of health care” has negatively impacted the practice of medicine. And 80% of the surveyed doctors said they think they are personally at risk of burnout at some point in their career.

In other words, the issue is at crisis level.

But with increased attention has come increased action. Health care groups have begun to examine and tackle the issue at their institutions, eager to find ways to relieve the burden on physicians and allow them to do their best work.

A broken system

The growing prevalence of burnout can be attributed to myriad factors.

The addition of new technological demands, new regulatory and compliance demands and other administrative burdens has left many physicians feeling dumped on and unable to keep up, said Dr. Alain Chaoui, president of the Massachusetts Medical Society.

And for too long, physicians themselves were the target of blame, he said.

“Health care is a big ship, physicians are overboard, in the water and we’re saying, ‘You need to swim a little faster, do some yoga.’”

But really, he says, “The system is broken.”

Electronic health records in particular have added an incredible burden to physicians’ workloads, without being a clear source of quality improvement.

“A lot of the electronic health platforms were designed to be billing tools. They’re not designed by nature to be tools to help clinicians provide better patient care,” said Dr. Marcela Del Carmen, chief medical officer of Mass General Physician Organization and a co-author of the JAMA study.

She says the amount of documentation required in EHRs, including work that is irrelevant, overly detailed and will never be seen, can be frustrating for providers.

In addition, team-based work and the constant innovations in medicine mean that care is delivered differently and also constantly changing, Del Carmen said. Plus, patients want 24/7 access to physicians, leaving physicians constantly connected to work, with little reprieve.

“It becomes indefatigable,” she said.

Today though, more and more leaders are recognizing the myriad factors that need to be part of a comprehensive wellness conversation for physicians.

Dr. Jonathan Ripp, chief wellness officer at Mount Sinai, says wellbeing is multifaceted. It can be efficiencies of the workplace, social support and community, an organizational culture – such as whether managers and leaders offer support and recognition for a job well done – as well as mental health issues and physical wellness in the form of exercise and nutrition.

“It’s important to have a conceptual model to put all of those efforts into an organized structure,” he says.

Also important: You can’t just pick one area to fix. They all need attention and improvement to be able to make a real difference.

Leaders paving the way

A number of health systems are at the forefront of tackling physician burnout and working to ensure physician wellness. And while each institution is different and tackling the issue in their own way, there are some commonalities.

First, you have to find out what’s not working.

The first thing Ripp did as newly appointed chief wellness officer at Mount Sinai was to “get a lay of the land.” He accomplished this by going on a listening tour of the large health system.

“The people who are in it are likely to know it better than anyone else,” he said.

This helps identify the top issues that need to be addressed.

Similarly, Mass General used a survey to identify four key domains affecting physician satisfaction. They are: finding fixes for IT and electronic health records, governance, workflow and, finally, wellness.

Del Carmen says wellness was not the No. 1 component because the burden of responsibility should be on the institution, not the individual.

Next is the testing and implementation phase. Groups must find programs, tools and ideas that can address the key issues and test them out.

And the experts all agree that no one-size-fits-all approach will work to tackle burnout. The solutions need to be personalized within each organization.

Mass General has given funding to each of 16 clinical departments to allow local leadership to conceive of, implement and test the initiatives that are most needed.

The groups will convene at the end of the year for a “hack-a-thon” to present their work, share ideas and determine if any best practices can be created and shared.

“No one should have to reinvent the wheel,” Del Carmen said.

Similarly, Mount Sinai also has launched faculty wellness champions, who will work at the department level to come up with an individualized plan that addresses local needs. From there, they will build out best practices to use across the health system as needed.

Listen, brainstorm, implement and test, measure, share. Then repeat.

Burnout being both complicated and widespread, those at the forefront recognize that it may take some time to see improvements. But they believe the effort and the patience will surely pay off.

“Medicine over the last couple of decades has become less personal in a way. We want to try to get a lot of that back,” Ripp said.

“We want to bring back the joy into the practice of medicine,” Chaoui said. “The bottom line is, please let doctors be doctors.”

 

Kathryn Doherty has been a health editor with SmartBrief for more than 13 years. She has covered many facets of the health care industry during that time and currently focuses on physicians, health care providers, nutrition and wellness.

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