Physician Burnout in 2019: Are the Numbers Getting Better or Worse?
Recent discussions about physician burnout have taken some interesting turns. Some say the wrong questions are being asked and the wrong solutions are being proposed. Some even question whether the term “burnout” is appropriate to label the well-publicized epidemic of exhaustion among physicians.
“The term burnout has taken on meaning far beyond what is understood about it as an actual diagnosis or even a syndrome,” say Thomas L. Schwenk, MD, and Katherine J. Gold, MD in an editorial accompanying two recently published studies in the Journal of the American Medical Association. “The medical profession has taken a self-reported complaint of unhappiness and dissatisfaction and turned it into a call for action on what is claimed to be a national epidemic that purportedly affects half to two-thirds of practicing physicians.”
One of the problems with that approach, says Dr. Gold, is that the questionnaire many researchers use to study burnout is based on studies of interpersonal relationships. “Medicine used to be like that,” she says, “but now we know it’s much more paperwork, it’s much more computer clicking, and checking boxes, and not being with patients. And so I think it’s a valid question to ask whether this construct that was designed based on interpersonal relationships applies, when most of us are spending very little of our time actually with our patients.”
In fact, one of the recent studies — a review of 182 previous studies in 45 countries — found “substantial variability in prevalence estimates of burnout among practicing physicians and marked variation in burnout definitions, assessment methods, and study quality.” Those findings, say the authors, “highlight the importance of developing a consensus definition of burnout and of standardizing measurement tools to assess the effects of chronic occupational stress on physicians.”
By any name
But whether you call it burnout or merely unhappiness and dissatisfaction, institutions need to do much more to address it, says Peter Grinspoon, MD, a primary care physician who teaches at Harvard Medical School. “Sadly, hospitals and other medical institutions have tended to address the problem of physician burnout merely by giving their doctors inspirational talks about ‘resilience,’” he says, “and then sending them back into their deteriorating clinical lives with no material change in circumstances. Sometimes they throw in a yoga mat.”
That’s an approach that’s destined to fail, agrees Dike Drummond, MD, author of “Stop Physician Burnout.” “We’re conditioned to be super hero, workaholic, Lone Ranger, perfectionists,” says Dr. Drummond says. “Nobody teaches the off switch on doctor. A workaholic only has one coping mechanism and that’s to work harder.”
One result of that perceived inability to self-regulate is that physicians are committing suicide at a rate of nearly 400 per year, a rate that’s more than twice as high as that of the general American population. We also know that physicians who experience burnout are more likely to make major medical errors.
The onus, says Dr. Drummond, must be on hospitals and other organizations that employ physicians to “complete the doctors’ medical education. Teach them everything about stress, stress management, burnout and burnout prevention so they can protect themselves against the number-one threat to their career: burnout. These topics are not in curriculum of med school or residency. Most doctors only learn how to take good care of themselves when they are recovering from their first episode of burnout.”
But that’s a leap that most healthcare leaders have been unable or unwilling to take, says Dr. Tait Shanafelt, MD, chief physician wellness officer at Stanford Medicine: “They say, ‘It’s a national epidemic, what can we do?’ My experience has shown that an individual organization that is committed to this at the highest level of leadership and that invests in well-designed interventions can move the needle and run counter to the national trend of physician distress and burnout.”
A persistent complaint associated with burnout is the feeling of being overwhelmed by regulations and administrative tasks. “Most of us primary care physicians are spending less time with our patients and much more time on clerical activities,” says Dr. Gold. “We know anecdotally that physicians are often really frustrated by the non-doctor things that we have to do: the charting, the things that we aren’t trained to do. I think what people find rewarding is our time with our patients, and we have less and less time for that. I think the stress that people are feeling is much more about external demands, like the electronic medical record and paperwork.”
“In my personal experience as a primary care physician over the last 20 years … hospitals will choose a medical record system that prioritizes their revenues, and which has the doctor facing the screen and pecking away,” says Dr. Grinspoon, “over one that allows for doctors and patients to speak with each other, comfortably, face to face.”
Dr. Shanafelt also cites a study conducted by investigators at Colorado University that found that when the number of assistants per provider was increased from 1.1 to 2.5, the rate of reported burnout fell from 53% to 13%, and that the increase in assistance was cost effective.
Moving the needle
That cry for help aligns with several studies showing that certified medical scribes can be one of the most effective and cost-effective solutions for physicians who feel overwhelmed by clerical tasks, and who long for more face-to-face interaction with their patients.
Bolstered by unique and in-depth training, ScribeAmerica scribes save providers from the despair caused by constantly increasing workloads, constant time pressures, chaotic work environments, and mind-numbing bureaucratic tasks. They’re a remedy for burnout at a time that one is sorely needed.