Since well before the pandemic, physicians have struggled to cope with an overburdened system. The obstacles they face tend to affect their day-to-day happiness, relationships, and approach to patient care. There’s a deceptively simple word for it: burnout. When accompanied by depression, burnout in the medical profession has been shown to lead to serious and even tragic consequences. To minimize this risk and the damage it causes, every healthcare organization needs strategies in place to offer support to physicians facing burnout.
SE Healthcare is an organization on a mission to empower providers and make healthcare better for patients and practices through data analytics. Their dedication to creating a safer, more effective healthcare environment has led them to create a proactive strategy, “The Physician Burnout Prevention Program.”
This interview with the chief clinical and quality officer of SE Healthcare, Stephanie Sargent, covers the critical topics practice leaders need to understand how to combat physician burnout, including:
- The cause of burnout in healthcare
- The impact on the individual and on the organization
- How organizations can help
- Five best practices for physician wellness infrastructure
Q: What causes burnout in healthcare?
A: “Dr. Christine Sinsky, the vice president of professional satisfaction at the American Medical Association, estimates that the workplace environment is causing 80% of the burnout among American physicians. System-generated issues are by far the largest contributor to day-to-day stress. Workload, documentation, administrative tasks, long working hours, and productivity demands are just a few very common examples.”
Q: Do you see a difference in burnout rates between male and female providers?
A: “Higher rates of burnout are reported in female physicians. The reasoning for that is not exactly clear, but one theory is that females may be more willing to admit symptoms. It’s also just the reality of our society that females take on more responsibility for childcare-related activities. If a person’s home environment is not supportive and restorative, this could be the tipping point over into burnout. The COVID-19 pandemic likely exacerbated this circumstance with homeschooling demands and lack of childcare.”
Q: How serious an issue is burnout?
A: “Burnout is a dilemma that requires strategies– multiple strategies – because the contributors to burnout are multifactorial.
71% of physicians state their burnout has a moderate or strong/severe impact on their life, and the statistics related to this impact are quite serious:
- Medical errors can be 3 times higher in settings with high burnout rates (medical errors are the third leading cause of death in the US, only behind heart disease and cancer).
- The Association of American Medical Colleges predicts a shortage of 139,000 physicians by 2033.
- Turnover can result in lost revenue of $990K, on average, per physician.
- The cost of recruiting/replacing a physician: $500K – $1M.
- Burnout doubles the risk of suicide – one doctor commits suicide in the U.S. every day — the highest suicide rate of any profession.”
Q: Has the COVID-19 pandemic affected the reported burnout rate?
A: “Physician burnout was present to a staggering degree well before the pandemic. A Medscape report published in January 2020 reported physician burnout at 42%. Some specialties, such as urology, reported burnout as high as 54%.
“Death by 1000 Cuts: Medscape National Physician Burnout & Suicide Report 2021,” released January 22, 2021, found 79% of physicians stated their burnout began before the COVID-19 pandemic. This is not a surprising finding, but brings to light that for 21%, the pandemic was the catalyst for burnout.
The pandemic brought an onslaught of blows to healthcare. For some specialties, in-office patient visits came to an abrupt halt. An AMA survey found that in-person visits in physician offices fell from 97 per week to 57. This resulted in physicians averaging a 32% decrease in revenue since February 2020. Telehealth use hit its peak utility during this time period, but almost 70% of physicians stated that despite telehealth increases, they were still providing fewer total visits (in-person and telehealth) at the time of the survey than pre-pandemic. The financial impact for many was devastating.
For physicians in the inpatient setting, the barrage of COVID-19 admissions was overwhelming. ICUs were full, and there were staffing shortages due to staff either falling ill or on quarantine from exposure. Physicians were pushed to the absolute maximum of their capacity. The most devastating news came when Dr. Lorna Breen, an emergency medicine physician at New York Presbyterian, committed suicide in April 2020. In the last conversation with her father, she described, “…patients who were dying before they could even be taken out of ambulances.” The burden was simply too much to bear.
Q: How do providers typically cope with burnout?
A: “In short, most physicians tend to “suck it up” until they just can’t give what they don’t have anymore. For some, this means leaving healthcare for something more rewarding, or retirement altogether. For others on the far end of the spectrum, the consequences are worse.
In practical terms, the most recent Medscape report found physicians take the following actions to alleviate burnout in the workplace (top 4):
- Reduce work hours (28%)
- Change work settings (21%)
- Make workflow or staff changes to ease their workload (20%)
- Speak with hospital/group administration about productivity pressure (17%)
Outside of work, physicians reported the following coping mechanisms:
- Exercise (48%)
- Talk with family members/close friends (43%)
- Isolate myself from others (43%)
- Sleep (39%)
- Play or listen to music (36%)
- Eat junk food (35%)
- Drink alcohol (26%)
- Binge-eat (21%)
- Use prescription drugs (3%)
- Smoke cigarettes/use nicotine products (2%)
- Smoke marijuana (1%)
It’s unfair to place the responsibility to “get more resilient” upon the shoulders of hard-working, dedicated physicians. They’ve already endured years of residency and fellowships. What we can do is offer basic education to help them better understand burnout, teach them to recognize it within themselves or others, and provide practical tools and resources to make their daily practice more satisfying and efficient, while optimizing their rest and restore time.”
Q: What’s the impact of burnout on the individual and on the organization?
A: “The impact on the organization is broad and includes increased physician turnover and lost revenue from job vacancies, increased medical errors, and increased risk of malpractice claims and payouts. When physicians become disengaged, cynical, or exhausted, connection with patients suffers. Satisfied patients are more likely to adhere to prescribed treatment plans and maintain an ongoing relationship with a health care provider. Patients who like their physician are also less likely to sue.
For the individual physician, there is an overwhelming dissatisfaction with their career – only 49% report happiness in their work life. 20% of physicians report depression. Further consequences of burnout include strained personal, professional and patient relationships, and increased suicide risk. It is estimated that 300 physicians commit suicide each year.”
Q: When is the best time for healthcare leaders to intercede and provide burnout relief?
A: “Research shows that if tools, education, and resources are provided early in a physician’s training, it can effectively inoculate them against burnout later in their career. So, when it comes to providing help with managing burnout, the sooner the better.
It is SE Healthcare’s great hope that healthcare organizations meaningfully adopt the same mentality towards the health and well-being of their physicians as they have with patient care – that is, investing in a proactive, comprehensive burnout prevention program – including tools, resources, and education.”
Q: How can organizations help?
A: “Many organizations are stuck believing nothing can effectively be done to address burnout. In reality, there are multitudes of actions, some with little investment, that can impact the issue. SE Healthcare’s expertise is pinpointing the issues directly from physicians and providing organizations with prioritized actions.
Though every organization will have unique strategies to address physician burnout in their system, there are five best practices across all settings that serve as the foundation of a physician wellness infrastructure:
- Make the commitment to physician well-being – words matter, but actions matter more. Include physician wellness with metrics in the enterprise strategic plan.
- Provide a 24/7/365 system-wide physician-specific 24-hour crisis hotline and physician EAP support program.
- Accept responsibility for the system-generated stressors. The majority of the contributors to burnout are caused by poor processes or environments that physicians are subjected to and must work within. From the most recent Medscape study, the most common contributors to burnout are (top 6):
- Too many bureaucratic tasks (58%)
- Spending too many hours at work (37%)
- Lack of respect from administrators/employees, colleagues, or staff (37%)
- Insufficient compensation/reimbursement (32%)
- Lack of control/autonomy (28%)
- Increasing computerization of practice (28%)
Organizations must develop a hard-wired process to identify and address system-generated contributors to stress.
- Measure burnout longitudinally. Measuring engagement is not a substitute for measuring burnout – 20% of your highly engaged physicians will tip over into burnout. Display the measures transparently. Include open-ended questions asking physicians what their top stressors are.
- Provide tools, education, and resources for the physicians. Our experience with needs analyses is that resources need to be free, accessible, confidential, and on-demand for all physicians, including content for building a personal burnout prevention strategy.”
Once you understand the root causes of burnout and the catalysts of disconnect, you can start to help yourself, as a clinician, as well as provide targeted support to your team. With a few core strategies in place, it’s entirely achievable to revive the morale within your practice or healthcare organization. As practice leaders who value their providers and their patients, you have the power to make healthcare safer and more effective for all involved.
The far-reaching repercussions of burnout can be significantly reduced with the proper education, tools, and resources. You can and should take an active role in not only supporting clinicians experiencing burnout but also preventing burnout from occurring in the first place.
SE Healthcare is a proud CareCloud GPO partner. GPO members are invited to participate in SE Healthcare’s Physician Burnout Prevention Program which provides a comprehensive strategy for addressing and preventing physician burnout. To learn more about SE healthcare’s burnout solutions and services, click here.