More than five years after her patient died, a physician is still haunted by her role in his final days.
Earlier this year, in an anonymous TED podcast, the physician told her story. Her patient — whom she called Mr. W — was screaming that he wanted to leave the hospital. Instead of using her usual empathy, compassion and well-honed communication skills to convince him to stay, the physician signed a “discharge against medical advice” order.
Mr. W died a few days later of a hemorrhage that the physician believes could have been diagnosed and treated if he had stayed in the hospital. In her podcast episode titled “Dr. Burnout,” the physician said the best version of herself — one who was not burned out — would have acted differently.
She is not alone among physicians. In 2014, 54 percent of U.S. physicians surveyed reported at least one symptom of burnout, up from 45.5 percent in 2011, according to a Mayo Clinic study. A work-related syndrome, burnout is marked by emotional exhaustion, detachment from one’s thoughts or body (known as depersonalization) and feeling a lack of personal accomplishment.
Supporting article: Starting a National Conversation About Burnout
While many physician organizations and health systems are trying to tackle physician burnout, surefire solutions are not yet known. One thing has become clear: This is not a problem that individual physicians or health care organizations can solve by themselves.
Mayo Clinic researchers, who have been examining physician burnout from many angles for more than a decade, put it this way in the Viewpoint section of the March 7 issue of The Journal of the American Medical Association. “Meaningful progress will require collaborative efforts by national bodies, health care organizations, leaders and individual physicians, as each is responsible for factors that contribute to the problem and must own their part of the solution. … Solving this problem will require cooperation at every level of the health care system.”
Supporting article: Case Study: Stanford Medicine Seeks to Understand Burnout Through Measurement
How did it get so bad?
Steven Strongwater, M.D., president and CEO of Atrius Health, agrees that addressing physician burnout requires a collaborative approach. “I personally believe that individual physicians are not able to tackle this,” says Strongwater, who heads an accountable care organization that includes 900 physicians in 36 locations serving 740,000 patients in eastern Massachusetts.
America’s physician burnout problem has many causes, but the regulatory and clerical burden associated with electronic health record technology makes everyone’s list. “I believe the electronic medical record is the tipping point,” Strongwater says.
The EHR movement, however, is not going to be whisked away just because it is a burden. Neither are other oft-cited causes of burnout, including reduced physician autonomy, the emphasis on productivity and the scrutiny of quality, cost and patient-satisfaction metrics.
Supporting article: The Tipping Point of Physician Burnout
That is why Jay Bhatt, D.O., senior vice president and chief medical officer for the American Hospital Association, thinks a national, multifaceted effort must be brought to bear on the problem. In addition to the personal toll that burnout takes on physicians — and, by extension, on their colleagues and loved ones — it has grave consequences for health care organizations and their patients.
Supporting article: Case Study: Novant Health Is Building Physician Resiliency to Counter Burnout
“We know that the growing threat to clinician well-being directly impacts the quality of care that they deliver, as well as the health and effectiveness of organizations in which they practice,” Bhatt says.
One threat is increased physician turnover due to burnout. Atrius Health estimates that the cost of replacing a physician, including recruitment and training, runs between $500,000 and $1 million. “Turnover is really expensive,” Strongwater says. “Apart from the human impact, there’s a business case to be made that if you could reduce burnout, you would save money.”
Supporting article: Burnout Among Hospitalists
In addition, a Stanford Medicine WellMD Center analysis showed that burned-out physicians were twice as likely to leave Stanford within two years than colleagues reporting low levels of burnout.
Even more disturbing is the effect that physician burnout has on patient care. A recently released National Academy of Medicine paper — which the AHA participated in developing — ties burnout to medical errors and patient incidents.
What’s to be done?
While burnout affects many providers, the causes vary widely across organizations and even departments or care teams. For instance, as described in a January article in Mayo Clinic Proceedings, the Mayo Clinic identified departments and divisions with high burnout rates compared with national benchmarks, as well as low satisfaction rates. But the drivers of burnout were different in each work unit, requiring different solutions.
“There's no one solution,” says the AHA’s Bhatt. “The practices and strategies that work are the ones that are contextually relevant to your environment and culture.”
Bhatt encourages health system leaders to consider using one of the physician wellness frameworks that have been developed in recent years. One example is the framework developed at Stanford’s WellMD Center, which focuses on improving efficiency of EHRs to ease physician workload and developing a culture of wellness and personal resilience. “Those are all areas [in which] to organize awareness, action and evaluation,” Bhatt says.
Related article: Stanford Medicine Seeks to Understand Burnout Through Measurement
The AHA has made resilience and well-being one part of its physician inclusion agenda. And personal resilience is what “Dr. Burnout,” the physician who told her story on the TED podcast, is focusing on. By redefining what it means to be a “good doctor,” she has stopped pressuring herself to be immediately responsive to everyone’s demands for her attention. Her priority is on being a caring doctor for the patient she is seeing at the moment.
“You work your whole career to not hurt people, and then you watch it happen,” she said. “I watched this happen to other people, too. We have got to do something about this.” — Lola Butcher is a contributing writer to H&HN.