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ID clinicians experience burnout but may be spared some root causes
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In a sample of 1,145 physicians in the Cleveland Clinic Health System, more than one-third met the criteria for burnout, which researchers characterized by their levels of emotional exhaustion and depersonalization, according to study findings published in JAMA Internal Medicine. Burnout can cause physicians to leave their job or continue on with a diminished emotional investment. Among infectious disease specialists, the rate of burnout historically has been low, but there are indications it is on the rise.
Sometimes it has little to do with the conventional tasks of being a physician.
“There are things like the electronic medical record, which, while facilitating some aspects of patient care, has made many things much more difficult,” Wendy S. Armstrong, MD, infectious disease specialist and professor of medicine at the Emory University School of Medicine, told Infectious Disease News. “It leads to more time spent on the computer, as opposed to at the bedside of the patient. We want to do the things we are passionate about — the reasons we went into medicine.”
ID physicians may be spared some of the root causes of burnout, according to Carlos del Rio, MD, professor of medicine at Emory School of Medicine, who said the daily tasks of someone in ID are generally more aligned with the calling of the medical profession.
“I think that all physicians and providers are experiencing, to a greater or lesser degree, burnout,” del Rio told Infectious Disease News. “In general, ID physicians are much more mission-driven, and the ability to be involved in broader issues are the hallmarks of ID. The frequent emergence of new challenges — for example, Zika and flu — and the natural fit with global health makes ID exciting and less prone to routine work and burnout.”
‘System issues’
Del Rio said burnout is largely a result of matters related to inefficient health care systems.
“I think it is a combination of increasing administrative burden and decreasing reimbursement that makes burnout an issue, but we need to remember that the issues are system issues,” he said. “Burnout revolves around frustration with systems that do not work.”
According to Cynthia L. Sears, MD, professor of medicine at Johns Hopkins University School of Medicine and Bloomberg School of Public Health and an infectious disease researcher, these system issues are much more prevalent in an outpatient setting.
“I have found it to be very different in the inpatient vs. the outpatient setting,” Sears said. “In the outpatient setting, I find it to be complicated and have struggled with it. In the inpatient setting, I don’t find it different than anything we’ve done before.”
Sears said that although EHRs provide some benefits, they often involve multiple, extensive checklists and other forms.
“The design of many of these systems has not always been helpful or intuitive to physicians,” she said. “I do think, as time moves on and the complaints rise, that some of this will be addressed, but meanwhile, it’s wearing people down.”
According to Darrell G. Kirch, MD, a psychiatrist, neuroscientist and president and chief executive officer of the Association of American Medical Colleges, it is important to remember that physician burnout may have its origins in any number of issues.
“The challenge to addressing clinician burnout is that there’s not a single cause,” he said. “Clinicians could have difficulty managing paperwork demands, electronic health records, staffing shortages, a lack of teamwork or collegial support, or the pressure to see an increasing number of patients in a limited time. There is a complex series of factors, which may vary from clinical situation to situation.”
Burnout in young ID clinicians
Results from a survey of more than 400 young medical microbiology and ID trainees and specialists published last year in the European Journal of Clinical Microbiology & Infectious Diseases showed that one in five respondents reported being bullied. Most said they experienced symptoms of burnout, including 63% who reported feeling worn out, 48% who reported feeling unappreciated and 68% who reported feeling frustrated. Women were likelier than men to report more major burnout feelings, especially feelings of achieving less than they deserved and of being worn out, according to the researchers.
“We need to be sensitive to our junior members,” Sears said. “We have had difficulty recruiting to the field of infectious diseases, despite the fact that it’s an exciting, ever-changing, global field, compared with some subspecialties.”
Sears cited financial stressors faced by young physicians, specifically in the form of lower salaries and substantial student debt.
“We are a cognitive specialty, and so reimbursement rates are not necessarily favorable to us. We’re not procedure-oriented,” she said. “Also, the debt from going to medical school is estimated to be $200,000 or more, which is enormous. It’s like graduating with a mortgage.”
Repercussions
Burnout can affect the quality of life of the individual physician, but its reach is potentially much greater.
“In the big picture, I think when people feel disengaged from what they’re doing, it can certainly worsen physician-patient relationships, and could lead to shortcuts,” Armstrong said. “It can lead to bad outcomes. It impairs what we do. It impairs the patients’ perceptions of what we do.”
Del Rio said burnout can lead to consequences ranging from lack of job satisfaction to medical errors. Recently published results of a survey of nearly 6,700 physicians in the U.S. supported that assertion. According to the findings published in Mayo Clinic Proceedings, 78% of physicians who reported making medical errors had symptoms of burnout, and physicians with burnout were more than twice as likely to have made errors than their peers.
“The major effect I see is that people seem stressed and not as happy and satisfied with their jobs as they should be,” he said. “Burnout is never good. Doctors are more likely to make mistakes if they are burned out.”
Sears also pointed out the potential for serious harm to physicians affected by burnout.
“In its most extreme form, it can push people to regret their life choices,” she said. “They’ve dedicated their lives to this field, and now we’re seeing rising suicide rates, which is horrifying.”
The path forward
Although burnout is widely acknowledged as a problem, how to solve it is less clear.
Sears said adapting EHR systems to be more user friendly would be an important step. For example, at her facility, she said “superuser” physicians have added a helpful dashboard to the hospital’s Epic EHR system.
“This dashboard summarizes key infectious disease data — with a single click, I can see a patient’s fever curve over time, their vital signs, the antibiotics administered, among other data. This is enormously helpful,” she said. “Each subspecialty has their own dataset that’s critical to their decision-making. Similar EHR adaptations may help other physicians.”
Kirch said any successful solution to physician burnout would need to be adjustable based on the individual clinician’s issues.
“It’s essential to remember that addressing burnout requires interventions tailored to the individual, focused on identifying and addressing the specific external and individual factors that the particular clinician is experiencing,” he said.
According to del Rio, some professional associations, including the Infectious Diseases Society of America, have begun investigating ways to address the issue.
“We need to remind ourselves that this will not be fixed by offering yoga classes in hospitals, but by hospitals and health systems addressing the system-level issues that contribute to burnout,” he said.
Armstrong agreed that wellness programs, which were emphasized in early discussions, are not the answer.
“The discussion needs to be centered around how to create systems that help us do our jobs better, that allow us to do what we do well, and allow us to provide the best care to patients that we can,” she said. – by Jennifer Byrne
- References:
- Maraolo AE, et al. Eur J Clin Microbiol Infect Dis. 2017;doi:10.1007/s10096-017-2937-4.
- Tawfik DS, et al. Mayo Clin Proc. 2018;doi:10.1016/j.mayocp.2018.05.014.
- Windover AK, et al. JAMA Intern Med. 2018;doi:10.1001/jamainternmed.2018.0019.
Disclosures: Armstrong, del Rio, Kirch and Sears report no relevant financial disclosures.