Physician burnout is a risk to the physician and the patient

LAS VEGAS — Despite the “great recipe” for success, and the personal and professional fulfillment that a physician may have, physicians as a group experience burnout and there are consequences to patient care, a well-known researcher on physician burnout said here at the Cardiometabolic Risk Summit.

“If I told you we have a system issue in the medical care delivery system in the United States that eroded quality of care, that limited access to care led to declines in patient satisfaction, we would assign a crack team of system engineers to try to figure out the root causes and fix the situation very quickly,” said Tait D. Shanafelt, MD, professor of medicine and medical education, and director of the Physician Well-Being Program, Mayo Clinic. “We have precisely that problem in our care delivery system.

Tait D. Shanafelt

“On a societal level folks look at health care professionals and think we have a great recipe for personal and professional fulfillment,” he said, noting that physicians are highly educated, universally employed, well compensated. “We engage in work that society says is meaningful, it matters.”

But the medical literature tells a different story, Shanafelt said. Studies have revealed high levels of stress, depersonalization, anxiety and depression, and a disproportionate amount of suicidal thoughts and suicide in the physician population vs. the U.S. population as a whole. More than half of U.S. physicians experience professional burnout, Shanafelt reported here and also in his article in the Mayo Clinic Proceedings.

Shanafelt also said that the use of electronic health records (EHRs) and computerized physician order entry (CPOE) may lead to unintended negative consequences such as an increased clerical burden on physicians and other health care professionals, and also an increased risk of burnout and dissatisfaction for physicians.

A coping mechanism for burnout is for a physician to reduce his or her hours or choose another practice setting such as concierge medicine, but more needs to be done, Shanafelt said.

Besides the effect on an individual physician, burnout also has “profound effects on the medical care you deliver for patients,” Shanafelt said, noting there is a decline in productivity, less patient satisfaction and an increase medical errors.

There are data that show that losing one family physician costs a health care system $1 million when taking into account loss in productivity, recruitment and training.

Not all medical errors reach patients. But even with the many safeguards in place, some medical errors do reach patients, and higher rates of burnout symptoms such as depersonalization, increase medical errors, he said.

“Errors cause distress for all of us as health care providers,” Shanafelt said. “If we make a mistake that potentially harms our patients, it takes a toll.” In the 3 months after a physician believes they have made a major medical error, each dimension of burnout increases by 2 to 5 points and a physician’s likelihood of depression triples — making medical errors “a professional risk factor for depression.”

“We need to fix that root cause [of burnout] and it will have a double benefit [for the physician and the patient],” Shanafelt said. – by Joan-Marie Stiglich

Disclosures: Shanafelt is the co-inventor of the Physician Well-being Index.

References:

Shanafelt T. Presented at: Cardiometabolic Risk Summit Fall Pre-Conference; Oct. 13, 2016; Las Vegas.

Shanafelt TD, et al. Mayo Clin Proc. 2015;doi:10.1016/j.mayocp.2015.08.023.

Shanafelt TD, et al. Mayo Clin Proc. 2016;doi:10.1016/j.mayocp.2016.05.007.