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Experts declare physician burnout ‘a public health crisis’
Experts from leading U.S. health organizations deemed physician burnout “a public health crisis” in a recent report.
“Physician burnout has received some attention in recent years, but not enough. As a result, it is both poorly understood and getting worse,” Andrew R. Iliff, MA, JD, lead writer and program manager at Harvard Global Health Institute, told Healio Psychiatry.
“Like the blind man describing an elephant, people have described the challenges in front of them, including unhelpful electronic health records and a looming physician shortage,” he continued. “We believe it is important to frame this as a systems problem, requiring systemic solutions in order to avoid further adding to ballooning health care costs and undermining the provision of care.”
In their paper, experts from Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and the Massachusetts Health and Hospital Association recommended ways to address the prevalence of burnout among physicians and other health care providers. Recommendations included:
- appointing an executive-level chief wellness officer (CWO) at every major health care organization;
- providing support for those experiencing burnout; and
- improving the efficiency of EHRs.
By 2025, the HHS has predicted a shortage of up to 90,000 physicians, and a major driver of this shortage will be the loss of practicing clinicians due to burnout, the report stated. One estimate from previous research showed that the lost revenue per full-time-equivalent physician was $990,000, and the cost of recruiting and replacing a physician can range from $500,000 to $1 million.
“Understanding physician burnout as a systems problem highlights how difficult it is for individual doctors to fight burnout on their own,” Iliff explained. “Doctors are doing everything they can, but some of the most effective solutions for managing burnout in individuals, like reducing their work hours, can exacerbate existing challenges — including a worsening shortage of physicians.”
It is vital for CWOs to evaluate physician burnout at their institutions and consult with physicians to design, implement and constantly improve interventions to reduce burnout, according to the report. All health care institutions must act to combat physician burnout, and the authors recommended institutions immediately improve access to and expand health services for physicians, including mental health services.
“In our report, we recommend that hospitals and medical schools make it easier for physicians and trainees to seek care and support when they experience symptoms of burnout, including taking steps to eliminate the stigma and professional consequences that can follow from seeking mental health care,” Iliff said.
The usability of EHRs must be addressed through reform of certification standards by the federal government; improved interoperability; use of application programming interfaces by vendors; and increased physician engagement in the records’ design, implementation and customization, according to the report.
Burnout not only causes physicians suffering, it also can adversely impact patients. Prior research has shown that burnout may increase the risk for medical errors.
“Our ongoing failure to address increasing physician burnout threatens to undermine the provision of care,” Iliff told Healio Psychiatry. “But we have a pretty good idea how to fix it — starting with making physician wellness a top priority at health care organizations and streamlining electronic health records to allow physicians to focus on patient care.” – by Savannah Demko
References:
Jha AK, et al. A Crisis in Health Care: A Call to Action on Physician Burnout. https://cdn1.sph.harvard.edu/wpcontent/uploads/sites/21/2019/01/PhysicianBurnoutReport2018FINAL.pdf. Accessed on Jan. 21, 2019.
Disclosures: Healio Psychiatry was unable to confirm any relevant financial disclosures at the time of publication.
Perspective
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Physician burnout is a significant issue that has gained increasing attention, and rightfully so — the consequences of physician burnout not only impact the physician but also patients and health care organizations as a whole. As Jha and colleagues discuss in their recent report, there are interventions at the individual and institutional levels that are applicable to the broad spectrum of physicians (from trainees to experienced practitioners) that can and should be implemented with urgency.
Our institution, as well as others, has begun to implement some of the changes consistent with the recommendations of Jha and colleagues including improving electronic health records and appointment of a chief wellness officer. While it takes times to shift the culture of an institution, making physicians and institutions aware that there are quantifiable improvements and a return on investment from addressing burnout and increasing joy is a major first step.
As a psychologist, however, I do not underestimate the impact of self-care practices institutionally promoted. I have been leading mindfulness group practices with not only significant changes in burnout, but also an increased sense of community and common humanity — powerful constructs that develop when one takes the time to pause and connect with others.
Finally, it’s important to note that burnout does not only impact physicians but other health care workers and staff facilitating the care of patients, which makes the issue of even greater importance and urgency to address.