Physician Burnout: A Public Health Crisis

By Christine Garver-Apgar, Ph.D., Research Director, University of Colorado Anschutz School of Medicine Behavioral Health and Wellness Program (BHWP)
This column originally appeared in the September/October 2018 BHWP e-newsletter. It has been reprinted with permission.

What is burnout? Burnout is a work-related syndrome involving emotional exhaustion, cynicism, and a sense of reduce personal accomplishment and effectiveness.(1) It often arises from chronic stress associated with emotionally intense work demands, particularly when the resources to address those demands are inadequate. Rates of burnout are markedly higher among physicians than people in other careers, even after adjusting for work hours and other factors.(2-3) In fact, recent national studies in the U.S. of both physicians-in-training and practicing physicians find rates of burnout symptoms reaching epidemic proportions – approaching or exceeding 50%.(3-5)

Why is it important? Burnout matters because it is associated with negative consequences for patient care (e.g. increased medical errors and malpractice suits), the physician workforce and healthcare system costs (e.g. reduced productivity and increased turnover), and for physicians’ own care and safety (e.g. increased risk of substance abuse and suicidal ideation).(6-12)

What can we do about it? Understanding factors which contribute to physician burnout offers clues to potential solutions. Both occupational factors and individual characteristics have been found to predict burnout among physicians and medical students, so the most effective solutions will likely combine both structural or organizational approaches as well as individual-focused approaches.13 Examples of organizational approaches include:

• Mitigating excessive workload by setting fair productivity targets and limits on work hours;
• Minimizing workplace inefficiency through the use of optimized electronic medical records and increasing non-physician staff support for clerical duties;
• Supporting flexible work schedules (including part-time employment) and respecting home responsibilities;
• Increasing physician autonomy through physician leadership, engagement, and shared decision-making;
• Prioritizing physician values by protecting physician time with patients, offering professional development opportunities, and addressing negative effects of productivity-based compensation formulas. 

Examples of individual approaches include encouraging physicians to reflect on life priorities and values and attending to their self-care, offering stress management, resiliency and coping, and communication skills trainings, and promoting mindfulness techniques and strategies.

Most interventions to date have focused solely on individual factors, and although these interventions are associated with modest improvements in burnout symptoms, the drivers of burnout are largely rooted within healthcare systems and organizations.(14) One of the reasons organizations are reluctant to take effective action is the belief that interventions to reduce burnout will interfere with other organizational objectives and/or be cost prohibitive. In fact, having an engaged physician workforce is vital to achieving organizational objectives, and many effective strategies are cost neutral.

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Wellness toolkit

The Colorado Medical Society's Committee on Physician Wellness lead the society's efforts on improving physician wellbeing and reducing burnout.

Together with the experts at the Behavioral Health and Wellness Program at the University of Colorado Anschutz Medical Campus, we developed a toolkit specifically tailored to physicians to address the eight dimensions of wellness with a focus on stress and burnout. It was released in September 2014.

>> Click here to download the toolkit

Background

In April 2011, CMS conducted an all-member morale survey that revealed only one-half of physician members are able to live a healthy lifestyle in regards to exercise and diet; fewer are satisfied they’re able to find time to relax through activities like yoga or reading. Following the survey, then-CMS President Brent Keeler, MD, named members to the CMS Expert Panel on Physician Wellness to advise the board of directors. The panel finalized their recommendations in February 2013 and the board approved their report at Spring Conference in May 2013.

The wellness panel recommends, first, strongly supporting and actively participating in the governor’s vision for health and wellness; more information is below.

Internally, CMS should:

• Educate members on the governor’s plan and encourage its support by all elements of organized medicine;
• Encourage individual physicians to lead by example, promoting prevention and wellness to their patients and the public by living a healthy lifestyle;
• Provide resources on healthy living and ways physicians can participate in public and patient education, specifically through this specialized section of the CMS website, which will be continually shaped by the wellness panel; and
• Partner with other stakeholders.

Click here to view the report of the CMS Expert Panel on Physician Wellness.

Gov. John Hickenlooper’s wellness plan

Colorado Gov. John Hickenlooper unveiled his plan, “The State of Health: Colorado’s Commitment to Become the Healthiest State,” in May 2013. He hopes to make Colorado the healthiest state in America through the promotion of prevention and wellness, expansion of health care access and capacity, improvement of system integration and quality, and strengthening of cost containment and sustainability.

Click here to view a statement from CMS President Jan Kief, MD, a CMS press release, and video coverage of the press conference.

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