January 18th, 2019
Being a doctor should be one of the most fulfilling professions — you improve peoples’ lives every day, while making a comfortable living in a respected occupation. Sadly, many doctors feel less fulfilled and more emotionally exhausted, ineffective, and detached — a phenomenon known as “burnout.”
According to Medscape‘s recently released National Physician Burnout, Depression & Suicide Report, burnout is becoming more widespread. Last year, 42% of the 15,000+ physicians surveyed reported feeling burnt out, while this year, the proportion rose to 44%. This is causing many physicians distress; 14% of physicians surveyed had thought about committing suicide and 10% of physicians surveyed were thinking of leaving medicine. Ironically, burnout can cause significant medical problems; for example, one physician said she suffered recurrent miscarriages due to stress at work.
Physician burnout doesn’t just affect doctors. More than half of doctors surveyed reporting that burnout affect their patient care, with 14% reported making medical errors because of burnout. And 70% reported a negative impact on their relationships with staff and other clinicians because of burnout.
The most frequently reported reason for burnout among survey respondents was having too many bureaucratic tasks, such as charting and paperwork, with 59% of respondents citing it as a reason for burnout. This makes sense, as doctors spend more time using the electronic medical record (EMR) than they do face-to-face with patients during patient visits. Doctors even spend their time at home after work and on weekends catching up, when they should be free to spend time with family, friends, or doing other hobbies.
“Electronic medical records have become the bane of doctors and nurses everywhere,” said Vikas Saini, president of the Lown Institute. “They are the medical equivalent of texting while driving.”
Long hours is another major contributor to burnout. More than a third of respondents in the Medscape survey said that spending too many hours at work made them burnt out. The more doctors work, the higher their level of burnout, the survey shows. In a recent blog post on NEJM Journal Watch, chief resident Dr. Ellen Poulose-Redger “calls BS” on the promise of “work-life balance” in medicine. The long hours required in medicine “doesn’t really leave a lot of time for any sort of a life, hobbies, research, or anything else that would help me to be a thriving and well-rounded person,” she writes.
In response to growing burnout crisis, leaders of the Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health, and Harvard Global Health Institute issued a joint Call to Action on Physician Burnout.
The authors offer three crucial policies to reduce burnout that focus on the root causes of burnout. The first is to provide proactive mental health treatment to doctors, to reduce the stigma of asking for help when doctors are overwhelmed. This is important because, according to the Medscape survey, many doctors (almost 20% of respondents) have gotten or considered getting mental health treatment in secret, because they were worried about being found out.
The second policy is to improve EMR standards with a focus on usability and “open APIs.” EMRs with open APIs (Application Programming Interfaces) would allow third parties to develop apps that could work with any EMR, making it easy for physicians to “customize their workflow and interfaces according to their needs and preferences.” In short, this would giving physicians a better EMR experience and hopefully reduce the time they spend on EMRs. While open APIs are supposed to be mandatory, progress on this front has been slow.
The last policy the authors suggest is to appoint executive-level Chief Wellness Officers. This would change the game in a good way, by making clinician wellness an ongoing issue, just like quality. With someone responsible for clinician health, there would likely be better tracking of burnout levels, more initiatives to solve the problem, and faster accumulation of best practices knowledge. Hiring a Chief Wellness Officer also signals to clinicians that their institution cares enough about this issue to investigate significant resources in a permanent position.
Several crucial elements were missing from the Medscape Survey and Call to Action that deserve mention. The Medscape survey asked doctors how they dealt with burnout, with suggestions like exercise, talking to friends, and sleep. However, they did not ask doctors whether they tried to address upstream factors of burnout with collective action or activism. Taking action, whether it is protesting, volunteering, or just discussing how larger social problems affect their patients, can be empowering to doctors who feel like a cog in the health care system.
Another missing discussion point was how to stop the roots of burnout in medical schools and training. As Dr. Timothy Hoff wrote in STAT, doctors in training are already burning out in high numbers. Medical schools need to take responsibility for teaching future doctors “street smarts, business training, resilience, adaptive mindsets, and emotional intelligence they need to navigate difficult and uncertain work circumstances,” writes Hoff.
The culture of medical school and training is also a problem, because it puts unreasonable expectations on physicians. Medical training and residency is extremely demanding, but as Dr. Ellen Poulose-Redger points out, there’s an expectation that doctors will be able to “have it all.” We should telling doctors the truth — that they will likely have to sacrifice other parts of their life for work — so that doctors don’t blame themselves when they find there isn’t a real work-life balance.