Who Watches the Watchmen? Physician Burnout in the 21st Century
TimeThursday, April 152:00pm - 3:00pm EDT
LocationPatient Safety Research and Initiatives
DescriptionPhysician burnout is a multifarious problem that is most often comprised of emotional exhaustion, depersonalization, and personal accomplishment (Murali, Makker, Lynch, & Banerjee, 2018). This triadic conceptualization is manifested through a multitude of symptoms (e.g., increased fatigue and lower job satisfaction) leading to many potential consequences (e.g., increased medical errors and increased staff turnover). In fact, physician burnout is one of the primary reasons physicians leave clinical practice irrespective of specialty (Sinsky et al., 2017). This poster presentation will discuss some of the different ways that burnout is caused and manifested in physicians.
With the increasing use of technology in medical settings, the daily tasks of physicians have evolved extending well beyond patient care to also include other tasks (e.g., electronic data entry and management). The physician’s time is consumed with a multitude of auxiliary duties beyond patient care including but not limited to: regulatory paperwork, insurance approvals, and reimbursement battles (Dyrbye & Shanafelt, 2011). In current medical practice, physicians often spend more time doing clerical work compared to spending time with patients (Sinsky et al., 2016; Wright & Katz, 2018). In fact, research has shown that electronic health records (EHRs) increase the clerical burden on physicians (Shanafelt et al., 2016), alter patient-physician interaction, and reduce the amount of time physicians have to dedicate to the more meaningful aspects of medical practice such as direct patient care (Shanafelt et al., 2016). Other evidence indicates that physicians in the U.S. spend more time interacting with the computer as they do interacting with patients face to face (Downing, Bates & Longhurst, 2018). and there is a growing sense within the medical community that EHRs and their influence on tasks and care is driving professional dissatisfaction and burnout (Downing et al., 2018).
In addition to reducing valuable time with patients, EHR can also be cumbersome and frustrating for physicians (Meigs & Solomon, 2016). One study which surveyed 6375 physicians found that 43% were dissatisfied or very dissatisfied with their EHRs (Shanafelt 2016). Many physicians have stated that time spent with the EHR is of no added value (Tutty, Carlasare, Lloyd, & Sinsky, 2019). Indeed, physicians who used EHRs or Computerized Physician Order Entry (COPE) were at a higher risk of burnout regardless of whether or not they were satisfied with their EHR (Tutty, Carlasare, Lloyd, & Sinsky, 2019). Other evidence suggests that providers who are unable to utilize the EHRs to facilitate diagnosing and treating patients are 2.8 times more likely to suffer signs of burnout (Gardner et al., 2018). Given the need for accurate diagnostics and effective treatment plans for cancer patients, the issues surrounding EHRs are particularly noteworthy.
A few organizational elements that have been associated with higher levels of burnout are perception of inadequate staffing (Helfrich et al., 2017), working overtime (Garrett, 2018; Van Ham, Verhoeven, Groenier, Groothoff, & De Haan, 2006) turnover in support staff, (Helfrich et al., 2017; Deckard, Meterko, & Field, 1994), extended weekend work hours (Helfrich et al., 2017), and an absence of social support (Azam, Khan, & Alam, 2017). Moreover, there is a dearth of research aimed at examining the crossover effect of burnout, referring to the idea that increased levels of job stress and dissatisfaction experienced by one individual may have
In addition to organizational and technological factors, burnout is a product of certain personality factors as well. Early in their medical careers, physicians are conditioned to exhibit certain character traits which improve their efficiency in practice. Paradoxically, some of the same traits that make them highly effective with patients, may also be detrimental to their own well-being. For example, some physicians (e.g. oncologists) garner trust with their patients by developing personal relationships over extended periods of time; however, such physicians could be particularly affected when the patient experiences negative health outcomes. Recent research echoes this sentiment by indicating that almost 50% of oncologists surveyed reported experiencing emotional exhaustion (Shanafelt et al., 2014). Drummond (2015) speculates that there are four common personality types which many physicians adopt due to their medical school conditioning. These categories include: workaholic, superhero, perfectionist, and lone ranger. A workaholic’s response to a challenge is to always work harder. Superheroes feel solely responsible for every challenge and problem. Perfectionists are obsessed with avoiding mistakes always. Lone rangers must do everything themselves and often micromanage others.
These physician characteristics can be compounded by ideals such as “the patient comes first” and “never show weakness”. The ideals embody the way in which medical training has historically acculturated physicians to deny their own self-care in the service of others (Bohman et al., 2017). The combination of these traits and beliefs create an inherently dangerous environment for a physician struggling with burnout as neuroticism has been associated with the three most common burnout dimensions: lower levels of accomplishment, higher levels of emotional exhaustion, and a greater sense of depersonalization (Brown, Slater, & Lofters, 2019).
It is important for organizations to understand their providers’ level of workload (i.e.., the amount of effort they put into various tasks and responsibilities) as well as providers’ level of autonomy they have over those tasks. Research has found that the amount of workload and autonomy physicians experience relates to exhaustion, cynicism, and burnout (Portoghese et al., 2014). In essence, the greater their perceived workload and the lower amount of perceived autonomy relates to increases in exhaustion and ultimately burnout. Physicians’ lack of autonomy that comes from long work shifts, increased use of EHRs and computers, and large amount of administrative duties are reported as the top causes of burnout (Peckham & Grisham, 2017). Other research has demonstrated that an increase in quantitative job demands (Azam, Khan, & Alam, 2017), excess patient volume (Helfrich et al., 2017), and low levels of autonomy are significantly related to increased provider burnout (Azam, Khan, & Alam, 2017).
Understanding the underlying causes of burnout among physicians is crucial to insuring the health of our health care system. Burnout is very much a personal, mental, and emotional phenomenon and understanding when and why it occurs will help us to prevent it. As the aging population increases, the demand for physicians in our society will grow, therefore it is imperative that we begin addressing burnout now so that the field of medicine will continue to attract and retain healthcare professionals.