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          Physician burnout: A major public health issue

          May 14, 2018

          CONTRIBUTOR

          Laura Mueller Essential Insights contributor, healthcare writer

          Laura Mueller

          Essential Insights contributor, healthcare writer

          Physician burnout poses a major threat to health systems and public health overall, calling for an ever-growing need to better define—and solve—the problems that lead to such widespread rates of stress and exhaustion among healthcare providers.

          The triple aim of healthcare, as defined by the Institute for Healthcare Improvement, is to optimize patient care and satisfaction, increase positive health outcomes, and reduce per capita healthcare costs. Physician burnout, however, has been associated with the antithesis of all three aims: reduced quality of care, worse overall health outcomes, and increased costs.

          Some doctors are now calling for the triple aim to evolve into the quadruple aim, with physician satisfaction and mental health being a critical factor for achieving success in all other major objectives. Figuring out how to better prevent and address physician burnout is a problem best tackled from the top down, and it all begins with a better understanding of the scope of the issue and its effects on the larger system.

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          Burned Edges Frame

          Physician burnout at a glance

          image-large-ei-phys-burnout-chart-1
          In 2018, 42% of physicians reported feeling burned out (a state of physical, emotional or mental exhaustion)
          image-large-ei-phys-burnout-chart-2
          Compared to other professions, the likelihood of a physician experiencing burnout is 37.9% compared to 27.8% and the likelihood of a physician experiencing dissatisfaction with their work-life balance is 40.2%, compared to 23.2%
          image-large-ei-phys-burnout-chart-3
          Reported rates of burnout by age

          Causes of physician burnout

          Leading drivers of the burnout epidemic include:
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          Excessive workloads


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          Increased performance measurements
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          Inefficient work processes

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          Clerical burdens, particularly the implementation of electronic health records
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          Work-home conflicts

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          Lack of input or control in work lives, organizational  support structures, and leadership culture

          Why physician burnout is a problem


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          Quality of patient care
          Physician burnout is associated with lower satisfaction among patients
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          nearly 1/3 of doctors reporting depression say they are less engaged with patients ; and
          29%
          say they are less friendly with patients

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          Overall health outcomes

          Increased emotional exhaustion and depersonalization are associated with:

          • Lower rates of clinician-rated patient safety
          • Higher standardized mortality ratios
          • Longer lengths of stay

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          Healthcare costs
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          doctors who experienced burnout were more than 2x as likely to leave
          $15.5 - 55.5 M
          the cost to the institution over a two year period for physician burnout and turnover

          How healthcare leaders can address burnout in the workforce

          Just how common are “burnout” programs in the healthcare space?
          image-large-ei-phys-burnout-chart-4
          Actionable steps to address physician burnout:
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          Routinely assess and monitor dimensions of wellbeing and engagement as part of larger institutional performance metrics
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          Improve efficiency of practice environment and processes
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          Identify, reduce, and delegate clerical work
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          Re-evaluate cost cutting measures that increase the burden on physicians by reducing documentation support
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          Employ proven models of process improvement (example: Six Sigma) with specific intent to improve work flow for physicians
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          Make targeted efforts to improve physicians’ work-life balance through increased flexibility and enhanced work-life integration
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          Invest in workplace programs that offer support to physicians experiencing burnout

          Stay tuned to cardinalhealth.com/essentialinsights as we look more at this and other topics to help your organization thrive in the challenging, dynamic world of healthcare.

          Sources:
          https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235#1 • https://www.medscape.com/features/slideshow/ lifestyle/2017/overview#page=6 • https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1351351 • https://link.springer.com/content/ pdf/10.1007%2Fs11606-017-4011-4.pdf • https://onlinelibrary.wiley.com/doi/abs/10.1111/joim.12752 • https://journals.lww.com/hcmrjournal/pages/ articleviewer.aspx?year=2008&issue=01000&article=00005&type=abstract • https://www.ncbi.nlm.nih.gov/pubmed/19934755 • https://www.ncbi.nlm. nih.gov/pubmed/21890381 • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302790/ • https://www.ncbi.nlm.nih.gov/pubmed/11874308 • http://www. mayoclinicproceedings.org/article/S0025-6196(17)30690-0/fulltext • http://www.mayoclinicproceedings.org/article/S0025-6196(16)00101-4/abstract • https://wire.ama-assn.org/life-career/stanford-physician-burnout-costs-least-775-million-year • http://wellmd.stanford.edu/content/dam/sm/wellmd/ documents/2017-ACPH-Hamidi.pdf • https://www.ncbi.nlm.nih.gov/pubmed/24148815 • https://www.rand.org/pubs/research_reports/RR439.html • http://www.mayoclinicproceedings.org/article/S0025-6196(15)00071-3/abstract • https://internalmedicinefaculty.wustl.edu/wp-content/ uploads/2017/04/2017-JAMA-Shanafelt-editorial-physician-burnout.pdf