Doctors are burning out and trite ‘wellness’ measures aren’t helping
“I'm already beat. The trick is to not let the caring get to you.”
These were the words recently uttered by one of my physician colleagues, referring to the stresses of caring for patients in the world of modern health care. The weariness was clear over the phone. Without missing a step, I responded, “I know. Of course.” It took me weeks to realize that it might be concerning that I immediately empathized with her sense of being submerged and overpowered by an uncaring health care system.
Burnout is a syndrome characterized by emotional exhaustion, cynicism and a pervading sense of professional ineffectiveness. What my colleague was referring to was the pervasive sense that her time with patients was being devalued in favor of other administrative tasks. For those suffering from burnout, patients, caregivers, and other providers are all reduced to objects, or worse, obstacles, rather than people worthy of respect and care. With the problem reaching epidemic levels, it’s no exaggeration to say burnout is the most pressing human resource problem we face in health care today.
A seminal paper from the Mayo Clinic a few years ago reported that over half of all working physicians in the U.S. reported at least one symptom of burnout in 2014, up from 45.5 percent in 2011. Notably, a general sample of similar non-physicians reported no difference in their scores during the same time frame. This held true even after controlling for factors we might think underlie burnout: age, sex, relationship status, and hours worked per week. In other words, the accelerating rate of burnout hitting physicians isn’t necessarily shared by other professions.
The consequences can be dire. Physicians who report symptoms of burnout can jeopardize the health of their patients. Studies have estimated that each one-point increase in measures of depersonalization or emotional exhaustion was associated with a 5 to 11 percent increase in risk for major medical errors. Moreover, burnout can lead to struggles with substance abuse and mental health challenges. Its most tragic form might be physician suicide, which claims 400 doctors annually in the U.S. A 2011 study found that surgeons were one and a half to three times more likely than the general public to have considered suicide within the prior 12 months.
The problem is not limited to physicians. The use of providers such as physician assistants and nurse practitioners, while essential, is not a sustainable solution, since data shows they too are exhibiting higher rates of burnout. Providing doctors with administrative help for paperwork and documentation is similarly crucial, but one study found nearly 70 percent of medical receptionists had been verbally abused by patients or providers in attempts to meet workplace demands. The modern healthcare environment can be deeply unhealthy for health care workers.
Increasingly, health care organizations are pushing “wellness” solutions for overworked providers. Some hospitals and clinics have collaborated with farmer’s markets, host mindfulness seminars and offer yoga classes. Physicians receive email tips on how to be more “resilient,” which is the buzzword du jour. (The subtext of many of these self-care strategies is that physicians are to blame for their inability to handle modern workloads.) Yet, these self-care solutions are not evidence-based. A 2015 Cochrane review on the emotional burden of health care providers wasn’t encouraging, finding only low-quality evidence to support the use of cognitive behavioral therapy and common physical or mental stress-relief techniques.
Burnout is an intense, personal response to a systemic problem. At a time when up to 75 percent of physicians are employed by larger health systems, we need strategies that go beyond trite exhortations for self-care. The stakes are high: The National Academy of Medicine has repeatedly highlighted the bond between patient safety and organizational culture. The stress of making complex decisions, with incomplete information and a growing set of demands is a toxic brew for doctors and the health care system at large.
Despite this, physician well-being is still rarely measured by health care organizations, which focus instead on clinical productivity and finances. Only recently was a medical billing code added for burnout. All the non-clinical activities outpatient doctors are now saddled with consumes nearly 50 percent of their time. Most hospitals have compliance and liability officers but few that focus on the opposite of burnout: physician engagement. Fewer yet understand what engagement really is — the journey to find purpose and meaning in the care of others. Stanford provides an example to emulate, as it is the first academic medical center to appoint a chief wellness officer for its health care workers.
Health care organizations are pushing “wellness” solutions. Some hospitals and clinics have collaborated with farmer’s markets, host mindfulness seminars and offer yoga classes. Physicians receive email tips on how to be more “resilient,” which is the buzzword du jour. Yet, these self-care solutions are not evidence-based.
The solution to the burnout epidemic is to restore meaning and human connection to medicine. Human connection and personal growth are key elements of fulfilling work, especially for physicians. Getting there will require more administrative support for doctors (such as scribes), and better, more intuitive electronic records. These would allow physicians to do what they are trained to do: take care of people. We also need to embrace value-based care, where the focus is on quality rather than quantity of care. Physicians are not factory workers and their outputs are not widgets but people’s health.
My friend continues to practice medicine with a mixture of pride and exasperation. Medicine is ennobling work but can be exhausting and transactional in reality. Navigating the system while still finding meaning and value in the care we provide is a daily challenge for most providers, and a struggle that follows me closely. Patient care has been and always should be the central aim of medicine. But the fundamental question still remains: Who will heal the healers?
Dr. Rusha Modi is a faculty member at the USC Gehr Center for Implementation Science, where he focuses on ways to improve the quality of health care.