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Analysis

Two Kinds of Interventions Reduce Physician Burnout

By Christopher Cheney  
   June 21, 2018

Researchers say these organizational and individual solutions can reduce overall physician burnout symptoms by 10%.

Physician burnout has reached crisis proportions, but there are several interventions that can ease the suffering, a recent review of the scientific literature on burnout shows.

More than half of physicians struggle with burnout, according to the review article published this month in the Journal of Internal Medicine.

"Rates of burnout symptoms that have been associated with adverse effects on patients, the healthcare workforce, costs, and physician health exceed 50% in studies of both physicians‐in‐training and practicing physicians," the researchers wrote.

"This problem represents a public health crisis."

Burnout is a work‐related malady with three characteristics: emotional exhaustion, depersonalization, and perception of reduced personal accomplishment.

The researchers say physician burnout has negative impacts on patient care, physician health, and healthcare system operations:

  • Patient care: medical errors, lower quality of care, longer recovery time, and lower patient satisfaction
     
  • Physician health: substance abuse, depression and suicidal ideation, poor self-care, and motor vehicle crashes
     
  • Healthcare system operations: physician productivity reductions, reduced patient access, and higher physician turnover

For healthcare organizations, there are significant financial losses associated with physician burnout. The cost to replace one physician can be more than $1 million depending on the specialty, the researchers wrote.

"Physician burnout may also increase healthcare expenditures indirectly via higher rates of medical errors and malpractice claims, absenteeism, and lower job productivity," they wrote.

Addressing physician burnout requires both organizational and individual interventions, the researchers wrote.

"Not only do both categories of approaches offer at least modest benefit, but both are necessary, and addressing physician burnout should be viewed as a shared responsibility across healthcare systems, organizations, institutions, and individual physicians."

However, organizational interventions have the highest potential to ease burnout, the researchers wrote.

"Individuals who choose to become physicians do not appear to be inherently more vulnerable to stress and burnout, emphasizing the importance of work‐related, organizational and healthcare system factors in the current physician burnout crisis."

The researchers identified five primary drivers for physician burnout: excessive workload, work inefficiency, work-home balance, loss of control, and loss of meaning from work. There are organizational and individual interventions for each driver.

Organizational interventions

  • Excessive workload: fair productivity goals, duty-hour limits, and appropriate job role assignments
     
  • Work inefficiency: optimize electronic medical records, shift clerical burdens to non-physician staff, and meet regulatory requirement appropriately
     
  • Work-home balance: respect home responsibilities in scheduling decisions, specify all required work tasks in assigned work hours, and support flexible work schedules
     
  • Loss of control: establish work requirements with physician engagement, and promote physician leadership and shared decision-making
     
  • Loss of meaning from work: promote core values, maximize patient time with physicians, foster physician communities, provide professional development opportunities, and offer leadership and awareness training about burnout

Individual interventions

  • Excessive workload: consider part-time status, and make informed practice choices to promote efficiency and physician satisfaction
     
  • Work inefficiency: prioritize and delegate tasks appropriately, and attend efficiency and workplace skills training
     
  • Work-home balance: reflect on life priorities and maintain self-care
     
  • Loss of control: attend stress management training, embrace positive coping strategies, and practice mindfulness
     
  • Loss of meaning from work: embrace positive psychology, recognize fulfilling work roles, practice mindfulness, and participate in small-group activities with other physicians to share work experiences

Healthcare organizations should consider burnout as a top metric, the researchers wrote. "At the organizational level, burnout assessment should be considered part of the 'dashboard' of tracked institutional performance measures, quality indicators, and leadership performance."

Once physician burnout is identified, interventions make a difference, they wrote.

With interventions, researchers have found decreases in the proportion of physicians with burnout symptoms: 14% for emotional exhaustion, 10% for overall burnout symptoms, and 4% for depersonalization.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

Physician burnout is simmering public health crisis

Burnout afflicts more than half of physicians

Best intervention strategies mix organizational and individual effort


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