Physicians who say they are involved in decision-making in a workplace environment that encourages collegiality, learning and respect report much lower levels of burnout.
Two studies published this week suggest that workplace culture plays a more important role in reducing physician burnout, and ensuing medical errors, than does improving safety protocols or using checklists.
One study by researchers at the NYU School of Medicine found that physicians who work in small, independent primary care practices with five or fewer physicians report dramatically lower levels of burnout than the national average.
Specifically, the NYU researchers found that 13.5% of 235 physicians who worked in 174 small, independent practices in New York City reported feeling burned out, compared with a national average of 54.4%.
While the scope of the study is limited, lead author Donna Shelley, MD, said the findings could help trace the root causes of physician burnout, which has become major concern.
“The more we can understand what drives low rates of burnout, the more likely it is that we'll find solutions to this problem,” said Shelley, a professor in the Departments of Population Health and Medicine at NYU Langone Health.
“The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors' needs, values, and competencies," she said, in remarks accompanying the study.
Burnout and Medical Errors
Clinical errors harm or kill hundreds of thousands of Americans each year, and physician burnout can be a contributing factor in these cases, according to the Institute of Medicine.
A study published this week by researchers at Stanford University School of Medicine found that physician burnout is at least equally responsible for medical errors as unsafe medical workplace conditions.
The Stanford researchers surveyed nearly 6,700 physicians in active practice across the nation, and 55% reported symptoms of burnout. In addition, 10% of the physicians made at least one major medical error during the prior three months.
"We found that physicians with burnout had more than twice the odds of self-reported medical error, after adjusting for specialty, work hours, fatigue and work unit safety rating," said study lead author Daniel Tawfik, MD, an instructor in pediatric critical care medicine at Stanford.
"We also found that low safety grades in work units were associated with three to four times the odds of medical error," Tawfik said.
The Stanford study found that rates of medical errors tripled in medical work units, even those ranked as extremely safe, if physician burnout was prevalent. Tawfik said burnout may be a bigger cause of medical error than a poor safety environment.
"Up until just recently, the prevailing thought was that if medical errors are occurring, you need to fix the workplace safety with things like checklists and better teamwork," he said. "This study shows that that is probably insufficient. We need a two-pronged approach to reduce medical errors that also addresses physician burnout."
Lowering Burnout Rates
NYU's Shelley said that burnout reflects "the practice culture and infrastructure" where physicians work.
"So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?" she said. "It's important to study the group that's not showing high burnout to help us create environments that foster lower burnout rates."
Shelley said that physicians were asked about the "adaptive reserve" of their practices, which she described as a workplace culture that provides opportunities for growth and the ability to learn from mistakes by talking and listening to each other.
Physicians who said they're included in decisions and have control over their work environment reported lower levels of burnout.
"The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout," Shelley said.
John Commins is a senior editor at HealthLeaders.