Understanding and Preventing Physician Burnout

If you talk to any doctor about their reasons for pursuing a career in healthcare, you’ll likely hear about their sense of calling to help individuals, treat diseases, and make the world a healthier place. Unfortunately, physicians are now experiencing a growing concern that threatens to drastically impact their ability to hold true to that calling. While trying to focus on healing others, they are also experiencing unparalleled levels of job burnout. The negative impact created by physician burnout is beginning to have serious consequences on the level of care patients receive. The situation is so pervasive that it’s become a crisis for many healthcare organizations. It is a business priority that healthcare leaders across the United States struggle to remediate.

What is Physician Burnout?

Burnout is a psychological term that refers to long-term exhaustion and diminished interest in work, which has been assumed to result from chronic occupational stress. However, there is growing evidence that its etiology is multifactorial in nature, with dispositional factors playing an important role. Despite its great popularity, burnout is not recognized as a distinct disorder, neither in the DSM, nor in the ICD-10. This is notably due to the fact that burnout is problematically close to depressive disorders. In the only study that directly compared depressive symptoms in burned out workers and clinically depressed patients, no diagnostically significant differences were found between the two groups: burned out workers reported as many depressive symptoms as clinically depressed patients. Moreover, a recent study by Bianchi, Schonfeld, and Laurent showed that about 90% of burned out workers meet diagnostic criteria for depression, suggesting that burnout may be a depressive syndrome rather than a new or distinct entity. Clinical psychologist Herbert Freudenberger first identified the construct "burnout" in the 1970s.¹

The Fact-Pace of Burnout

According to a 2016 Medscape report, physician burnout rates have increased by 28% in just the past four years (2013-2016)². Furthermore, a startling 88% of physicians cited in the report confirmed feeling moderately to severely stressed and burned out on an average work day. Burnout at these levels is unsustainable and if not addressed will have a long-term impact on our society’s overall quality of care.The underlining culprit many practitioners identify as the root cause of their frustration stems from the unproductive use of their organization’s electronic health record (EHR) platform. Adoption of EHRs in the United States is now the de facto standard for most healthcare organizations. While many EHR deployments have enabled physicians increase their ability to provide a higher level of quality of care. A growing number of these deployments have also been cited as the reason for the decline in physician’s productivity and patient satisfaction.

SOURCE: Medscape National Physician Burnout & Depression Report 2018³.Many physicians complain that most EHRs are not as intuitive, attractive, and easy to navigate as popular websites like Facebook, Twitter, Instagram, and Amazon — or most Smartphone apps. Even the most tech-adverse physicians are somewhat familiar with the slicker interfaces that are the norm with mainstream applications, so why wouldn't they feel frustrated by their EHR's relative “clunkiness.”While most physicians view their work not only as a career but also as a calling, the threat of burnout and the added stress of the modern medical environment have brought many to the brink of distress about their future in healthcare. When this happens, physicians begin to consider alternative career options, and a growing number have begun to head for the doors.Some of the negative feelings highlighted in the survey include:

• Decreased job satisfaction
• Decreased daily productivity
• Insufficient work-life balance
• Conflict at work and home
• Feelings of irritability, moodiness, anger, and hostility
• General tiredness, lack of sleep, and difficulty sleeping
• Negative impacts on physical health
• Negative impacts on mental health, including depression, anxiety, apathy, cynicism, and less social/relational interest
• Patient-safety concerns such as difficulty making decisions, communicating effectively, and increased medical errors

Strategies to Remediate Physician Burnout

Here a few practical steps that can be taken to reduce physician burnout:

• Vendor Communications & Partnerships - A strong relationship between buyer and vendor can make or break any technology implementation. Choose the best vendor that fits your organization’s culture. When a physician practice or hospital adopts an EHR system, there are many things for the office management to learn. Some of these items to learn may be confusing for professionals who are not information technology experts. This point in time is where a strong relationship between buyer and vendor is extremely important. In fact, that relationship can often determine the success (or lack thereof) of the EHR system.
• Training, Training, Training - Not all training programs are the same. Training should be delivered in various forms depending on the audience and their learning styles.
• Workflow Optimization & Shortcuts - Shortcuts are how physicians can get relief from administrative tasks, reduce duplicate and/or time-consuming entries of data, and save time by not having to search for records in multiple places.
• Reduce Information Overload - Some EHR products feature automatic alerts to physicians. These notices have created a sense of overload, particularly for primary care physicians. The goal should be to reduce the number of unnecessary messages that reach them to a number they believe they can handle diligently.
• Address Insufficient Integration - Address the issue of insufficient integration of exchange of health information between EHRs. Physicians in multiple specialties and a range of practice settings described that their frustration increases when health information was not exchanged between EHRs.
• Turn Your IT into a “Utility” - Establishing upfront a realistic budget for monthly technology expenses (i.e. regular system upgrades, hardware refresh, security testing, etc.) helps physician leadership make sound decisions around the ROI that they can expect to achieve from their EHR deployments.
• Technology Oversight and Governance - Many organizations skip ahead to investment and deployment without first establishing guiding principles and policies to make informed decisions.
• Collaborate with Colleagues - Finally, we recommend collaborating with other physicians in your practice or department to identify common themes in the EHR’s use that can impact the level of stress and improve overall well-being. Furthermore, it can be useful to stay connected to other physicians in the organization to help them work through their own challenges by encouraging cooperation and soliciting others’ input.

All healthcare organizations should be evaluating how their technology is impacting the current state of physician burnout. If identified as a growing issue in their practices and/or hospitals, a call to action is necessary to begin to turn the tide before consequences of this phenomenon becomes more severe. Coker Group can help your organization in selecting and implementing the right EHR system that can support your physicians and help alleviate the symptoms of burnout; contact us today to speak with a skilled consultant.

1. Bianchi, R., Schonfeld, I.S., & Laurent, E. (2018). Burnout syndrome and depression. Kim, Y.-K. (Ed.), Understanding depression: Volume 2. Clinical manifestations, diagnosis and treatment (pp.187-202). Singapore: Springer. doi:10.1007/978-981-10-6577-4_14. https://academicworks.cuny.edu/gc_pubs/473/
2. Peckham, Carol. “Medscape Lifestyle Report 2016: Bias and Burnout.” January 13, 2016. “https://www.medscape.com/slideshow/lifestyle-2016-overview-6007335#2
3. Peckham, Carol. “Medscape National Physician Burnout & Depression Report 2018.” January 17, 2018. https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235