Burnout: No laughing matter

Organizational, individual efforts are needed to combat this serious – and growing – condition.



Much has been written about burnout in U.S. physicians over the course of many years. Burnout is a syndrome that is exemplified by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. It appears that hospitalists are particularly prone to burnout, being at the very front line of patient care. In addition, the prevalence of burnout appears to be getting worse. According to a survey from the American Medical Association, the prevalence of burnout in 2011 was 45%. Three years later in 2014 the prevalence was up to 55%.1,2

Although triggers for the onset and intensity of burnout likely vary by specialty, a recent Medscape Lifestyle Report found the most common causes of burnout among physicians included (see graphic):3

• Bureaucratic tasks.

• Work hours.

• Computerization.

• Compensation.

A list of the causes of burnout
And there is convincing evidence that burnout is detrimental not only to the individual experiencing it, but also to those who have to work with the individual, the patients and families being cared for by them, and the system as a whole. In physicians, burnout has been linked to:

• Lower work satisfaction.

• Disrupted personal relationships.

• Substance misuse.

• Depression.

• Suicide.

Burnout also leads to lower productivity, higher job turnover, and early retirement. In addition, from a systems perspective, burnout is associated with higher medical errors, reduced quality of patient care, and lower patient satisfaction. And, at its most extreme, burnout is deadly: Sadly, every year, 300-400 physicians in the United States commit suicide. Female physicians are 2.3 times more likely to commit suicide than are female nonphysicians; for males, the risk is 1.4 times higher among physicians compared to the general population.1

Proactive approaches

Despite all these sobering statistics on the prevalence and outcomes of burnout among physicians, the ongoing question is, what can we do about it? Although awareness and recognition of burnout has grown substantially over time, successful interventions to prevent or mitigate burnout have not. Many potential interventions and ideas have surfaced and have been published, but none have had impressive impacts or have been adopted widely within or across institutions. According to a Modern Healthcare survey of approximately 100 health care CEOs, only about one-third reported that their organization had programs to address physician burnout, although about another one-third reported attempts to develop such programs.1

The good news is that at least there is a lot of activity around trying new interventions to reduce burnout, including in medical schools and graduate training programs. The thought is that if you can employ healthy resilience tactics during training, these can be carried throughout a career to diminish the risk and/or severity of burnout, despite any challenges that arise along the way.

Some of these interventions are aimed at individuals (to enhance personal resilience and coping skills) while others are aimed at the level of organizations (to reduce organizational stress and/or workload). A recent Modern Healthcare article found several good examples:1

• New York’s Albert Einstein College of Medicine’s WellMed program has been designed to help students develop healthy and balanced habits and attitudes, and to enhance their personal resilience, for the short and the long term.

• Baystate Health in Massachusetts hosts a physician leadership academy that offers training in communication, unconscious bias, strategy, and other management skills, to enhance individual resilience and organizational engagement.

• HealthPartners, a not-for-profit, Minnesota-based health care organization, has specific programs to engage physicians and allow them to have organizational impact, as well as programs to simplify technology use.

Organization efforts are key to prevent, treat

The key to reducing burnout does seem to be employing a combination of self-directed and organization-directed interventions, each of which enhances resilience and reduces workplace stressors (i.e., administrative tasks and workload). Specific to hospitalists, Leslie Flores, MBA, recently wrote about burnout at The Hospital Leader blog. Her list included several specific examples to reduce the top causes of burnout among busy hospitalists:4

• Modifying the skill mix in hospital medicine groups so that less costly support staff are doing much of the work not requiring a physician’s expertise, freeing up hospitalists to provide better care to more patients.

• Reducing unnecessary interruptions and the stress they cause, via both technology and process improvement.

• Paying deliberate attention to hospitalist personal and professional well-being.

• Adjusting hospitalist schedules and work flow so that hospitalists can be more efficient (that is, do less low-value work and re-work) and have better work-life balance.

• Ensuring that hospitalists have the training, clinical competencies, and support to comfortably perform in expanded clinical roles.

Many of these systemic solutions were recently validated as likely able to have an impact on burnout (and seem to be more effective than interventions focused on individual resilience).5 A recent meta-analysis found that physician-directed interventions were associated with small but significant reductions in burnout; these were primarily mindfulness-based stress reduction techniques, educational interventions targeting physicians self-confidence and communication skills, exercise, or a combination of these features. More impactful were organization-directed interventions, which were associated with more significant reductions in burnout; these were primarily aimed at reducing workload and enhancing teamwork and leadership.

In sum

It is important for all of us hospitalists to understand and try to mitigate burnout within our teams. Although individual-focused interventions can have some effect, most efforts should primarily be focused on system-based interventions, to reduce administrative burdens and workload. Through such system design and redesign, we can likely reduce burnout amongst our teams, and therefore improve the sustainability of our specialty.







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