CLINICIAN BURNOUT – Part 2
The rate of medical errors in the US have risen to astonishingly high levels during the past decade (Please refer to Part 1: Medical Errors are on the Rise for more details about the medical error rate). In addition to this high rate of medical errors we are also seeing another growing crisis in healthcare on the horizon – healthcare provider burnout.
Physician burnout specifically has received the majority of research and publication focus in the past decade which is why this blog will focus on physician data. However, it is noteworthy to add that burnout can occur to any healthcare provider. Hopefully there will be more broad healthcare provider burnout data collected in the future which will provide much needed insight into the extent of this growing crisis.
The meltdown of healthcare providers: A Growing Crisis
There is an epidemic of physician burnout in the United States, and it has a pervasive negative effect on all aspects of medical care.
Medscape, a global resource for healthcare professionals, publishes an annual National Physician Burnout, Depression, and Suicide Report. In 2019, Medscape’s physician survey  reported 44% of the physicians surveyed reported signs or symptoms of burnout, up from 39.8 percent in the 2013 survey. Gender differences in reported physician burnout is stark: 39% of male physicians versus 50% of female physicians report signs of burnout. Burnout rates also vary by specialty:
The bottom line – on average nearly 1 in 2 physicians report burnout!
burnout rates (2019)
Now, “what is burnout?”, you may ask
“Burnout is the constellation of symptoms that occur when your energy account has a negative balance over time. You can continue to function in this depleted state; however, you are a shadow of the doctor you are when your account has a positive balance.”
Dr. Drummond continues to outline three energy accounts inside each of us that needs to be kept in balance in order to the ones best work and live a balanced life:
- Physical energy
Sustained with the help of rest, exercise, nutrition
- Emotional energy
Maintained with healthy relationships with the people one loves
- Spiritual energy
Supported by regularly connecting with a personal sense of purpose
He notes that unfortunately physicians are conditioned to ignore their physical, emotional, and spiritual energy levels and this tends to carry on despite complete exhaustion of their energy reserves. This places them at very high risk for burnout.
Cardinal Burnout Symptoms
In a state of energy level depletion, the three cardinal burnout symptoms are easily ignored. These burnout symptoms are the core of the Maslach Burnout Inventory developed by Christina Maslach and her colleagues at the University of San Francisco in the 1970s :
Low physical and emotional energy levels which are in a downward spiral
- Depersonalization or “Compassion Fatigue”
A state of having no emotional energy left to provide to others or even oneself characterized by cynicism, sarcasm, and the need to continue to express frustration about patients or work.
- Lack of efficacy
Low spiritual energy levels causing one to question the meaning and quality of one’s own work. A common thought of this state is “What’s the use? My work doesn’t really serve a purpose anyway.” At this point, one may also worry that a mistake will be made if this feeling persists.
FACTORS CAUSING MEDICAL BURNOUT
Many factors can cause burnout, but it seems that there are two main areas which contribute to this astonishing high physician burnout rate.
- Healthcare Culture
- Healthcare Work Environment
In the medical field, there is an additional workplace pressure for healthcare providers to perform against all odds. The healthcare ecosystem doesn’t allow for clinicians to be anything less than “superbeings” who cannot admit weakness or need breaks, sleep, or emotional support. Burnout remains a taboo subject in the workplace and reaching out to colleagues can be perceived as a sign of weakness. Stress management and burnout prevention are also not covered in detail in medical school or residency training. To make things worse, in addition to this burnout taboo work culture, there are also additional cultural aspects that add stress to doctors:
- Culture of perfectionism
- Individual blame in medicine
- Insufficient organizational support,
- Insufficient support from colleagues
Healthcare Work Environment
The 2019 Medscape’s National Physician Burnout, Depression, and Suicide Report  highlighted several contributing factors to burnout as well as provided quotes from physicians who self-reported burnout. I have broken down these contributing factors to three main areas:
1. Workflow Format
- Too many bureaucratic tasks (e.g., charting, paperwork) – 59%
- Spending too many hours at work – 34%
- Increasing computerization of practice (EHRs) – 32%
“There’s so much redundant work due to incompetent third parties’ data collection” – Endocrinologist
“All that paperwork sucks all of the enjoyment out of being a doctor” – Family Physician
2. Perception of Self in the Workplace
- Lack of respect from admins/employers, colleagues or staff – 32%
- Lack of control/autonomy – 23%
- Feeling like a cog in a wheel – 20%
- Lack of respect from patients – 16%
“ It’s too hard to schedule time off; the rules on clinic cancellation plus poor administrative support to help organize and plan anything makes it impossible. “ – Internist
“Fear of litigation, bad reviews, and complaints make everything worse.” – Dermatologist
3. Profit & Regulation
- Insufficient compensation/reimbursement – 29%
- Government regulations – 20%
- Emphasis on profits over patients – 17%
“ I need a lot of time away from the office to find balance and reenergize. It was never an issue 15 years ago.” – Pulmonologist
“I’ve lost enthusiasm for patient care.” – Neurologist
This unfortunate combination of a burnout taboo culture and stressful healthcare work environment has put physicians in a very vulnerable position as medical errors in healthcare mount (See Part 1- Medical Errors are on the Rise). In fact, physicians are now becoming “second-victims” of medical errors in addition to the more obvious “first-victim” – the patient.
To learn more about how physicians are becoming “second victims” to medical errors as well as the growing importance of Human Factors in mitigating medical errors please stay tuned for Part 3 – Second Victims of Medical Errors- Physicians.
Agatha Kalinchenko, MD – Sr. Human Factors Consultant
Dr. Agatha Kalinchenko is a physician trained at Karolinska Institute in Stockholm, Sweden. Years of clinical exposure to surgery, hospital wards, and out-patient environments helps her bring a physician’s perspective to Sage Research & Design. Her other passion is behavioral science. Agatha earned a Master’s in Psychology from Lund University in Sweden. Her expertise in medicine and interest in the human mind translated easily to the applied fields of user experience and human factors. Before starting with Sage Research + Design, Agatha developed her UX skill set and design knowledge by providing strategic guidance to clients of the digital health company, JOOL Health. Now at Sage, she works as a medical and UX consultant, and is employing proven UX and Human Factors techniques to improve safety and patient satisfaction through improved healthcare product design.
Physician Burnout: Its Origin, Symptoms, and Five Main Causes https://www.aafp.org/fpm/2015/0900/fpm20150900p42.pdf
 Maslach C, Leiter MP. The Truth About Burnout: How Organizations Cause Personal Stress and What to Do About It. San Francisco: Jossey-Bass; 1997.