Doctor Burnout is a Patient Care Issue

The AMA has recently highlighted Dr. Mark Linzer’s work on Physician Burnout by reviewing his 7 signs of physician burnout. The 6th sign on the list is “You lack control over your work schedule and free time” with the added comment “When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout.”

It is this link between burnout and what is traditionally understood as a key feature of professionalism- control of work and time- that attracts our attention here. That is to say we need to understand the relationship between a diminishing professionalism, burnout, and most importantly quality of care.

In Dr. Linzer’s 2005 study, there is a clear call to understand the changing nature of physician work and the quality of care provided:

“… as doctors move away from managing their own practices to increase their practice time, they find themselves with less control over their work environments and removed from some of the decisions and values of their office leaders. Future research must address the critical issues arising from this medical milieu, including the patient related consequences of these busy offices and high stress levels, and the potential effectiveness of physician stress management programs.”

Perhaps the most radical call from Dr. Linzer is his suggestion in a 2013 editorial to include metrics of physician well being into how an institution judges itself. He writes that we must:

“Ensure that metrics for institutional success include physician satisfaction and well-being. Any system that does not measure, monitor and optimize clinician well-being and sustainability is at risk. We suggest measuring the following metrics: predictors (e.g., work control, time pressure, pace of work [chaos] and values alignment between clinicians and leaders), and outcomes (e.g., physician satisfaction, stress, burnout and intent to leave the practice).”

If we believe there is a relationship between physician well being and quality of care then we cannot ignore the problem of physician burnout. Unfortunately it is too often the case that when patient and population outcomes are measured without understanding physician well being, a culture of doctor blaming can rise up. The easiest thing for an institution to do when it is not reaching its metrics is to blame the doctor and other health professionals. Perhaps one way of addressing this culture is treat physician satisfaction with the same seriousness that we treat other issues- by defining, measuring, and improving it.

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