More on Physician Burnout

“Dr. Paul Batalden has frequently stated that “every system is perfectly designed to produce the results it gets,” and health-care systems have been perfectly designed to produce burnout. “ — William Spinelli

In the current medical climate, reform and physician burnout seem to go hand and hand.  Older posts on this blog have addressed this issue:  Doctor Burnout is a Patient Care Issue  and Burnout: Is it me or is the system designed that way.

A recent study by Spinelli et al “Seeing the Patient Is the Joy:” A Focus Group Analysis of Burnout in Outpatient Providers” uses focus groups in an attempt to understand the physician’s own experience of the burnout.

The study identified three major themes associated with burnout: work environment, work tasks and e-stress.

Burnout caused by the changing work environment, which includes professionalism and expectations, speaks to the physician’s declining sphere of influence.   What does it mean when a physician’s sense of autonomy and professionalism is diminished?  One focus group doctor explains:

“Part of it is that our professionalism ought to help us do things above and beyond what we get directly paid for. Yet when we start feeling pressured by this rule and that rule, this task and that task, it starts to feel overwhelming and then the professionalism loses some of its impetus.” (Focus Group 4)

Another cause of Burnout is the change in work tasks, which includes volume and control of the work.  The link between responsibility and authority seems to be severing.  Physicians experience the new work environment as a speed up. One doctor explains:

“We’re getting more and more tasks, tasks that either we didn’t have to do or tasks that we could delegate to somebody to do, and now the expectation is why aren’t you doing that.” (Focus Group 5)

E-stress, which includes time, skills and patient relationships, speaks to a fundamental tension in medicine.  Increasingly the data collection, metrics and volume needed to transform the medical system away from the hospital-based model creates a feeling of alienation in the actual face-time doctors have with patients.  One doctor explains:

“I really struggle with how you get excellent results during the day when you’re face-to-face with people and you’re looking at that computer and typing and then look back, and you’re doing this (computer work).” (Focus Group 6)

Spinelli et al also authored a recent quantitative analysis of burnout “Extending Our Understanding of Burnout and Its Associated Factors: Providers and Staff in Primary Care Clinics”

Spinelli writes “Our data suggest that the most critical areas of work life in predicting EE [emotional exhaustion] are the intensity of workload, degree of job control, and congruence between staff and organizational values; workload, values congruence, and a sense of workplace community were the most critical areas of work life associated with DP [depersonalization].”

Physician burnout impacts older and younger doctors, as well as staffing and patient care.  As Jessica Lapinski, D.O. wrote in Why it’s not OK for older doctors to dismiss physician burnout, there are some alarming aspects of physician burnout:

• “[B]urnout has been studied in all stages of the medical training trajectory: from student to resident to attending physician.
• There is high occurrence of burnout among medical students and physicians, with rates ranging from 25 percent to 75 percent.
• During residency training, burnout is the most prevalent resident impairment, more so than either depression or substance abuse.
• Burnout has been linked with poor health, sleep issues, depression, hypertension, anxiety, alcoholism, and myocardial infarction.
• Medical errors have also been linked with burnout in a cause and effect relationship: For each 1-point increase in depersonalization, there is an 11 percent increased likelihood of reporting a major medical error.
• Burnout and physician dissatisfaction are related to increased rates of job turnover, absenteeism, decreased job performance and reduced job commitment.
• Over half of current physicians state that if given the opportunity to choose again, they would not choose medicine as a career.
• Suicide rates are steadily increasing, with male physician rates being 70 percent higher and female physician rates being 250 to 400 percent higher when compared to their non­physician gender counterparts.
• Further, patients of unhappy physicians are less likely to follow prescribed treatment plans.”

Physician autonomy and authority, similar to the authority of autonomy of the patient, cannot be faked.  At Doctors Council we believe that burnout is the result of doctors losing control over their time, their practice and their profession.

Either doctors and patients are at the center of health reform, or they are not, and if they are not poor patient experience and physician burnout will be the result.