Preventing MD Burnout

Physicians in the United States spend about 28,000 hours in medical school, residency and fellowship learning to be physicians. But once they start practicing, only 18 minutes of each hour is with patients on an average workday. Administrative and other tasks take up the remaining 48 minutes. Physicians want to focus on patients, so this disturbing statistic creates a conflict that often leads to burnout.

My goals are to help trustees and administrators understand what burnout can mean to your hospital or system, understand why you should be concerned about burnout and encourage you to champion programs to reverse and prevent the condition.

Embrace the issue

A 2015 Medscape Physician Lifestyle Report found 46 percent of physicians responded that they had burnout — defined as prolonged stress that has physical and/or psychological symptoms — an increase from less than 40 percent in the 2013 report.

Statistics from the Annals of Internal Medicine and the Archives of Internal Medicine show that burnout is a growing issue and starts early in physicians’ careers. Studies show burnout rates are lowest among the youngest and oldest physicians. Also, female physicians are more susceptible to burnout.

Hospitals and systems invest in programs to engage their physicians in helping to achieve the organization’s overall goals. An engaged physician is willing to actively partner with the physician enterprise to transform the health care delivery system so they can provide the highest-quality care to patients they serve. But it’s almost impossible to engage a burned-out physician. Studies show regulations and rigorous documentation that increase workload, long hours, productivity pressures and lower pay are the top triggers pushing physicians to burnout. Each decreases patient face-to-face time and colleague interaction.

Burnout symptoms include exhaustion, depersonalization and lack of sympathy for patients, as well as inefficiency and inability to be successful or contribute toward achieving goals. These symptoms can lead to depression, substance abuse, divorce and even suicide.

The effects of burnout can derail a system’s culture of caring. Productivity and the quality of care physicians deliver will decline. Both lead to medical errors and less-satisfied patients, and have a direct impact on revenue.

Losing physicians to burnout also has a profound negative impact on the bottom line. Trends show the United States is on a path to a physician shortage, especially because many are reaching retirement age while the patient population increases. The Association of American Medical Colleges projects a shortage of more than 90,000 physicians in America by 2020 and 130,000 by 2025. Other studies show traditional private practice physicians are more than twice as likely to stay with their jobs as those employed by a physician-owned enterprise.

You can help to slow this trend. A burnout reversal and prevention program can cost each facility in the neighborhood of $10,000 annually while surveys estimate the cost to recruit and hire a physician is in the $50,000 to $1.2 million range, depending on the physician’s experience level.

Give top-level support

It takes direct support from the top and physician involvement to launch programs that successfully reverse and prevent burnout. While physicians are obligated to take care of themselves, employers have an equal obligation to take care of their employees. Both trustees and administrators can be catalysts to create and support a lower stress work environment that also encourages physicians to take better care of themselves.

A nap or vacation won’t address burnout. New government-required documentation obligates organizations to identify causes and then educate physicians on preventing and treating burnout. Solutions are complex and unique to each hospital or system. Since most trustees and hospital administrators are not physicians, it’s difficult for them to empathize with the daily pressures of physicians — and understand how burnout can be the outcome. Perhaps the best way for a trustee to understand is to become a patient to see firsthand the challenges physicians face. Administrators should talk to their physicians and shadow them to experience an average day.

One possible solution to giving top-level support is creating a task force to focus on burnout prevention and maintaining work-life balance. The task force should concentrate on recognizing the signs of burnout, treatment, re-entry to work and prevention. If the organization is large or geographically spread out, forming a task force at the physician group level could be more effective. At the physician group level, however, there should still be oversight from and accountability with system-level trustees. Also, it’s critical for communications between the system- and group-level boards to be transparent — especially since geography may add to the distance between the organizations.

There are three other challenges the task force should tackle. First, physicians are taught not to show weakness and to remain in control. The task force should encourage an environment in which it’s safe to seek assistance.

Second, no two organizations are the same. The task force should determine and address your organization’s unique issues from the start rather than researching and mirroring what peer organizations have done.

Finally, many organizations form burnout prevention groups, but don’t supply the support they need to have any chance for success. The task force should create metrics and keep administration and trustees updated on progress. In addition to trustee and administration support, any program of this magnitude must have a budget and dedicated time to participate.

Trustees’ to-do list

Trustees should demand programs to identify system-level issues that lead to burnout so physicians are aware that the condition could affect them. Leadership from trustees and administrators can address issues by:

• Managing productivity vs. quality and patient satisfaction goals so demands on physicians aren’t too great
• Monitoring metrics, including electronic health record documentation and physician satisfaction
• Preventing clinical staff shortages by adding care teams and other staff support to deal with paperwork and administrative tasks
• Creating an autonomous environment that allows physicians to make the best decisions for their patients
• Replacing outdated or dysfunctional technology
• Supporting programs that educate physicians and their families to prevent and treat burnout

The results from an effective burnout prevention program can have tremendous effects on your recruiting efforts, patient care and bottom line. Your physicians will have better work-life balance, make fewer errors and be more engaged in the organization’s overall mission and initiatives. Relationships among physicians, employers and peers will improve. And organizations can remain focused on achieving strategies and maintaining a caring culture. The first step is to recognize the negative impact of burnout. 

Craig Cunningham (craig.cunningham@medsynergies.com) is director of physician engagement at MedSynergies, an Optum company, Irving, Texas.