Growing list of responsibilities helps fuel hospitalist burnout

By Lola Butcher

Working as a hospitalist for many years, Daniel L. Roberts, M.D., has heard it both ways: Some say hospitalists are more prone to burnout than other physicians. Others say hospitalists are more protected from burnout than their colleagues in other specialties.

Roberts, an internist who practices at the Mayo Clinic in Phoenix, dug through survey data to find out which theory was correct. Initially, his comparison of burnout rates among hospitalists with those of general internists who practice in outpatient settings did not reveal a major difference: More than 52 percent of hospitalists and nearly 55 percent of outpatient internists are affected by burnout, according to the 2014 Journal of Hospital Medicine study.

“We really have a problem with medical practice at large,” Roberts says. “It's not just individual pockets of physicians here or there.”

Burnout specifics among hospitalists

But hospitalists differed from internists in some ways. For instance, hospitalists were more likely to have low scores on one key symptom of burnout: personal accomplishment. Hospitalists and outpatient internists, though, had similar scores on emotional exhaustion and depersonalization, which are other common burnout symptoms.

Roberts and his research colleagues dug deeper into the physician survey responses to find a few other alarming data points:

Forty percent of hospitalists reported symptoms of depression.
Nine percent of hospitalists reported recent suicidal thoughts.

When he first saw those findings, Roberts couldn’t help scanning his own work environment.

“If 40 percent are experiencing symptoms of depression, and there are five of us on this week, which two are they?” he says. “Am I one of the two?”

The causes of burnout among hospitalists — and the actions needed to prevent or mitigate burnout — vary from one hospital unit or department to the next. But there are a few burnout contributors specific to hospital medicine that health system executives should investigate, says Danielle Scheurer, M.D., chief quality officer at Medical University of South Carolina in Charleston.

Scheurer has worked as a hospitalist since 2002 and has experience at large, tertiary care academic medical centers and small community hospitals alike. A root cause of burnout among hospitalists, in her view, is an ever-expanding list of responsibilities.

“They can be in situations where they end up being the jack-of-all-trades — the pharmacist and the case manager and the social worker,” says Scheurer, who is also a member of the Society of Hospital Medicine board of directors. “They don't necessarily have the skills and competencies to be great at those things, and it takes away from their core background skills and competencies.”

Taking steps to address burnout

Assembling the right multidisciplinary care team to address the problem is just the beginning of a solution. A standard communication protocol must be established so that hospital staff members can work with hospitalists effectively and efficiently.

“For example, [you should] page for this, but not for this,” Scheurer says. “Let's create a whiteboard or a chat room in the medical record so the hospitalist can address nonurgent things as opposed to getting paged every 10 to 15 minutes.”

Perhaps the most important thing hospital executives can do, she says, is to start talking with physicians about the burnout epidemic. Like their colleagues in other disciplines, most hospitalists fear that admitting to having burnout symptoms will be perceived as a sign of weakness.

“Let’s break the silence and talk about the fact that there’s a 50-50 chance that everyone within your walls has some symptoms of burnout,” she says. “If we don’t talk about it and we pretend it’s not there, we should not expect the situation to get any better.”