Physician Burnout: The Feel-Bad Factor

Most discussions about health care are about the patient. But lately, how the doctor feels has also made headlines — in both professional journals and the general media.

To put it simply: The doctor doesn’t feel so good. And that’s an understatement.

“Physician burnout,” once mere scuttlebutt within the profession, has in recent years been recognized as a serious malady affecting not only doctors themselves but also the quality of care they provide.

The burnout takes the form of “a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment,” according to the dean of the University of Michigan Medical School, Marschall S. Runge.

For those who require the imprimatur of officialdom, The World Health Organization manual, known as the International Classification of Diseases (ICD), has decided to add physician burnout to the list (though not as a medical condition but as an “occupational syndrome”).

Burnout can occur in any line of work where the pressures wear people down. Journalists, air-traffic controllers, teachers, police officers, moms, all suffer from it to a greater or lesser degree. (Interestingly, politicians operate unscathed.)

For doctors in the United States, however, the burnout rate has been estimated at almost twice that of other workers. A 2018 report from the Physicians Foundation said that as many as 78 percent of those surveyed feel professionally burned out at least sometimes, which is 4% higher than the 2016 survey. More worrying, the suicide rate for physicians reported in this study is twice the level of the general population.

The feel-bad factor has significant medical and financial consequences. The studies indicate that burned-out doctors are more likely to make medical errors, and their patients have worse outcomes and are less-satisfied with treatments.

Burnout costs the United States some $4.6 billion every year, according to the journal Annals of Internal Medicine. “Marketing costs to advertise the position, costs of hiring, costs associated with training and starting out a physician — all of these really add up pretty quickly,” said Joel Goh, a visiting scholar at Harvard Business School.

Finding it hard to heal themselves, clinicians have turned to such palliatives as wellness counselors, yoga and massage, according to reports. And while a vigorous rubdown can’t hurt, it does nothing to solve the endemic problems that bring on the burnout.

Shorter hours are certainly desirable, and should yield benefits, but this is not an automatic cure. For example, the European Union’s working-time directive, which sought to limit doctors’ workload to 48 hours a week, actually did harm. A study in the U.K. found that the EU worktime regime led to fumbles in the handoff from one hospital shift to the next. These delays contributed to 407 out of 1635 deaths studied. This doesn’t mean that a less onerous workload won’t help matters, but rather that it should be implemented carefully.

Electronic record keeping is a major culprit. It is no doubt one of the great ironies of modern healthcare that the very technology that was supposed to make health care more efficient is actually wrecking the doctors’ workday. Incredibly, physicians spend twice as much time in putting information into electronic health records (EHR) as they spend with their patients.

But going back to written records is like going back to dial telephones; it’s not going to happen. Instead, the remedy for the ills of technology will likely be more technology.

For example, 3M has developed technology that will enable doctors to put data into databases electronically without the use of a keyboard, and to ask for lab results and charts to be displayed automatically with a single voice command.

Still, achieving the goal of a more rational workload will require a larger pool of medical professionals to share the burden. An anticipated physician shortage makes the problem all the more acute.

The answer would seem to lie not only in training more doctors, but also in training more physician assistants (PAs) and advanced-practice registered nurses (APRNs). This has been happening. The number of NP degree programs (Master’s or doctorate) rose from 282 to 424 between 2000 and 2016; and PA degree programs rose from 135 to 238 between 2000 and 2016, according to official figures.

At this stage, it’s clearly not enough. But it is hoped that the problem will ease as awareness increases and efforts to correct doctor overload go into effect.

Ultimately, the health of the doctor is an issue for the patient. If the doctor can’t function optimally, the patient is bound to suffer.