Physician Burnout: Causes, Prevention and Solutions

Whether it’s the day-to-day grind or the tireless commitment to success weighing down on a physician, if they are not careful in balancing out caring for the patient with their own self-care, the job can overwhelm a doctor’s capacity to perform their work properly.

As in any occupation, a physician can experience burnout. Due to the job's life-and-death pressures, this condition can be more common among physicians than other professionals. By the same token however, the consequences of burnout among physicians can be far more dire than those in other vocations. For those reasons, it is essential that every physician learns about physician burnout: what it is, how to recognize it, and, most importantly, how to prevent, reduce, and relieve it.

What is Physician Burnout?

The National Institutes of Health describes burnout in terms of one's metabolism. If you think of your metabolism as an account into which you can deposit energy through recharging activities that rest and rebalance you and from which you can draw energy for your daily activities and work, burnout is essentially a fundamental disorder of that mechanism.

Specifically, the NIH defines burnout as: "the constellation of symptoms that occur when your energy account is in a negative balance."

In particular, when it comes to physician burnout, numerous studies have shown that, while a doctor may continue functioning in this energy-depleted condition, it is at a fraction of the capacity and competence they normally possess when that account is suitably flush.

Three Kinds of Energy

To extend the metaphor of metabolism as an energy account, there are three categories of assets:

• Physical Energy – The energy you use to move your body and engage in the activities of life
  
• Emotional Energy – The capacity to be compassionate and emotionally available
  
• Spiritual Energy – Your feelings of connection to the world and purpose in your work

In the medical profession, stores of physical, emotional, and spiritual energy seem to be running low across the board. Research suggests that more than half of all healthcare providers experience burnout symptoms. That’s a much higher incidence of symptoms than for those in non-healthcare professions. These statistics may begin early, following providers from medical school through residency and fellowships into their years of full-fledged medical practice.

Aside from its effect on patient outcomes, physician burnout can also have a devastating impact on the provider’s mental health. Without management, physician burnout can rapidly escalate into depression, substance abuse, and suicidal ideation. It’s vital that organizations take every step they can to help clinicians counter stress in healthcare environments.

COVID-19 transformed physician burnout from a pressing concern into a global emergency. “Coronophobia” is a recent term that describes the fear experienced by frontline healthcare professionals that they will or would contract coronavirus. This fear led to a sharp increase in feelings of emotional exhaustion and depersonalization among healthcare workers. This exhaustion and depersonalization not only harms mental health but can reduce the safety, quality, and delivery of care.

Causes of Physician Burnout

There can be many causes of physician burnout. These can be based on the physician's overall mood and personality as well as extenuating circumstances, including the area of medicine in which the physician practices. Personal characteristics, such as the tendency to be critical of oneself or a focus on perfectionism at work, can hasten burnout. However, the majority of factors relate to the job itself or the way the health care organization is run.

1. The Natural Stress of Clinical Medicine

The nature of the job is a huge determinant of burnout. Physicians are constantly working with the most physically and emotionally needy people, many of whom are in pain or dying. They must also work with family members of patients who may demand answers to unanswerable questions. This job naturally has a great deal of stress even on the best of days because physicians often have very little control over who they see and what will happen.

2. The Specialty Area and Specific Job

The physician specialty practice area has its own set of stressors, which can serve to make burnout that much worse. For example, some physicians must take on-call or overnight hours more often than their colleagues do. Others do not make as much money as their colleagues despite working longer hours. Physicians may see more burnout within each specialty area based on facility politics, problems with colleagues, and stressors in a specific provider group. Although it may be tempting to switch jobs, physicians should be aware that they will most likely find themselves faced with another set of stressors if they do so.

3. Poor Work/Life Balance

Physicians frequently have poor work/life balance because of their long hours, demanding work schedules, and requirements of the job that exceed normal business hours. In addition, other stressors at home, such as relationship or financial problems, can further complicate the situation. In these cases, physicians are left with nowhere to relax and rejuvenate their bodies and minds. Unfortunately, medical students are not taught ways to create a healthy work/life balance while they are in school.

One study assessing the impact of poor work/life balance in Turkish frontline healthcare professionals found that long hours can contribute to work addiction, which has moderately significant links to poor mental health. Struggling to administer patient care while striving to resolve personal issues can lead to a feeling of low personal accomplishment despite extensive work hours.

Extended shifts packed with difficult, emotionally draining work and a low sense of personal achievement converge with constant strains on a physician’s personal life to create the ideal breeding ground for burnout symptoms.

4. Ingrained Traits From Medical School

Medical training can teach new physicians attitudes that can actually lead to increased burnout after graduation. Medical students are frequently trained to think that they must be workaholics who never turn down a challenge, who have unlimited supplies of energy, and who are not ruled by their emotions. While the idea that the patient comes first is an important one, medical students must also learn that they cannot successfully care for the many needs of their patients if they do not first address their own needs in healthy manners.

5. Poor Management in the Health Care Setting

A physician’s direct supervisor can also greatly influence how he deals with stress and how close he is to burnout. The fact that a bad supervisor can quickly distort job satisfaction and increase burnout levels have only recently been studied. However, it is a significant problem for many physicians today as new physician groups form more rapidly than ever before without having enough qualified supervisors.

How to Treat Physician Burnout?

As any physician knows, you first have to identify and acknowledge it in order to treat a problem. While defining and describing physician burnout is typically not difficult, identifying and acknowledging it certainly can be.

Similar to depression, burnout can be tough to diagnose because so many doctors are not even aware of the problem until they are already deep in the end stages.

Symptoms of Physician Burnout

While physician burnout is displayed in a huge variety of symptoms, there are three key symptoms that can be seen in nearly all physicians feeling extremely overwhelmed and stressed. These symptoms were described by Christina Maslach in the 1970s and are the foundation for the Maslach Burnout Inventory.

1. Exhaustion

The first key sign of burnout is extreme exhaustion. This is not just typical tiredness after a stretch of long work hours or after dealing with a few demanding patients. Instead, this exhaustion is the feeling that the physician can hardly go on with his work any longer. In fact, some physicians actually question whether or not they can keep up with their work if their feelings do not change.

2. Emotional Unavailability

As burnout worsens, all of a physician’s emotions may be sapped by the job. He or she may feel little more than irritation and anger about the job and the patients. Cynical or sarcastic comments become common as the physician cuts himself off emotionally from his or her patients. The physician’s other relationships, such as with a spouse or significant other, can suffer from this compassion fatigue.

3. Lowered Work Efficacy

Some physicians, particularly female physicians, will also feel as if their work no longer matters when they are burned out. The sense of meaning that the individual once gained from health care work is no longer there. The physician may also worry about making an enormous medical error if no changes occur.

Other Symptoms of burnout

While these three symptoms are among the most common experienced by burned-out physicians, some individuals may experience other symptoms, including:

• Sense of detachment

• Depression

• Inattention

• Variety of mood disorder

In most cases, symptoms build gradually over a period of months or even years. However, for some physicians, a single traumatic event, such as a particularly bad malpractice suit or a major medical error, can immediately bring these symptoms.

Physician Burnout Solutions

Already, you’ve reviewed some suggestions for how to deal with depletions of your various energy accounts. What follows are some more ways that physicians can implement those strategies practically and effectively.

As Tait Shanafelt, director of the John Hopkins Program on Physician Well-Being and professor of medicine at Mayo Clinic explains: "For physicians to avoid burnout, they need connections with colleagues, a sense of control over their work and schedules, and opportunities to grow and excel."

As important as these goals are, however, physicians are unable to achieve them on their own, he goes on to assert, citing that only 20% of the onus is on the individual, the other 80% on the level of the organization and system where the individual works.

In a study Mayo Clinic published entitled "Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systemic Review," American Medical Association and IBM Watson Health researchers found that the source of burnout more typically comes from factors on the system and organizational levels.

Thus, they find interventions that focus on alterations to the system rather than the individual physicians potentially more effective at keeping physicians from experiencing burnout.

The Four Ts

In the study cited above, the researchers categorized burnout interventions into one of four categories, each labeled with a word conveniently starting with the letter "T," thereby making them "The Four Ts." While they were devised uniquely for this study's purposes, they have lasting value as a way to evaluate interventions directed at an organizational level to determine their effects on physician burnout.

1. Teamwork

Twenty of the 50 interventions the researchers examined in the study focused on building better teamwork using techniques like:

• Offering team-based care

• Using scribes to input EHR data

• Improving communication among physicians

In every teamwork subcategory, the researchers noted improvements in physician burnout measures as well as stress levels and job satisfaction. In addition, they found less cynicism and exhaustion, increased practical ability to provide primary care services, and greater chances the physician would recommend the given clinic to other physicians and medical workers as a potential place of employment. Medical practices that offered physicians clerical support full time to enter in orders and other patient information reduced weekly self-reports of physician burnout. The percentage of burned-out doctors dropped from 43% to 14%.

2. Time

Fourteen of the 50 interventions to resolve physician burnout involved restricting working hours, adjusting work schedules, and incorporating a time-bank system. Of these, eight resulted in positive self-reports of their impact on physicians. Six more of the 50 interventions involved limiting the number of hours worked, but only two found that it relieved any burnout due to the pressure many of the physicians felt to complete the same amount of work in less time. Meanwhile, time banking helped medical school faculty spend more time teaching, mentoring, providing clinical services, and other activities, which, in turn, also improved satisfaction.

3. Transitions

Eight of nine studies examined involved workflow changes and transitions, such as separating workflows and targeted projects to improve service quality. These had a significant positive impact on physician burnout and satisfaction. Another study noted vast improvements in physician burnout measures following the implementation of quality-improvement initiatives, particularly in places physicians found most cumbersome, like reconciling medications. As a result, levels of job satisfaction among physicians increased, and stress decreased.

4. Technology

Of ten studies examining the use of technology to solve physician burnout, researchers reported that half successfully improved both physician burnout and job satisfaction. Interventions involving improvements to the EHR system resulted in drastic improvements in physician burnout and satisfaction levels.

There was, however, one study in which implementing EHR in a workflow either increased burnout or had no effect on it. This may have resulted from inadequate training causing inefficiencies in the EHR system. The addition of new features to EHR systems only caused physicians to feel more stressed and burned out. Along the same lines, increased use of computer keyboard due to increased EHR use lowered job satisfaction. If, however, a physician did happen to appreciate the implementation of information technology systems in the workflow, they were also four times as likely to have high job satisfaction.

Organizational dysfunction can catalyze the development of burnout. Technological alternatives can introduce new efficiencies and free up valuable time for support staff. This can help healthcare providers retain more of their own spiritual, emotional, and physical energy. Forward-thinking healthcare facilities urgently need to invest in initiatives that reduce physician burnout. Medical facilities can offer telehealth to their patients as an effective way to automate time-consuming bottlenecks in the patient journey, improve flexibility, and reduce the risk of no-shows.

It’s important to remember that the physicians experiencing burnout are patients themselves. They too can support their mental health as the end-user of a telehealth setup. An advisory report from a high-volume ICU at the height of the COVID pandemic suggested that offering occupational counseling and peer support via telehealth services may provide a way to reduce the incidence and severity of physician burnout.

A telehealth arrangement allows providers to deliver care in a way that’s both sustainable for their own mental health and convenient for patients. The healthcare industry needs to take steps now to facilitate its ability to retain experience and talent. A 2019 study found that 30% of clinical staff and 41% of support staff had left their original posting in primary care or moved to another healthcare system. The extra flexibility and efficiency afforded by telehealth services can help facilities hold on to their experienced staff.

Concrete Steps to Prevent and Reduce Physician Burnout

Here are some practical tips for preventing and reducing physician burnout:

• Change your schedule: Not that it always works, but sometimes just a schedule change can give you the shift in job satisfaction you need to break out of your burnout. Whether it’s the timing of the shift or the number of hours you’re working, try changing it up, if you can, and seeing what that may do to help.
  

• Impose limits: If you can delegate certain tasks to others, it may sometimes be useful. If you can’t, then set limits on how much you can do in a set amount of time. Make realistic expectations for yourself so you can meet them with excellence, and ask for assistance when you need it, which may include restructuring workload distribution among colleagues.
  

• Make time to exercise: Just 30 minutes each day can improve mood and sleep and help you maintain a healthy weight.
  

• Read non-medical material: You may like reading medical news, but even just 10 minutes of reading an article on an entirely different topic or a short story or chapter in a novel can help clear your mind and emotions and remove your focus from occupational stressors.
  

• Spend some quality time with your family: The longer the hours you work, in fact, the more important it is to make sure to give your family some of your best energy and not what’s left at the end of a long shift.
  

• Take a class: Continuing education helps keep your mind sharp and focused, and the process of learning can be immensely enriching. Alternatively, join a book club or take a public speaking class.
  

• Take on a hobby: Pursue an interest in something completely outside your work field, and you may discover you find more satisfaction in your job when you do work.
  

• Join a support group or meet with a mentor: Safe and confidential conversation with peers can help relieve stress and provide you with a new chance to review ways others like you have combated their burnout.
  

• Participate in task forces and committees: Joining groups at your workplace that allow you to influence the culture and policies there in ways that promote beneficial change for everyone in the environment.

Conclusion

Physician burnout is a very real and significant problem that can threaten the efficacy of an entire community's medical system if not adequately addressed.

Fortunately, many proven ways exist to both alleviate the pressures that cause physicians to experience burnout and improve their satisfaction with their practice. While incorporating EHR in practice or system may have mixed effects on these two factors, other organizational efforts could have a pronounced positive impact on them, including those that promote teamwork, better time management and work-life balance, and targeted adjustments to the workplace's workflow.

There are also many steps an individual physician can take to proactively reduce his or her own likelihood of burnout, including those that fuel the individual's physical, emotional, and spiritual energy accounts. By properly addressing and ameliorating burnout, physicians, practices, and hospital systems alike can ensure their abilities to give patients the absolute best medical care they can.