The Leading Cause of Physician Burnout

The Leading Cause of Physician Burnout, What You Can

Your patients and colleagues may think that you’ve got it altogether—at least most of the time—but down deep you suspect that something is wrong. Consider this checklist to see if any of these feelings apply to you:

  • A sense of lack of accomplishment
  • Cynicism
  • Lack of enthusiasm for your work 

  • Sound familiar? These are common symptoms of physician burnout. If you or a colleague are exhibiting these symptoms on a regular basis, you could be suffering from this all-too-common condition.

    In an August 2018 commentary in the American Journal of Medicine, Kenneth A. Ballou, MD, and Andrew G. Alexander, MD, described these three symptoms of physician burnout. They also pointed out that burnout is more than just a problem with a physician’s work–life balance; it can threaten a doctor’s health and medical career.

    “[Doctors who feel this way] are not alone,” said Ballou. “Those feelings are not just feelings that they feel or that their friends feel. This is almost universal. Everybody is kind of fed up with this system, and it seems to be only getting worse, not better.”

    In some cases, physician burnout could even be life threatening. The suicide rate among physicians is more than double the rate among the general population, according to research presented at the 2018 American Psychiatric Association’s annual meeting in May.

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    From burnout to recovery

    The Agency for Healthcare Quality and Research describes burnout asa long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.”

    This description rings true to family medicine physician Clark Gaither, MD. Gaither remembers how he felt when he developed physician burnout. He knew something was wrong, but he wasn’t sure exactly what. But he knew it was getting worse.

    “I wasn’t enjoying what I was doing anymore. It felt like drudgery,” he recalled. “I dreaded going to work on Monday, and I looked forward to the weekends. But I couldn’t even enjoy the weekends because I dreaded going back to work on Monday again.”

    Gaither eventually walked into his partner’s office and said, “If something doesn’t change, I am going to have to leave medicine.”

    All the demands that come along with the business of medicine, including the time pressures, had worn him down. So Gaither made some changes.

    He cut down his hours to try to achieve a better work–life balance. He also began blogging and speaking about physician burnout, and authored a book on the subject titled Reignite, which was released in March 2018. He now serves as the medical director of the North Carolina Physicians Health Program (NCPHP), which works to support the well-being and recovery of medical professionals, and consults with organizations on how to avoid job-related burnout among their staff. 

    The No. 1 factor in physician dissatisfaction and burnout 

    Based on a review of several studies on physician burnout, Ballou and Alexander’s article discussed potential contributing factors, including many “major transformational medical practice events that occurred between 2011 and 2014,” leading to the development of burnout in physicians.

    The electronic health record (EHR) quickly rose to the top of their list.

    “I think that’s something that’s going to resonate with a lot of physicians,” said Ballou.

    Many physicians report spending hours working on their charts on their own time, which upends their work–life balance. “This really eats away at their precious downtime, when they should be with their families or doing things that make them happy,” said Ballou.

    They also worry that the documentation requirements affect the doctor–patient relationship, distracting them from their patients. In fact, the 2016 Survey of America's Physicians, conducted by Merritt Hawkins on behalf of The Physician’s Foundation, found that only 11 percent of physicians reported that EHRs have improved patient interaction, compared with 60 percent who said they’ve done the opposite.

    The current design and utilization of the EHR could be the culprit.

    Many practices and organizations have invested large amounts of money and time in their EHR technology and implementation, since they’re essentially required for quality reporting and billing, noted Russell Libby, MD, a board member of the Physicians Foundation and president of the Virginia Pediatric Group.

    The EHR was more or less created to be an efficient billing tool—not so much an efficient patient care tool. Perhaps it’s time to change that. Some experts believe that pressure from physician groups could result in the design of a new type of EHR that would work better for physicians.

    “That will be an incredible tipping point,” said Libby.

    Showing signs of burnout? Diagnosis and treatment

    Do you wonder if you’re suffering from job-related burnout, or are in danger of doing so? Gaither suggested doing some self-education on the topic, including checking out burnout assessment tools like the Maslach Burnout Inventory.

    If you’re showing signs, it may be helpful to pull back and take stock of your situation.

    “Acknowledge that you have a problem,” said family practice physician Marjorie Binette, MD, founder and editor of the health and wellness blog Sisters in Health. “That’s important. Some physicians may feel that they have failed in some way and then they don’t express their concerns. That leads to a bigger problem.”

    After acknowledgment, you can explore ways to address your situation. Find ways to optimize workflow at the office, if that seems to be a contributing factor. Look for ways to carve out time to do the things that bring you satisfaction. Binette also suggested talking to your peers about how they keep their personal and professional lives in balance.

    “Let’s take care of ourselves so we can take care of our patients better,” Gaither said.

    If electronic medical record use is a problem for you, Ballou and Alexander’s commentary suggests a few ways to address that particular problem.

    “Make your note meaningful, and never make your EHR more important than your patient,” they wrote. “Demand more productive voice recognitions-linked diagnostic EHRs in the future. Lobby to rid medicine of bullet-point-based reimbursement. For the sake of our profession, get out of the current EHR rut, and enjoy the balance of the rest of your life as a doctor.”

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