In a 2019 opinion piece for the New York Times, Dr. Danielle Ofri of Bellevue Hospital in New York, argues that “corporate healthcare” regularly takes advantage of the ethical commitment physicians and other healthcare providers feel toward their patients. When 15 minutes isn’t enough time for a sick patient, they extend the consult, ultimately extending their workday. Rather than leave patients without care, physicians work overtime when there is no coverage. They spend their time “off” dealing with insurance companies, updating charts from home, or answering emails, all in an effort to fulfill the desire that sent them to medical school in the first place – to help patients.
To quote Dr. Ofri, “This ethic holds the entire enterprise together. If doctors and nurses clocked out when their paid hours were finished, the effect on patients would be calamitous. Doctors and nurses know this, which is why they don’t shirk. The system knows it, too, and takes advantage.”
Of course, what Dr. Ofri describes as “exploitation” is not at all the intent of healthcare organizations. As the business of treating patients grows more and more complicated, healthcare systems increasingly struggle to find cost-effective ways to deliver quality care. As a result, the well-being of physicians and other staff is sacrificed, and physician burnout grows.
Increasing Levels of Burnout
No doubt, many physicians are overworked, a problem only magnified by the COVID-19 pandemic. A pre-COVID study cited in a 2020 JAMA article, found 44% of physicians experienced signs of burnout on a weekly basis. More recent studies indicate this number is increasing. A Medscape study published in September of 2020 reported 65% of US physicians experienced increased burnout as a result of the pandemic. An October 2020 survey of emergency physicians found 72% felt more burnout due to COVID-19.
Physician burnout is concerning for a number of reasons. According to the American Medical Association, physician burnout can have a significant impact on organizational productivity, morale, costs, and the quality of care being delivered. Physicians experiencing burnout are also more likely to retire early or leave their jobs.
In Q4 of 2020, Jackson Physician Search conducted a survey of physicians and administrators to understand their current views on physician retention and gauge how organizations are addressing the problem of physician burnout. The findings, reported in the White Paper: On the Verge of a Physician Turnover Epidemic, suggest the usual methods may not be doing enough to manage the problem.
Why Administrators Cannot Ignore Burnout
While the well-being of physicians is obviously important, healthcare administrators may not see their own actions as directly related to the problem, so they may focus attention on issues they see as more manageable. However, the impact of physician burnout can be felt throughout the organization in ways that may not be obviously related. When administrators acknowledge the far-reaching impact, they will understand that they can’t afford to ignore the problem.
Perhaps most alarming, multiple studies link physician burnout to increased medical errors. A 2018 study led by researchers at Stanford University School of Medicine found physicians with burnout had more than twice the odds of having made a major medical error in the previous three months. While the exact rate of impact varies depending on specialty and other factors, multiple studies show an association between increased physician burnout, decreased quality of care, and reduced patient satisfaction.
Studies also show that physicians experiencing burnout are more likely to leave their jobs. In a 2020 study by Medical Economics, 73% of physicians confirmed burnout had caused them to consider leaving their jobs. Administrators are all too familiar with the high cost of physician turnover at their organizations, and thus, most organizations have programs in place that attempt to address physician burnout in some capacity. However, are these programs effective?
How to Support Physicians Experiencing Burnout
The aforementioned Jackson Physician Search study asked both administrators and physicians about the types of programs used to address physician burnout at their organizations. Wellness programs were the most common answer given by both physicians and administrators, followed closely by mental health programs. Paid leave, professional coaching, and physician hotlines were other methods reported. Interestingly, administrators mentioned paid leave and professional coaching twice as often as physicians, suggesting physicians don’t see these benefits as methods for combating burnout. Physicians were twice as likely as administrators to mention the “physician hotline” as a way of addressing physician burnout.
The Jackson Physician Search white paper notes that the survey’s write-in comments reflected an overall sentiment that programs designed to combat burnout are lacking. Perhaps it is because they focus primarily on helping physicians deal with the stress, rather than striving to alleviate the stress itself. The problem is put on the physician to correct, suggesting the issue lies in the individual’s response to his or her circumstances. If the physician can only be tougher, or more resilient, they won’t suffer from feelings of burnout.
While it has been documented that resilience has an inverse relationship with burnout, that same study found that physicians already have higher levels of resilience than the general population. The conclusion was that increasing resilience is not the most effective means of managing the problem of burnout.
If one agrees with Dr. Ofri’s thesis that physicians experience burnout when they are overworked, it’s not surprising that wellness efforts and mental health programs would do little to address the issue if workloads are not also adjusted. A study in Behavioral Science concluded decreasing the administrative burden on physicians would go a long way toward lowering the levels of physician burnout. Other studies suggest factors such as payment reform, the improvement of electronic medical records, and even increased professionalism would improve the situation significantly.
There is certainly no simple, one-size-fits-all solution for physician burnout. Programs focused on helping the individual handle his or her circumstances are useful attempts to contain the problem, however, each organization should also consider the system-level practices that may be contributing, and where possible, take steps to improve the circumstances. These changes will not only benefit physicians, but organizations will see reduced medical errors, higher levels of patient safety, and lower recruiting costs.
If your organization concludes an increase in headcount is needed to reduce workload and combat physician burnout, the recruitment team at Jackson Physician Search is eager to help. Contact us today to learn more.