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A panel of physicians said it’s not about building more resilience. Health organizations need to offer resources and reduce burdens that are taxing their physicians.
More doctors are experiencing burnout, and it’s becoming a matter of serious concern for healthcare leaders.
Physician burnout has reached a new high, according to a study published in Mayo Clinic Proceedings. Researchers reported that 63% of physicians had experienced burnout in 2021, compared with 38.2% in 2020. The American Medical Association teamed with researchers from Stanford University School of Medicine and the University of Colorado School of Medicine on the study.
Health Affairs hosted a virtual roundtable Thursday with several healthcare leaders. Alan Weil, Health Affairs editor-in-chief, asked the participants, all physicians, on addressing burnout.
Some of the members stressed one point early in the discussion. They focused more on the need to make structural changes, in organizations and health policy, than in strengthening doctors.
“The problem isn’t a deficit of resiliency in individual physicians,” said Christine Sinsky, the AMA’s vice president of professional satisfaction.
Policy makers are paying closer attention to the well-being of doctors and other healthcare workers. President Joe Biden signed a law this year directing grants to healthcare organizations to address burnout and mental health. Health groups pushed for the bill, dubbed the Lorna Breen Act, after an emergency physician died by suicide in April 2020, early in the COVID-19 pandemic.
An organizational challenge
It’s important to understand that burnout is different from mental illness, panelists agreed.
“Burnout is not a mental illness,” Sinsky said. “It’s an occupational distress syndrome.”
Physicians, including the panel members, have cited a host of factors contributing to burnout, including the stress of treating COVID-19 patients for more than two years. Growing staff shortages are adding to physicians’ burdens, particularly as health systems are now seeing patients who deferred care during the pandemic and are now quite sick.
However, some burdens are more familiar, including the stress of documentation and hassles with dealing with electronic medical record systems. Doctors are spending more of their time outside work dealing with documentation on patient records, panelists said.
Samuel T. Edwards, assistant professor of medicine at Oregon Healty & Science University and a doctor in the Veterans Affairs system in Portland, said, “Burnout is both a practice and an individual-level phenomenon.”
“Burnout is an organizational-level phenomenon that requires an organizational-level response,” Edwards said.
Many physicians don’t feel as if their employers are concerned about their well-being. Slightly more than one in three doctors (36%) said that their workplace culture places a priority on their well-being, according to a survey released earlier this month by the Physicians Foundation.
Healthcare organizations need to provide resources to their physicians to get help, but they must ensure doctors know what help is available, said Amy Frieman, chief wellness officer of Hackensack Meridian Health.
“It’s not only having the resources … it’s making sure physicians are aware of those resources, but even more importantly that they’re comfortable in accessing those resources,” Frieman said.
Many doctors are still concerned about seeking help for their mental health because they’re worried it could have harmful professional ramifications, including with their licensure. Nearly 4 in 10 said they were either afraid or knew someone wary of seeking help due to questions on licensure or insurance applications. At the behest of health advocates, some licensure boards have modified questions about mental health.
Panel members agreed that reducing the administrative burdens on physicians will go a long way toward helping their well-being. A Medscape survey of doctors in January 2022 found the bureaucratic aspects of healthcare emerged as the top factor contributing to burnout.
“Our physicians are just incredibly burdened and frustrated when it comes to documentation,” Frieman said.
Doctors are finding less fulfillment in their work, largely due to burnout, the AMA study found. Just over half of all doctors (57.5%) said they would choose a career as a physician if they could do it over again, compared to 72.2% in 2020.
Burdens on women, doctors of color
Women physicians are especially suffering from burnout, panel members agreed. More than two out three women physicians (68%) said they were experiencing burnout, compared to 58% of male doctors, according to the Physicians Foundation survey.
“We see high rates of women burned out and leaving the workforce,” said Vineet Arora, professor of medicine and dean for medical education at University of Chicago Medicine.
Women doctors have suffered bigger career setbacks from the COVID-19 pandemic, according to a study published in Jama Network Open. Women physicians were more likely to have work conflicts and symptoms of depression, while also handling more child care duties. Women were also more likely to reduce hours.
There’s a glaring lack of data on mental health and physicians of color, said Rachel Villanueva, clinical assistant professor of obstetrics and gynecology at NYU Grossman School of Medicine. She said that underscores the need “to diversify research and the need for researchers of color,” as well as the need to find more researchers who are at least interested in the challenges faced by doctors of color.
Black physicians and doctors in other underrepresented groups endure the same hassles of administrative duties and long hours. However, physicians who are members of minority groups also face “systemic racism,” as well as microaggressions and bias.
Doctors ‘deserve better’
Even as doctors are increasingly dealing with burnout, there’s not clear evidence that it’s hurting patient care, said Lawrence Casalino, professor of healthcare policy and research at Weill Cornell Medical College. Casalino was the lead author of a recent study in Health Affairs on how physician burnout affected patient outcomes.
“At least in the short run, patients of burned out physicians may get better quality,” Casalino said. “Conscientious physicians may work harder than other physicians and may worry more about their patients, and may be more susceptible to burnout.”
However, he added, “‘How much that can be sustained is another question.”
The Physicians Foundation has worked with the Lorna Breen Foundation to raise awareness about the need to protect the mental health of doctors. They’ve also created a campaign, “Vital Signs”, to prevent physician suicide.
Gary Price, president of the Physicians Foundation, said he is part of a sad fraternity. He is among the many physicians who have lost a colleague to suicide.
“It is undeniable our physicians need and deserve better,” Price said.
Help is available
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