Physician Burnout: What Can be Done?

Physician burnout: everyone knows about the problem and many doctors have experienced it firsthand, but what can be done about it?

In this video, David Nash, MD, MBA, founding dean of the College of Population Health at Thomas Jefferson University in Philadelphia, discusses this ongoing problem, its consequences for doctors and their patients, and some possible solutions.

A transcript of his remarks follows:

So, what exactly is physician burnout? What's the differential diagnosis? And then we'll talk about some possible solutions. There are many dimensions of wellness, from the occupational, emotional, spiritual, intellectual, and social. Stressors in the clinical workplace that are known to contribute to burnout, according to the literature, are things like loss of control and flexibility, inefficient processes like over-reliance on the electronic medical record, poor work life integration, frustration with insurance-related issues, and of course, declining reimbursement for clinical care.

Burnout can lead to some untoward effects like lack of empathy, increase in medical errors, compromised quality of care, decreased safety, turnover in physician practices, more malpractice claims, and of course, increased risk for clinician-related substance abuse, troubled interpersonal relationships, and very sadly, high rates of suicide.

The dimensions of this problem, according to the experts, are staggering! More than half of all physicians report aspects of professional burnout. Nearly 1 in 5 doctors have reported that they intend to reduce clinical work hours in the new year, and roughly 1 in 50 have left medicine altogether, in the last two years alone, to pursue a different career. Family physician and primary care general internists, the gatekeepers of population health, those on the front lines, see nearly twice as many patients per hour, at approximately half the cost for service. Because of all of this stress, they are particularly prone to burnout.

So, what can we do about this seemingly intractable, gigantic, and important problem? Well, we can start by monitoring physician well-being with a big focus on prevention. We should promote, in the workplace, physician self-care; paying attention to sleep, exercise, nutrition, taking appropriate vacations, getting reconnected with the community. We should promote self-awareness and resilience activities with mindfulness training, narrative medicine, storytelling, and a better connection to the humanities. We should also conduct a proactive annual check-up, and give doctor's a sense of how we are doing, and give them feedback about their emotional status. We should also focus on treating clinicians, who need it, with appropriate counseling, and minimizing the stigma and barriers for those who are seeking help.

We should also focus carefully on the work environment, because a burned out clinical workforce may indicate that a system is prone to error and causing harm. We should look at models of health system science that make our daily work more efficient without burning out staff. We should support research that looks into promoting clinician well-being, and we should educate the leadership of health systems. After all, that's where most doctors work. We should educate the leaders about physician burnout to make sure that they support workplace wellness for clinicians at all levels.

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