July 24, 2023

Physician burnout: a system disorder

As physicians we are trained to take responsibility: for our patients; for maintaining and improving our skills and knowledge; for our teams, colleagues, and organizations. We are notoriously poor at taking responsibility for our own health and well being – hence our high rates of burnout, mental illness, addictive disorders, and suicide.

Physician burnout is not solely the result of individual physician characteristics, but is significantly influenced by systemic factors within the healthcare industrial complex.

In this blog, we will delve into the concept that physician burnout is more accurately described as an administrative disorder rather than a physician disorder, emphasizing the organizational and systemic factors that contribute to burnout in doctors.

Understanding Physician Burnout

Physician burnout is characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. It can lead to decreased job satisfaction, reduced quality of patient care, and even early retirement among physicians (Maslach et al., 2001) [1].

While individual factors such as coping skills and resilience can play a role, it is essential to recognize the significant impact of administrative and systemic factors in driving burnout among physicians.

Physician burnout is not solely the result of individual physician characteristics, but is significantly influenced by systemic factors within the healthcare industrial complex.

Admin burden and physicain burnout

Electronic health records (EHRs), insurance claims, defensive medicine, and profit-over-patient priorities are all common complaints from doctors seeking our support.

1. Excessive Administrative Burdens

Physicians face an increasing administrative workload, including documentation requirements, regulatory compliance, and electronic health record (EHR) demands. The administrative burden goes well beyond just EHRs. Credentialing, Continuing Medical Education/Professional Development (CME/CPD), Maintaining Certification (MoC), and so many other administrative tasks are huge consumers of scarce physician time. Many studies have shown that physicians spend more time on administrative tasks than on direct patient care, leading to increased stress, decreased job satisfaction, and heightened burnout levels (Sinsky et al., 2016) [2].

2. Workload and Time Pressure

Physicians often experience heavy workloads, long working hours, and high patient volumes, leading to chronic stress and exhaustion. The relentless demands placed on physicians, including excessive patient caseloads and limited time for breaks or self-care, contribute to burnout (West et al., 2016) [3].

3. Lack of Autonomy and Control

When physicians feel a lack of control and autonomy over their work environment, it can contribute to burnout. Excessive bureaucracy, micromanagement, and limited decision-making authority can erode job satisfaction and increase emotional exhaustion (Shanafelt et al., 2017) [4].

4. Inadequate Resources and Support

Insufficient resources, including staffing shortages and limited access to support services, can strain physicians and hinder their ability to deliver quality care. The lack of support in managing the increasing complexity of healthcare further exacerbates burnout (Dyrbye et al., 2017) [5].

Lack of resources can force physicians into impossible choices and lead to moral injury and worse, as we have previously explored.

Moral injury can be as mild as the feeling of unease stemming from situations where institutionally required behavior does not align with the clinician’s moral principles. Or it can cause serious psychological trauma.

5. Disconnect between Values and Practice

When physicians perceive a disconnect between their professional values and the reality of their work environment, it can lead to moral distress and emotional exhaustion.

Misaligned priorities, financial pressures, and conflicts between patient-centered care and administrative demands contribute to burnout (Dzau et al., 2018) [6].

Tackling Administration for physician wellbeing?

To combat physician burnout effectively, it is crucial to focus on addressing the administrative factors that contribute to the problem. Here are some strategies that healthcare organizations and policymakers can adopt:

1. Streamline Administrative Tasks

Simplifying documentation requirements, improving EHR usability, and reducing bureaucratic inefficiencies can alleviate administrative burdens, allowing physicians to spend more time on patient care and reduce burnout (Shanafelt et al., 2017) [4].

2. Enhance Work-Life Integration

Implementing flexible scheduling options, promoting work-life balance, and encouraging self-care can help physicians manage their workload and reduce burnout. Supporting physicians in achieving a healthy integration of personal and professional life is crucial (West et al., 2018) [7].

3. Foster Supportive Organizational Culture

Promoting a culture of open communication, mutual support, and teamwork can help physicians feel valued, heard, and empowered. Providing resources such as peer support programs, counseling services, and wellness initiatives can further support physician well-being (Dyrbye et al., 2017) [5].

4. Advocate for Systemic Change

Healthcare leaders and policymakers should advocate for systemic changes that address the root causes of physician burnout, such as regulatory reform, fair reimbursement models, and better resource allocation. Collaborative efforts are needed to ensure a sustainable and supportive healthcare system (Dzau et al., 2018) [6].

Conclusions

Physician burnout is a complex issue with far-reaching implications for healthcare professionals and patient care. Recognizing that it is primarily an administrative disorder, influenced by systemic factors within the healthcare system, is crucial.

By addressing excessive administrative burdens, providing adequate resources and support, fostering autonomy and control, and aligning values with practice, healthcare organizations and policymakers can mitigate physician burnout.

Creating a work environment that values physician well-being and supports their professional fulfillment will ultimately lead to improved patient outcomes and a more sustainable healthcare system.

References
1. Maslach, C., Schaufeli, W. B., & Leiter, M. P. (2001). Job burnout. Annual Review of Psychology, 52, 397-422.
2. Sinsky, C., Colligan, L., Li, L., Prgomet, M., Reynolds, S., Goeders, L., … & Murphy, D. (2016). Allocation of physician time in ambulatory practice: A time and motion study in 4 specialties. Annals of Internal Medicine, 165(11), 753-760.
3. West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2016). Physician burnout: Contributors, consequences, and solutions. Journal of Internal Medicine, 283(6), 516-529.
4. Shanafelt, T. D., Noseworthy, J. H. (2017). Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings, 92(1), 129-146.
5. Dyrbye, L. N., West, C. P., Sinsky, C. A., Goeders, L. E., Satele, D. V., Shanafelt, T. D. (2017). Medical licensure questions and physician reluctance to seek care for mental health conditions. Mayo Clinic Proceedings, 92(10), 1486-1493.
6. Dzau, V. J., Kirch, D., & Nasca, T. (2018). To care is human—collectively confronting the clinician-burnout crisis. New England Journal of Medicine, 378(4), 312-314.
7. West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician well-being and professionalism. The Journal of the American Medical Association, 319(15), 1543-1544.

Dr Corrigan

A recovering physician who left medicine after burning out and more. Overachiever. Impostor syndrome. Addict. Had never heard of Corrigan's Secret Door* until it was too late. Co-founded Physicians Anonymous with intention to solve physician burnout, mental illness, and addiction. Hopes to prevent future medical career disasters through peer support, advocacy, policy change, and innovation. * https://physiciansanonymous.org/corrigans-secret-door-and-other-stories/

Physicians Anonymous