Systemic struggles

With nearly half of doctors burned out, US is in a public health crisis, reports find

Medscape and the Harvard T.H. Chan School of Public Health reveal details about the current state of doctor burnout and offer solutions.

Forty-four percent of doctors say they’re burned out, a slight increase from last year, according to Medscape’s 2019 report on doctor burnout and depression, which was published last week and comprises the responses of more than 15,000 physicians across more than 29 specialties.

Physician burnout is a public health crisis that is threatening the health and well-being of U.S. patients, according to a paper from the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and the Massachusetts Health and Hospital Association, which was also released last week.

‘Poorly designed digital health records’

“The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” said Ashish K. Jha, MD, MPH, an author of the paper, in a statement. “There is simply no way to achieve the goal of improving health care while those on the front lines–our physicians–are experiencing an epidemic of burnout due to the conflicting demands of their work.”

5 things to know from the reports:

1. Solutions need to be systemic. Measures designed to increase individual physician wellness, such as yoga classes and mindfulness, will not solve the root cause of doctor burnout, notes the Harvard/Massachusetts report, which says change needs to occur across health systems. Here are the report’s top three recommendations for alleviating physician burnout:

  • Institutions should facilitate mental health treatment for physicians without stigma or unneeded constraints on doctors’ ability to practice.
  • Every health system should appoint a chief wellness officer to explore and implement technological and staffing interventions to reduce the administrative burden doctors face. Interventions include scribes, EHR customization and workflow improvements.
  • EHR standards need to be improved, with a strong focus on usability and open APIs.

2. That being said, some physicians have taken matters into their own hands. Work-related steps many physicians have taken to alleviate burnout include reducing their work hours (31 percent), changing their work settings (24 percent), making workflow/staff changes to reduce their own workload (21 percent), and speaking up to institution leadership about productivity pressure (18 percent), according to the Medscape report.

3. Few physicians are seeking professional help for burnout. Just 13 percent of physicians are seeing a professional to deal with burnout or depression, according to Medscape, which also found that another 13 percent have sought professional help in the past, and over 60 percent have never gotten professional help and don’t intend to.

Licensure requirements can discourage physicians from seeking help; however, the Federation of State Medical Boards recently called for state licensing boards to reconsider probing questions about doctors’ mental health on applications, the Harvard/Massachusetts report noted.

Doctors in Florida are currently trying to remove extensive mental health history questions on the state board of medicine’s doctor license application.

4. The extent of doctor burnout varies by specialty. Urologists (54 percent), neurologists (53 percent) and physical med & rehab specialists (52 percent) are the most burned out, while preventive medicine specialists (28 percent), nephrologists (32 percent) and pathologists (33 percent) are the least burned out, according to Medscape’s report.

5. More female physicians report burnout than male physicians. Half of all women physicians report experiencing burnout, while less than 40 percent of male physicians do, the Medscape report found. A psychiatrist quoted in the report noted that women are more likely to admit to and seek help for psychological problems, which means they may be more likely to admit to being burned out.

Further reading:

5 facets of physician burnout

Doctor burnout: Two brand-new JAMA studies raise more concerns

7 comments

  1. I agree wholeheartedly with the problem and I don’t see a quick fix. EMR’s are frequently chosen by administration and corporate officers of hospitals and medical groups on the basis of usability for their own needs and not how well they facilitate the physician who actually has to use them. If cost and MIS approval dictate which program to use and the physicians themselves have little input then nothing will change. I have worked as an emergency room physician for well over35 years and as an instructor for several EMR’s. One other major factor in burnout prevention would be to shoot the developers of the Press Ganey scores and recognize the patients are not happy consumers of medical care. This type of evaluation might work well for restaurants but not in fact for physicians. We have been downgraded to healthcare providers the same way McDonald’s workers are french fry providers. Add to this the stigma of being responsible for the opioid crisis doesn’t help to elevate physician morale.

    1. While some EMRs are poorly implemented, a good EMR makes your life easier. I think EMRs take a lot of blame because their rise seems to have coincided with quality metrics and other aspects of turning documentation into things for billing and coding or legal purposes. Look at it this way: with all of the stuff that needs to go into a progress note today, would you really rather be jotting it all on paper? I certainly wouldn’t – with an EMR, I don’t think I’d ever get anything done.

      But I admit, sometimes I look at those notes from the really old-school physicians – the ones who write two or three sentences, if that’s all that it takes, and whose notes are devoid of all the autofill, copy-and-paste garbage, and I am jealous. I have no idea how they’re billing, but I’d bet they’re happy.

  2. Go totally independent and stay out of Medicare! I have done it and have a wonderful, no stress Osteopathic practice.

    It can be done.

  3. I am an emergency medicine physician and have been practicing for 20 years.
    Burnout is a real problem but, it is not just for doctors. Nurses, techs, clerical staff that works in this environment can be affected. Stress comes from not having control. At one point in history we, as physicians had control but lost it to profit and patient satisfaction. We now have PI departments and CEOs dictating medical care and result of this is the opiate crisis and still, care has not improved, just wait times and patient safety is worse. Maybe, we as physicians should stop being victims and stop talking about burnout and use the actual data and science we were trained with and become the doctors that patient need and trust instead of the push-overs they want!

  4. Instead of trying to mask the problem why not fix the problem. If the major issue is poorly designed EMRs then use user friendly EMR such as MEDENT. The cost of integrating would ultimately pay dividend with happier more productive providers.

  5. The administrative burdens that 3rd party payers place on us regarding documentation and reimbursement are contributing factors. That needs to be acknowledged.

  6. The roots of burnout has been due the past 20 year plus war on healthcare by the government and their paid for ideologically associated university based “research” supporting their agenda. They believe that physicians and hospitals have been ripping off the system making themselves rich at the expense of the rest of society. Hence a never ending stream of “research “ that shows what a disaster our healthcare system was and the desperate need for reform. This led to a never ending stream of poorly developed and hastily enacted regulations that would “solve “ our systems problems. But lo and behold the follow up “studies” show our healthcare system is still getting worse and needs more and more regulations. One tiny but impactful example is the 1999 Harvard IOM study that declared that 100,000 Americans were dying every year due to medical errors and only mandating EMRs could solve this problem. Then last year, Hopkins “researchers” concluded that 400,000 Americans are now dying every year due to medical errors. If you actually look at the methods used to reach these conclusions, you would be absolutely shocked. Problem is healthcare Leadership is asleep at the wheel or ideologically in agreement.

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