Professional satisfaction

6 ways to reduce doctor burnout at the systemic level

New National Academy of Medicine report urges health care organizations, educators and entities to address clinician burnout.

Mounting pressures in the health care system—including long hours, burdensome documentation requirements and insufficient workplace resources—have contributed to today’s sky-high rates of clinician burnout, notes a brand-new National Academy of Medicine report that urges health care organizations, health care educators and other health care entities to address clinician burnout at the systemic level.

At least a third, and up to half, of all clinicians are experiencing burnout, and advising individuals to use stress management techniques will not sufficiently address the problem, notes the report, which urges health care employers to approach burnout from a systemic, rather than an individual, standpoint.

“Humanism and professionalism are two major motivating factors for most clinicians, and many aspects of the modern work environment conflict with these fundamental ethical norms,” wrote Christine Cassel, MD, and Pascale Carayon, PhD, in the report’s preface. “… Work system transformation with meaningful, effective involvement of clinicians is necessary at multiple levels to tackle the critical problem of burnout.”

The report’s messages provide a long-overdue but encouraging sign that the health care profession may be ready to move beyond awareness and start taking meaningful action to combat clinician burnout, says Tiffany Lowe-Payne, DO, a family physician who has given talks about burnout, most recently at OMED 2019.

“There are things physicians can do on their own to fight burnout, but it can’t stop with them,” she says. “They need support from legislators and their employers. My hope is that institutions will take this report seriously and develop strategies and plans to prevent and decrease burnout.”

These are the 6 things the health care system needs to do to prevent and alleviate clinician burnout, according to the report:

1. Create positive work environments.

A health care work environment should prioritize the following:
-High-quality care
-Job satisfaction, and
-Social support.

Health care organizations should have an executive leader devoted to clinician well-being. They should consider how organizational changes and the adoption of new technologies will impact levels of clinician burnout. They should also measure clinician burnout using validated tools and report the results at least annually.

“The recommendation to have a dedicated staff member focused on wellness is one of the most important ones in the report,” says Dr. Lowe-Payne. “That will show clinicians that reducing burnout is truly a priority for the employer and hopefully encourage them to seek help when they need it.”

2. Address burnout in training and at the early career stage.

Medical schools should do the following:
-Use a pass/fail grading system
-Monitor students’ workloads more closely, including time spent on required training activities
-Make scholarships and affordable loans more widely available
-Create new loan repayment systems.

3. Reduce tasks that do not improve patient care.

Standard-setting entities, including federal agencies and state governments, should identify regulations and policies that are contributing to clinician burnout and get rid of any that aren’t improving patient care.

4. Improve usability and relevance of health IT.

To reduce burnout, EHRs must be as user-friendly and intuitive as possible. Health IT vendors and health care employers should use technology to reduce documentation demands and automate tasks whenever possible. Lawmakers and health IT companies should work together to develop technologies that facilitate shared decision-making between clinicians and patients.

5. Reduce stigma and improve burnout recovery services.

Lawmakers at the state level should ensure clinicians have access to employee assistance programs, peer support programs, and mental health providers—and they should make sure the details of a clinician’s use of such services are not admissible in malpractice litigation.

Applications for medical licensure or renewal should focus only on current impairment, not on the past diagnosis of a mental health condition.

“It’s critical that the profession provide resources to support clinician mental health,” says Dr. Lowe-Payne. “Organizations also need to make sure physicians know about these programs and feel comfortable using them. There’s a sense in our profession that if you seek help, you are weak. But as we continue to talk about this, we can help to change the tide and pave the way for future physicians to feel more supported.”

6. Create a national research agenda on clinician well-being.

By the end of 2020, federal agencies should have a coordinated research agenda for clinician burnout, which should include the following research priorities:
-The causes of burnout for clinicians at different points in their lives and careers
-The impact of burnout on the clinician workforce and patient safety outcomes
-Potential systems-level changes to improve clinician well-being.

Related reading:

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

Doctor burnout costs the US $4.6 billion annually, study finds

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