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Janae Sharp talks to four experts about which steps healthcare leaders can take to fight physician burnout.
Healthcare executives must learn how to prevent physician burnout and fight its effects.
What gets measured gets attention. Coverage of physician burnout is bringing awareness of increasing rates of physician suicide and the systemic issues that contribute to this problem. Physicians are unhappy with their loss of autonomy, billing complexity and electronic health record (EHR) burdens that interfere with their day-to-day work with patients. Programs focused only on developing mindfulness or resilience have been criticized by activists, as have solutions that implicitly blame physicians for mental health repercussions inherent to a job with lack of sleep and structural inequality. Increasing regulatory burden has been targeted as causing more clicks in EHRs that do not match the work needs of physicians or patients. Other programs focus on yoga or wellness, adding another tick on the growing physician to-do list.
But what steps, if any, can healthcare leaders take to heal the healers? I spoke to several experts on physician burnout and asked them just that: What do we need to do to solve this nationwide problem? (Editor’s note: Their responses have been lightly edited for style and clarity.)
Annahieta Kalantari is a board-certified emergency medicine physician practicing in Hershey, Pennsylvania. She is the associate program director of the Emergency Medicine Residency Program and an assistant clinical professor of emergency medicine with Penn State Health. I asked her about what healthcare leadership needs to do to ensure that fault isn’t placed on an individual physician, and how we can use technology as an asset rather than a source of physician burnout.
I think the first and foremost positive solution is to have members of the C-suite not only accept there is a problem, but also provide funding to implement solutions that are beneficial to all members of that organization. That takes money. When you think about the costs of replacing someone who left as secondary to the issue of burnout, investing money in wellness actually makes sense, since burnout is a big driver of attrition rates.
Another solution may be to move away from the productivity, workaholic culture. The system places pressures on us to produce. We need to move quickly. In the emergency department (ED), all of our times — our physician-to-patient times, physician-to-order times, ED length of stays, disposition times, — are all monitored. And for some groups, quickness is incentivized. This is a productivity model. We don't have time to sit and talk to our patients, to bond with them, to provide emotional support because we are too busy running from room to room. Shifting away from this incentive model and moving toward one that allows the humanity aspect of medicine to flourish would be beneficial, not only to patients, but to physicians themselves.
Additionally, the general culture of medicine does not support wellness. Think about it: Calling out of work when we are sick or needing to care for family is generally considered a sign of weakness or lack of consideration for our colleagues because they have to come in and cover for us. Our needing help is considered selfish. Our licensing process requires us to disclose whether we have experienced any depression, substance issues, etc. If we say yes, that leads to a cascade of events that can prevent a physician from obtaining a license. We are healers, but we are not permitted to require healing.
There are a lot of aspects of medicine that contribute to rates of burnout not only among physicians, but also among trainees, nurses and other members of hospital staff. Some drivers are small and individualized, but making changes at the systemic level will have the biggest downstream effects on the greatest numbers of people.
Suvas Vajracharya is CEO of Lightning Bolt Solutions, a company that works to optimize physician scheduling and workflow with artificial intelligence (AI) and other technologies. I asked him which real-life solutions contribute to solving the physician burnout problem for healthcare systems.
Do your physicians love coming to work? It's a simple question, but one that many healthcare organizations don't ask themselves. Physician satisfaction isn't just a "nice-to-have" — it is crucial to your bottom line. Happier doctors collaborate; they adapt to change more easily; they have lower rates of turnover; they have more satisfied patients. In short, happier doctors produce better outcomes.
Organizational change to create better working conditions can be hard, but there are technologies ready to help. Giving physicians more flexible and balanced schedules doesn't necessarily mean an increase in cost or a reduction in patient access. AI technologies can crunch the numbers to find schedules that meet everyone's needs in an organization, and they can adapt in real-time as needed. It's a first step.
Lakshman Swamy speaks on the systemic failures that lead to physician burnout. He specialized in pulmonary critical care in the intensive care unit and is now a fellow at Boston Medical Center, with his academic work focusing on burnout. He is passionate about improving the quality and experience of care delivery. He has served as a co-chair of the Institute for Healthcare Improvement National Forum and, more recently, on the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review evaluation committee. He talks about how often regulations change and physicians need to adjust their workflow to match what an insurance company will accept.
We can approach the problems around clinician wellness, including burnout, at several levels.
First, it’s important not to neglect the regulatory changes to the way we pay for and provide access to healthcare and larger strategies regarding social determinants of health. That aside, local change is not only possible, it is critical. At the organizational level, leadership can empower clinicians, for example, by providing experts to conduct improvement efforts based on front-line clinician guidance. Leadership should proactively seek out drivers of workplace stress — some of which may vary by unit or service, while others may be institution-wide. What is your institution doing to ensure psychological safety for every member of every care team? What is it doing to root out harassment or gender and racial inequity? Is it seeking out and providing support for the mental health of its clinicians?
Senior leadership often seems blissfully unaware of the conditions clinicians work in; providing a voice to all clinicians is essential. One important way to do this is to administer a validated survey to assess institution-wide well-being. Focus on at-risk units and chart trends over time. The patient’s EHR also cannot be neglected; many clinicians feel they don’t have a voice in improvement of the EHR experience.
Clinician well-being is a shared responsibility between the institution and the clinician; we must take care to avoid victim-blaming, but there are important items the clinician can own. In my experience, prioritizing and optimizing sleep is high on that list. Clinicians have a responsibility for workplace improvement as well; when given a voice, it must be used to highlight what may seem apparent at the front line but is unappreciated at middle-management and leadership levels. Our healthcare delivery systems are incredibly complicated, and improvement isn’t possible without the close collaboration between front-line clinicians and leadership, with all of us advocating for the care this country needs and deserves at the state and federal level.
Arlene Sujin Chung is the residency director for Maimonides Medical Center. I asked her about the problem of burnout in residency systems. She is the chair of the American College of Emergency Physicians’ Physician Well-Being Committee. I asked her what a residency program should do to ensure that physicians don’t see burnout as a personal failure.
The prevalence of data from Dr. Tait Shanafelt and his colleagues shows us that 50 percent of physicians in the U.S. report symptoms consistent with burnout. But research also tells us that medical students are more resilient than their age-matched peers at the beginning of their medical training. It’s not as though medical schools are recruiting individuals who are predisposed to burnout, so there has to be some other explanation for the 50 percent burnout rate that we see in practicing physicians.
The practice of medicine is very different than it was 50 years ago. In many ways, technology has made things safer, but, ironically, it has also made many things more time-consuming. Physicians spend 41 minutes out of every hour documenting in front of a computer screen instead of building face-to-face rapport with their patients. Increased clerical burden has been shown over and over again to be associated with increased burnout, probably because it reduces the time for the sense of satisfaction and fulfillment that most physicians derive from interaction with patients.
There are certainly improvements that we know can improve physician well-being. Interventions such as optimizing EHR systems, providing scribes, ensuring adequate staffing ratios for patient volumes, hiring administrative assistants and providing efficient communication systems between hospital services all have a huge impact on the individual providers. Each of these interventions allows for more time at the bedside — more time doing the real and true meaningful work of caring for patients. No one went into medicine to sit in front of a computer all day. We went into medicine to make a difference in the lives of the patients who need us.
Physician burnout has made the jump from a widely known but little-discussed taboo to a problem that healthcare admins are eager to address. The next step is moving from quantifying the problem to developing wide-ranging solutions, leveraging both positive design changes and technology that center around physician needs, to improve the practice of medicine for everyone involved. Finding balance and solutions will happen with better workforce management.
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