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January 17, 2019

Physician burnout has reached 'critical levels,' experts say. Here are 3 ways health systems can fight back.

Daily Briefing

    A leading group of health care experts has declared physician burnout a "public health crisis," citing its impact on physician well-being and the U.S. health care system as a whole. In the paper, published Thursday, researchers offer three ways that organizations and policymakers can use to reduce the problem. 

    The 5 biggest risk factors for physician burnout, according to our 13,371-physician survey

    About the paper

    The paper was published by researchers from:

    • Harvard T.H. Chan School of Public Health;
    • The Harvard Global Health Institute;
    • The Massachusetts Health and Hospital Association (MHA); and
    • The Massachusetts Medical Society.

    For the paper, researchers looked at scholarly and policy literature on physician burnout and the results of a survey taken by Massachusetts physicians in different phases of their careers.

    Burnout at 'critical levels'

    The researchers write that professional burnout "has reached critical levels" among physicians in the United States—and it's only getting worse.

    For instance, they cite the 2018 Survey of America's Physicians Practice Patterns and Perspectives by Merritt-Hawkins, which found the vast majority of physicians experience burnout at least some of the time. Specifically, 78% of physicians reported experiencing burnout in the 2018 survey—a 4% increase from those who reported experiencing burnout in the 2016 survey.

    According to the researchers, burnout is becoming more prevalent because "[t]oo many physicians find that the day-to-day demands of their profession are at odds with their professional commitment to healing and providing care." This conflict leads to "moral injury," the researchers write.

    The effects of physician burnout

    While burnout directly affects physicians, it indirectly, affects the quality and operational efficiency of the health care system.

    For instance, the researchers found that burnout can lead to a 1% reduction in physicians' work effort. And that estimate does not include physicians who retire early or exit the profession due to burnout.

    The reduction in the workforce has implications for the industry's ability to keep up with demand. The authors note that HHS predicts that physician burnout will result in a shortage of almost 90,000 physicians by 2025.

    Study co-author Alain Chaoui, president of the Massachusetts Medical Society and a practicing physician, said, "The issue of burnout is something we take incredibly seriously because physician wellbeing is linked to providing quality care and favorable outcomes for our patients." He added, "We need our health care institutions to recognize burnout at the highest level, and to take active steps to survey physicians for burnout and then identify and implement solutions."

    In fact, some health care leaders have called for revising the "Triple Aim" of patient experience, population health, and cost reduction to a "Quadruple Aim" that accounts for provider well-being.

    What institutions can do

    After identifying the sources of physician burnout, the researchers offer short-, medium-, and long-term recommendations health care leaders can take to reduce physician burnout.

    In the short term, the authors write health care institutions should support proactive mental health care treatment and provide support for physicians experiencing burnout.

    "Physicians face stigma and professional obstacles to seeking appropriate care and treatment for burnout and related mental health concerns," the authors write. "Physician institutions—including physician associations, hospitals, and licensing bodies—should take deliberate steps to facilitate appropriate treatment and support without stigma or unnecessary constraints on physicians' ability to practice."

    As a medium-term solution, the researchers recommend that institutions improve the usability of EHRs.

    "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," which contributes to burnout, according to co-author Ashish Jha, a physician for the Veterans Administration and professor at Harvard Medical School.

    The proposed changes to EHRs include reforming the federal government's certification standards, improved interoperability, and a commitment to reduce the burden of documentation on physicians.

    Finally, to decrease the impact and prevalence of burnout in the long-term, institutions should appoint chief wellness officers to study and assess the incidence and effects of physician burnout in order to develop and implement high-level interventions to reduce burnout, the authors write.

    Returning the 'joy' to practicing medicine

    While the report does not offer an "exhaustive list of solutions," the researchers say that their "recommendations ... represent concrete opportunities to stem the tide of the crisis both in the short and medium terms while setting the stage for long-term improvement in both physicians' 'joy in work' and health care more broadly."

    According to Steven Defossez, VP for Clinical Integration for MHA, without making changes to the system to accommodate physicians' emotional and moral conflicts, there is "no way to achieve the goal of improving health care," in the long-term (Harvard T.H. Chan Press release, 1/17; Jha et al., "A crisis in health care: A call to action on physician burnout," 1/17; Massachusetts Medical Society release, 1/17).

    Learn more: How to combat physician burnout

    More than half of physicians feel “burned out” due to the never-ending list of mandates and unrelenting pace of change in today’s health care world. With physician burnout reaching epidemic levels, it has also become a top priority for health care executives because of its very real effects on patient experience, quality, and cost.

    This research briefing includes five insights to help organizations better understand physician burnout and to mitigate further detriment to their physicians, patients, and business.

    Get the Report

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