A recent American Medical Association (AMA) webinar shared its latest research on physician burnout. The statistics are staggering, but not surprising.
The AMA’s study found that 62.8% of physicians reported at least one symptom of burnout at the peak of the Omicron variant in 2021, compared with 38.2% in 2020 and 43.9% in 2017. Even before the pandemic, more than 40% of America’s one million practicing physicians were burned out.
Even more concerning are the findings on physicians’ intentions to leave the field in the next one to three years. Thirty-seven percent of physicians surveyed in 2021 planned to leave, and about 30% of those will follow through. Research published in Mayo Clinic Proceedings in May 2023 found that 43% of physicians regret their career choice.
“This is the biggest increase of emotional exhaustion that I’ve ever seen, anywhere in the literature.” Bryan Sexton, Director of the Duke University Center for Healthcare Safety and Quality
The nature of healthcare today has changed the practice of medicine for many physicians. Today, the Quadruple Aim includes improving care team well-being, and the AMA has created a Recovery Plan for America’s Physicians to reduce burnout and enhance resilience.
What does physician burnout look like?
First published in 1981, the Maslach Burnout Inventory assesses three dimensions: emotional exhaustion, depersonalization from work, and a sense of personal accomplishment.
As a long-term stress reaction characterized by distancing oneself from feelings, burnout can reveal itself through cynical or negative attitudes toward patients, feeling emotionally drained or exhausted, experiencing a decreased personal sense of achievement or purpose, and a growing lack of empathy for patients.
In 2019, the World Health Organization categorized burnout as an occupational health syndrome in the International Disease Classification (ICD-11).
Without intervention, physician burnout has been linked to higher rates of alcohol abuse and suicidal ideation, increased medical errors, and worsening patient outcomes.
However, some physicians and groups don’t believe burnout is the best term to fully encompass the amalgam of forces that are creating burnout symptoms. The Editor In Chief of the American Osteopathic Association’s “The DO” publication posits that other terms may better represent the situation physicians face, posing alternative terms like “moral injury.” Some physicians suggest that burnout is just a symptom of demoralization.
Which physicians are experiencing the highest levels of burnout?
While all physician burnout is real and valid, there are indications that certain physicians are experiencing higher levels of burnout.
Two research projects published in 2021 looked at two aspects of physician work and life, revealing patterns that can be useful for organizational development and wellness efforts.
Published in JAMA Network Open, survey results from more than 4,000 US physicians assessed work-life integration (WLI). A study published in The Joint Commission Journal on Quality and Patient Safety uncovered a link between physician task load (PTL) and the risk of burnout.
Work-life integration among U.S. physicians: This cross-sectional study based on survey data of more than 4,000 physicians from various healthcare segments (private, academic, military, and veteran’s practices) uncovered indicators of poor work-life integration where career and personal responsibilities conflict, contributing to high rates of burnout.
- Female physicians saw poorer WLI scores; however, a gender disparity was most pronounced for mid-career physicians, those with adult children, and those working fewer hours per week.
- Physicians aged 35-44 years and 45-54 years had the worst WLI scores for men and women.
Physician task load (PTL) associated with risk of burnout: Task load, measured by the National Aeronautics and Space Administration (NASA) Task Load Index (TLX), correlated with burnout scores. Assessing four PTL areas – mental, physical, and temporal demands, and perception of effort – analysis revealed that 44% of study participants experienced at least one symptom of burnout, while 38.8% had high emotional exhaustion, and 27.4% showed depersonalization.
Specialties with the highest PTL score included:
- emergency medicine
- urology
- anesthesiology
- general surgery subspecialties
- radiology
- internal medicine subspecialties
And while this study highlighted which specialties had the highest overall PTL score, it’s important to also view the highest mean scores across the four domains – mental, physical, time, and effort. It shows how different types of tasks create more burdens for some specialties than others.
For example, the specialty with the highest mean score in mental demand was radiology, and the top scores for physical demand were urology, general surgery/subspecialty, anesthesiology, and neurosurgery. Emergency medicine was the specialty with the highest mean time and effort demand score.
Combinations of these factors and the sub-groups of physicians the data represent can provide insight into which physicians may be experiencing more stress, less work-life integration, and higher incidents of burnout.
What’s causing physician burnout?
More than 10 years of data from AMA physician surveys confirm that pre-pandemic levels of burnout were increasing and, since the pandemic, have risen to alarming levels.
Some physician leaders point to a mix of new problems alongside exacerbated old ones. There are a number of high-level, systemic, and economic-driven issues that are impacting physician behavioral health and career satisfaction.
For example, pandemic losses could include witnessing the amount of life lost, personal fear and family loss, or feeling unappreciated when patients won’t mask or seek vaccination. But other factors have been around much longer, including:
- Minimal time allotted to spend with patients
- Ever-increasing productivity quotas
- Misaligned reimbursement rates
- Electronic health records complexity, usability problems, and interoperability challenges
- Nursing staffing shortages and loss of seasoned nurses to traveling contracts
- Shifting financial priorities and pressures from leadership
- Inefficient systems and administrative burdens
- Increased compliance, reporting, and insurance requirements
- Mounting complexity of modern medicine and technology
- Personal and professional liability
- Lack of autonomy and decision-making power
- Practice absorption into corporate entities
These and other issues have led to physicians experiencing decreasing levels of feeling valued by their healthcare organization. A 2022 AMA survey found that 15% of physicians thought they were valued “not at all,” and 34% felt valued “somewhat.”
A report published by the National Academy of Medicine in 2019 on physician burnout found that “many doctors’ dissatisfaction with their work could be caused by an incongruence between what they cared about and what they were incentivized to do by the health care system.”
This disconnect can lead to deleterious effects on physicians’ health and well-being, their families, their healthcare organization, and the overall strength and resiliency of the US healthcare system.
The high cost of physician burnout
Primary care physician turnover alone is estimated to cost about $979 million in excess healthcare expenditures for public and private payers annually. Of that, $260 million is attributed to burnout-related turnover.
Beyond the adverse effects on care continuity, patient satisfaction, and cost, the consequences of physician burnout have been linked to:
- Increased medical errors
- Lower care quality
- Higher malpractice claims
- Reduced clinic hours
Several longitudinal studies have shown that physicians experiencing burnout are two times as likely to depart their organization within two years. But the mental and physical cost to the physician and their family can become too great.
Physician suicide: The ultimate cost
At a time when suicide rates are increasing across all age groups, it’s crucial to face the fact that approximately 300-400 physicians die by suicide in the US each year. And although males commit suicide four times more often than females in the general population, female and male physicians die by suicide at the same rate. This difference may be attributed to the physician’s knowledge of drug lethality and access.
While couched within the genuine impact of burnout, the systemic treatment of physicians is critical to the health and well-being of the organizations that employ them and the system that relies on their expertise and skill. In addition to medical societies and association initiatives, health systems are working to change the fundamental culture and structures that should support physician value.
But what meaningful change can be made to the recent and longstanding systemic issues that are eroding physician meaning?
What’s being done by provider organizations and associations?
With a membership representing 25% of physicians, the AMA has several initiatives to advocate for physician health, wellness, and fair treatment. Their Recovery Plan for America’s Physicians focuses on five essential issues:
- Reducing physician burnout
- Reforming Medicare payment
- Fixing prior authorization
- Addressing the scope of practice
- Supporting telehealth
The AMA has developed a series of toolkits and playbooks to support physician well-being. However, their work to advocate for physicians at the national level through Medicare and the Centers for Medicare & Medicaid Services (CMS), and in support of recommendations to create systemic change through provider organizations, could contribute the most significant value to changing the trajectory towards physician workforce loss and degradation of quality care.
“We’ve now got substantial data that shows that physicians who are happy in their work and are well-supported actually have better patient outcomes and are able to take better care of patients,” 2022-2023 AMA president, Jack Resneck, Jr., M.D. said. By removing specific burdens in the workplace, it will contribute to “restoring joy in the practice of mental health,” he said.
Resneck points to the value of supported and satisfied physicians, which enable better patient outcomes, fewer care costs, and long-term organizational health.
He reflects post-pandemic on the AMA’s plan, stating that it is “largely focused on making sure that, after physicians have really spent the last 3 years holding together a health care system that has been stretched way too thin, we make sure we take care of physicians and protect our ability to take care of patients.”
The AMA’s recent physician burnout webinar provided key takeaways from their decade of research, offering healthcare organizations ideas for getting to the heart of what’s creating physician burnout, including the following six recommendations:
- Measure and report on burnout: Burnout manifests in individuals, yet it originates within systems
- Demonstrate physician value in meaningful says: Feeling valued serves as a protective factor against stress and anxiety
- Assess workplace atmosphere and find ways to ensure physicians have more control over workload, which are significant agitators to satisfaction and burnout
- Track and use EHR metrics to identify and prioritize needed changes in workflow and workload
- Push for public policies and organizational compliance requirements that are effective but less burdensome
- Ensure leaders provide timely, relevant, and authentic communication that fosters stability and workplace value
Sanford Health takes on professional fulfillment and physician burnout
Sanford Health is a sterling example of a health system taking a hard look at itself and creating positive change for physicians and other clinical staff.
As one of the largest rural integrated health systems in the US, covering 47 medical centers and more than 300 clinics, Sanford Health’s new president, Luis Garcia, MD, took stock of physician burnout in 2018. His goal was three-fold:
- Take an objective assessment of the existence and level of burnout
- Inventory their programs and tactics to determine their effectiveness
- And discover how to evaluate successes
At that time, Dr. Garcia and his leadership team gave Sanford a 2:10 score for dealing well with physician burnout. He found fragmented and siloed efforts, low levels of awareness and engagement from corporate executive leadership, and a lack of a concerted team effort.
Sanford focused on five dimensions of well-being, including mental and emotional support, a sense of purpose, personal support, financial health, and meaningful connections. Through engagement and analysis, they discovered that their size, medical group demographics between physicians and advanced practice providers (APPs), and generational differences were big influencers on their ability to deal well with burnout and what clinical employees wanted.
The Sanford team developed a lifespan of well-being and engagement plan that focuses on different types of engagement at each stage of employment, from pre-employment to onboarding to clinical practice to succession planning. They established several specific priorities and programs to support physicians and APPs, including:
- Onboarding and mentoring programs like their “Transition into Practice Program” for APPs
- Resiliency programs like a Clinician Assistance Program for mental health wellness and a Professional Practice Support Program that provides internal coaches
- Providing opportunities to learn and engage through leadership development like Sanford RISES and their Department Chair Development Series
Most importantly, Sanford's leadership established a physician director of clinician experience and well-being, established a Clinician Wellness Council, and began to document metrics like turnover rate, Net Promoter Score, engagement rates, and exit interview feedback. Data dashboards help focus on changes that indicate improvements or areas needing more intense focus.
Start with a Listening Campaign
The first step to engage physicians and uncover sources of burnout is to conduct a listening campaign.
The AMA provides a toolkit to guide the effort, which can highlight general areas of concern and monitor trends over time, but also gather the personal narratives behind the issues. A listening campaign can offer a systematic and practical process for clinicians to voice their stressors, propose improvements, and create positive change.
Physicians can advocate for themselves, their colleagues, their staff, and their patients
Physician burnout is an evolving and increasing issue with dire consequences for personal and patient health, as well as organizations dependent on physician education, expertise, and skill. While professional stigma, licensure risk, and physician culture can deter seeking help or advocating for others, addressing the invisible pandemic of physician mental health and self-care is critical.
Additionally, building care management teams within practices or provider organizations can enable clinicians, such as medical assistants and registered nurses, to balance out the workload. These individuals can help create care plans, perform check-in calls with patients, manage medications, deliver risk assessments, and other tasks that don't need to be done directly by a provider. ThoroughCare provides a software platform that can help those teams thrive.
How ThoroughCare can help
Digital software solutions are available to help practices, clinics, and health systems streamline clinician workflow and maximize time spent with patients. At ThoroughCare, we’ve designed our care coordination software for easy clinical use with an intuitive interface that allows you and your team to:
- Streamline documentation and accuracy of multiple care management and wellness programs
- Personalize patient engagement through comprehensive care planning
- Utilize clinical recommendations and assessments to educate, motivate, and guide patients
- Access and share data across electronic health records, health information exchanges, and care team stakeholders
We offer extensive training opportunities and learning resources. Our tech support team is readily available, and we integrate with several of the leading EHR providers.
