Report urges action on physician burnout

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A new report by the National Academy of Medicine urges action by government, educational institutions, and health care organizations to address the causes of physician burnout, which is experienced by up to one-half of clinicians in the U.S. and threatens patient care.

A combination of cumbersome and sometimes seemingly unnecessary rules and payment procedures, plus staff shortages and pressure to enter the age of electronic medical records, is causing emotional exhaustion, detachment, and a low sense of personal accomplishment, the report says.

“Studies estimate that between 35% and 54% of U.S. nurses and physicians have substantial symptoms of burnout, and the range for medical students and residents is between 45% and 60%. There are indications that burnout is a problem among all clinical disciplines and across care settings,” the report states.

“The high rates of burnout reported among U.S. clinicians and learners is a strong signal that the nation’s health care system is failing to achieve its aims for system-wide improvement.”

“Burnout is real,” said AUA President John H. Lynch, MD. “It impacts the entire health care system, and exacerbates already-existing work force shortages in many specialties, including urology.”

Report reflects AUA Census findings

Dr. Lynch said the report reflects the findings of the AUA Census, which reported burnout rates for urologists as being high, with more than one-third experiencing symptoms.

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“Addressing causes of burnout is a priority for the AUA,” said Dr. Lynch. The AUA endorses the six goals outlined in the report:

Creating positive work environments. Health care executives should commit to, and be accountable for, creating a work environment that promotes high-quality care, job satisfaction, and social support, the report says. It recommends that health care organizations create and maintain an executive leadership role dedicated to clinician well-being.

Addressing burnout in training and at early career stages. Schools of health professions (including medical schools, nursing schools, schools of pharmacy, and others) should alleviate major sources of stress by monitoring workload (including preparation for licensure examinations and required training activities), implementing pass-fail grading, improving access to scholarships and affordable loans, and building new loan repayment systems.

Reducing tasks that do not improve patient care. Federal agencies, state legislatures, and other standard-setting entities should identify and address the sources of clinician burnout related to laws, regulations, and policies, eliminating those that contribute little or no value to patient care. They should specifically evaluate regulations and standards related to payment, health information technology, quality measurement and reporting, and professional and legal requirements for licensure.

Improving usability and relevance of health information technology. Health information technology (IT), including electronic health records, should be as user-friendly and easy to operate as possible to reduce burnout. Health IT vendors and health care organizations should deploy technologies to reduce documentation demands and automate non-essential tasks. In addition, federal policymakers and private sector health IT companies should collaborate to develop the infrastructure and processes that enable shared decision-making between clinicians and patients.

Next: Reducing stigma and improving recovery servicesReducing stigma and improving recovery services. Many clinicians do not report burnout because they fear the potential consequences, including loss of licensure. In order to eliminate the stigma of getting help and to promote recovery and well-being, state legislative bodies should facilitate access to employee assistance programs, peer support programs, and mental health providers without the information being admissible in malpractice litigation.

Creating a national research agenda on clinician well-being. By the end of 2020, federal agencies-including the Agency for Healthcare Research and Quality, the National Institute for Occupational Safety and Health, the Health Resources and Services Administration, and the U.S. Department of Veterans Affairs-should develop a coordinated research agenda on clinician burnout, according to the report.

The report points out that mounting system pressures have contributed to an imbalance in which the demands of the clinician’s job are greater than the resources available to complete the job effectively.

All of that is intensified by the increasing push for performance improvement, technology that hinders rather than supports patient care, changing professional and societal expectations, and policies that are insufficiently aligned with professional values or the goal of better patient care, the report concludes.

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Overwhelming job demands and insufficient job resources cause physical, psychological, and emotional stress, including burnout-a workplace syndrome that is characterized by high emotional exhaustion, high depersonalization (ie, cynicism), and a low sense of personal accomplishment from work, the report observes.

Work system affects well-being

“The work system-including the physical environment, the technologies in use, and how care team members interact with each other-deeply influences clinicians’ professional well-being,” said Pascale Carayon, PhD, co-chair of the committee that wrote the report and professor and director of the Wisconsin Institute for Healthcare Systems Engineering at the University of Wisconsin, Madison. “To provide the best patient care possible, health care organizations must create a work environment that fosters clinicians’ safety, health, and sense of fulfillment.”

“For many clinicians, developing real relationships with patients is what attracted us to health care in the first place, but administrative tasks often take us away from patient care,” said Christine Cassel, MD, senior adviser on strategy and policy and professor of medicine at the University of California, San Francisco and committee co-chair. “With this report, we have a real opportunity to change the culture of health care delivery and help restore clinicians’ well-being and joy in medicine.”

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