Expert says addressing physician burnout must start with improving the workplace

In a recent the American Medical Association (AMA) webinar, AMA president and health policy expert Jack Resneck Jr., MD, said that addressing the physician burnout crisis must focus on fixing the workplace, not the worker.

Most doctors point to administrative hassles as their top contributor toward burnout.

“The answer won’t be found in telling physicians to be more resilient,” Resneck said.

The webinar featured Surgeon General Vivek Murthy and other healthcare leaders who have tackled the issue. While several ideas were discussed, they focused on a common theme of improving the healthcare workplace.

They stressed the importance of allowing doctors to focus on patient care, and ensuring that doctors aren’t spending excessive time on documentation and working day and night.

“We need to fix what’s broken and it’s not the doctor,” Resneck said.

Physician burnout appears to be higher than it has ever been, according to a study¹ published in Mayo Clinic Proceedings. Researchers reported that 63% of physicians experienced burnout in 2021, compared with 38% in 2020.

While burnout was a problem before the arrival of COVID-19, it has only been exacerbated after three years of battling the pandemic.

“The crisis of burnout in our profession has been brewing for a long time,” Murthy said. “It’s worsened in the pandemic”

Focus on the workplace

As many as one out of five doctors plan to leave medicine within two years, and as many as one in three plan to reduce their hours, Resneck said. A Massachusetts Medical Society poll indicated about a quarter of the state’s doctors are considering calling it quits within the next two years.

If nearly two-thirds of doctors are saying they’re battling burnout, “that can’t possibly be related to individual weakness on the part of physicians,” said Christine Sinsky, the AMA’s vice president of professional satisfaction.

“Rather than fixing the worker, we need to focus on fixing the workplace,” she said.

Given the current burnout rates, a system with 1,000 doctors is investing $13 million annually replacing doctors, and not because of better jobs but because of excessive stress, she said.

“Our message is, invest a fraction of that upstream,” and systems will see a strong return on their investment, Sinsky said.

Most doctors point to administrative hassles as their top contributor toward burnout, according to a survey by Medscape in January, echoing other polls of doctors.

Health systems need to find ways to reduce bureaucratic headaches for doctors, said Murthy. The surgeon general also cited that as a key recommendation to reducing burnout in a report Murthy issued last year.

Doctors didn’t get into medicine “to chart,” he says.

Panelists agreed that many doctors are spending too much time documenting in their supposedly off hours or during “pajama time.” Sinsky said work during pajama time is “driving burnout.”

Health systems can look at their electronic health record systems to gain insights into how much time doctors are spending on documentation, said Anjalee W. Galion, physician wellness officer of Children’s Health of Orange County.

Her system is looking at the number of clicks and amount of time spent after hours on charting. The tool is “a mirror to see what’s going on in our organization,” Galion said. “It’s really powerful.”

Health systems need to be tracking ways on reducing burdens and burnout.

“If a system is going to change, we have to have measurable ways to make a difference,” Galion said.

Murthy also cited the frustrations of doctors in dealing with prior authorization, the process of securing approval from insurers for treatments and medications. The administration is pushing for reforms in prior authorization, he said.

Make it easier to get help

The panelists on the webinar all discussed the importance of making sure doctors understand the importance of getting help.

Health systems need to reinforce that message, but they can also make it easier for doctors, nurses and other healthcare workers to get assistance.

“Bring care to where clinicians are, which is often at work,” Murthy said.

Health systems should offer rooms where clinicians could talk to a mental health professional via telehealth. Murthy said he has heard from nurses who would like to talk to a mental health professional but aren’t able to leave the hospital for a couple of hours to travel to a provider.

Healthcare executives should lead by example, including sharing if they have received assistance for burnout, depression or anxiety. When leaders get care and do it publicly, “it helps other clinicians see that it’s OK,” Murthy said.

“It doesn’t make them weak. It actually makes them human,” he added.

Nigel Girgrah, chief wellness officer & medical director of liver transplantation at Ochsner Health, shared his own struggles. Girgrah, who participated in the webinar, talked about his own issues with anxiety and depression. In the summer of 2020, he was dealing with the pandemic, and the anniversary of the death of his son.

“I called it languishing,” Girgrah said. “I think I was anxious and depressed.”

In September 2020, he shared his story in an open letter to Ochsner staff. While he said he was nervous in disclosing his story, Girgrah said he was heartened by the response.

Helping doctors

While the bulk of the discussion was focused on improving the workplace, the panelists also talked about helping physicians feel less isolated.

“When we’re isolated in our work, we start to feel more weighed down in work, that accelerates stress,” Murthy said.

As arduous as his training was, Murthy said, “I loved my time in residency.” And he said the main reason was due to his friends, who he said had his back and were there for him.

After training is completed, some physicians feel more lonely, he said. Murthy said doctors need to have good relationships, inside and outside work.

“I think the social connections we foster, they’re not just nice to have,” he said. “They’re absolutely necessary.”

Galion also discussed the importance of rest for physicians, and why health systems should reduce their workloads so doctors can get more sleep. A study² of physicians published in Jama Network Open found 29% of doctors tested positive for at least one sleep disorder. Researchers found doctors with sleep disorders had a greater likelihood of burnout.

“We have better cognitive performance when we’ve had good sleep,” Galion said.

This article was first published on our sister publication, Chief Healthcare Executive.

Reference

1. Shanafelt TD, West CP, Sinsky C, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2020. Mayo Clin Proc. 2022;97(3):491-506. doi: 10.1016/j.mayocp.2021.11.021

2. Weaver MD, Robbins R, Quan SF, et al. Association of Sleep DisordersWith Physician Burnout. JAMA Netw Open. 2020;3(10):e2023256. doi: 10.1001/jamanetworkopen.2020.23256