Increased Physician Burnout Challenging U.S. Healthcare System

Physician burnout impacts every aspect of healthcare delivery — quality, safety, cost and human resource. And physician burnout is on the rise — with almost 55 percent (up from 45 percent in 2011, according to one study) of all doctors currently reporting diminished professional satisfaction and an increase in emotional exhaustion.

The term “physician burnout syndrome” was first coined in the 1970s, and many studies have noted the correlation between physician burnout and medical error. But burnout is also associated with physicians having the highest suicide rate of any profession and around $17 billion in annual cost attributed to physician turnover and lost productivity.

Driving the acceleration in physician burnout has been the unprecedented, rapid change that has been occurring in the U.S. healthcare delivery system. Doctors report a loss of autonomy as they face constant pressures associated with the move from a fee-for-service to value-based reimbursement model, new regulatory requirements and the mandate to move from paper to electronic medical records.

Two significant independent studies that examine physician burnout were published. A study by the Stanford University School of Medicine found that physician burnout is at least equally responsible, if not more so, for medical errors than unsafe healthcare workplace conditions.

Looking at the interrelationship between medical errors and physician burnout as well as medical error and healthcare workplace safety conditions, the Stanford researchers found that physicians with burnout symptoms had more than twice the likelihood of self-reporting a major medical error within the previous three months. The study also showed that rates of medical errors actually tripled in healthcare work units — even those ranked as extremely safe — if physicians working on that unit had high levels of professional burnout.

A new survey study from the NYU School of Medicine found that doctors who work in small, independent primary care practices of five-or-fewer physicians report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent). Results also showed that those physicians who described working in a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other reported lower levels of burnout. According to the researchers, the data they have collected can inform ways for larger systems to foster a culture of autonomy within their practices that would result in a lower frequency of physician burnout.

In addition, medical professional liability insurer The Doctors Company published a risk management article by Howard Marcus, MD, FACP, that looks at how increasingly burdensome nonclinical demands — electronic medical record order entry, prior-authorization issues with health insurers, an increased number of diagnostic codes — have resulted in emotional exhaustion, depersonalization and a loss of perceived accomplishment for the modern physician.

According to Marcus, the root causes of physician burnout are interwoven into the U.S. healthcare delivery system, and any solution will require a willingness on the part of physicians, institutional leadership, EMR software designers and those involved with healthcare regulation as well as documentation requirements to collectively confront the issues leading to burnout.

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