Introduction
Physician burnout, a work-related condition that depletes physical and emotional energy, is on the rise since the arrival of COVID. Health care burnout is characterized by exhaustion, losing meaning in work, depersonalization and feelings of low efficacy. According to the Medscape Physician Burnout & Depression Report 2022, stress and staff shortage has caused an increase of 5% in physician burnout, from 42% in 2020 to 47% in 2021. ER physician burnout also increased from 43% in 2020 to 60% in 2021 due to longer working hours involved in caring for COVID patients.
The whole healthcare system suffers due to the negative impact of physician burnout. Moreover, the aforementioned report showed that women have faced greater role strain than men during the COVID pandemic due to fulfillment of personal responsibilities besides taking care of patients. In 2020, 51% women faced doctor burnout compared to 36% men. Unable to cope with the burnout, many physicians tend to turn to drugs or alcohol. The worst case scenario is development of suicidal risk.
While physician burnout definitely affects the physical and mental well-being of a physician, it also affects the quality of healthcare they are able to provide.
Symptoms of physician burnout
Physician burnout is exhibited as changes in physical, emotional and behavioral characteristics. In the 1970s at the University of San Francisco, Christina Maslach and her colleagues developed the Maslach Burnout Inventory to diagnose burnout. This standard includes three cardinal symptoms to identify physician burnout, which include;
- Exhaustion
The energy levels fall as the physician faces stress, leading to a downward spiral. The physical and emotional energy levels become extremely low and the physician feels too exhausted to continue working. Signs such as feeling drained, feeling sick, frequent pains in different parts of the body, change in appetite or sleep patterns and drop in libido signify that the physician is facing exhaustion.
- Depersonalization
Once the emotional energy of the physician is depleted, they experience ‘compassion fatigue’, at which point they fail to be emotionally available for their patients and experience depersonalization. Cynicism, sarcasm, and venting about patients and work are tell-tale signs of physician burnout. Besides these, the physician also feels a sense of failure, loses motivation and sense of accomplishment, feels helpless or trapped, develops a negative outlook and stops finding joy in fun activities.
- Lack of efficacy
Health care burnout often leads to doubts regarding physician’s efficacy. The physician is not able to find meaning in their work and worries about making mistakes. Behavioral signs such as withdrawal from responsibilities, isolation, procrastination, skipping work, and using food, drugs or alcohol to cope are often exhibited in case of physician burnout.
Apart from these cardinal signs and symptoms, physician burnout is also manifested as headache, insomnia, tension, anger, narrow-mindedness, impaired memory, etc.
What causes physician burnout?
Since being a physician is a high-intensity job, constant stress can result in physician burnout. Physicians are also at a higher risk of burnout than those in other professional fields, according to a survey. There are several external and internal causes of physician burnout. Some physicians are often very critical of their work and end up burning themselves out if they continue to overexert themselves. However, doctors burnout occurs mostly due to external factors, which are described below;
- Bureaucratic tasks
Several physicians blame paperwork and charting for their burnout. According to the Medscape report, 60% of the physicians faced burnout due to too many bureaucratic tasks. Apart from being responsible for patient treatment, physicians end up taking care of such administrative jobs that act as a stressor for them.
- Lack of respect from administrators or staff
Physicians expect to be respected by their supervisors and other staff. Since they put in a lot of hours saving lives, a disrespectful colleague rubs off wrong on them. The build-up frustration often results in physician burnout. This is the second-highest contributor to physician burnout at 39%.
- Working too many hours
Being a physician can sometimes require working long hours and being on call at odd times. The demanding nature of their job leaves the physicians feeling burnt out and unable to care for patients. Physician burnout also occurs due to unpredictable working hours and the problems posed by different patients. Since physicians need to be empathetic towards their patients, they also get affected by their patient’s diagnosis. Working too many hours was quoted as a burnout factor by 34% of the 13,000 surveyors as per the Medscape report.
- Loss of Autonomy
Earlier, physicians were solely responsible for the prognosis of their patients. However, these days they need to deal with technological advancements and new information everyday to treat the patients, which ends up in a physician burnout.
- Poor compensation and insufficient rewards
Despite being such a time- and energy-intensive job, doctors are sometimes not accordingly compensated or rewarded. This leads to poor career satisfaction and a sense of ineffectiveness. Doctors are also punished more harshly for any mistakes. If the compensation is less than what the physicians feel is just for their job, it can cause health care burnout.
- Increasing computerization of medical practices
Due to technological advances, maintenance of electronic health records (EHR) is a must and the task falls on physicians at times. This overloads the physician further, who feels burdened by the additional responsibilities. EHR are often problematic due to being in the nascent stage, which can further irritate the physicians and lead to burnout.
- Adhering to Rules
The physicians these days are controlled by various policies and rules such as Health Information Portability and Accountability Act (HIPAA), Accountable Care Organizations (ACOs), quality indicators, and other standards, which causes further stress as they get acclimatized to working in such environment. Failure to comply can result in adverse effects and hence, the necessity to keep up with the rules keeps the physicians on their toes, adding to more stress, which can cause burnout.
Recently, the stress and anxiety related to COVID have also contributed to physician burnout as the doctors are sometimes unable to save many patients or fear that they will end up dying from COVID-19 themselves.
How to prevent physician burnout?
Since physician burnout statistics show that 54% physicians feel that being burned out has strongly impacted their lives, it is crucial to prevent the worst from happening. While physicians turn to coping mechanisms such as exercise, isolation, sleep, eating junk food and drinking alcohol, prevention is always better than cure. Healthcare management and physicians are required to recognize symptoms of physician burnout and create strategies to prevent burnout in the first place. The following strategies can be used to help physicians in times of stress;
- Physical activities
It is mandatory for the physicians to indulge in activities such as gymming, running, walking, cycling or yoga. Such activities keep the body active and help in managing the stress of dealing with multiple patients.
- Mindful activities
To relieve stress, physicians are advised to meditate, read and practise mindfulness. It is also advised to invest time in a hobby and take part in leisure activities. These activities should be undertaken either alone or with friends and family to feel connected to loved ones.
- Vacations
A balanced work/life culture is important for the healthcare sector. Physicians must get time off to take vacations to rejuvenate themselves. A change in surroundings and daily schedule can destress the mind and disconnect the physicians from their work for a while. Time away from work is beneficial in preventing physician burnout.
Healthcare organizations can take further steps in preventing doctors burnout. One such method is providing professional coaching to work around the physical and emotional stresses of the medical profession. Besides coaching, organizations should insist on cognitive behavioral therapy for all physicians when they feel stressed. There are several programs such as Mindfulness-Based Stress Reduction (MBSR), AMA STEPS Forward, Physician Burnout Prevention Program etc, which have been implemented by healthcare providers to manage stress in workplaces. MBSR is a eight-week behavioral program and an educational course that uses meditation techniques, body scanning and yoga postures to acquire mindfulness, mitigate stress and improve empathy. Including such experiences for the doctors can effectively reduce chances of burnout.
Besides these measures, assessment of work life and personal challenges should also be carried out. Another way to reduce stress is to redirect non-essential administrative tasks to assisting staff. To prevent time pressure, healthcare organizations should schedule appointments efficiently and appoint support staff to send out appointment reminders, to ensure smoother operations. Healthcare organizations can also use automated technology services to prevent physicians from doing bureaucratic work. Physician burnout not only leaves the doctors incapacitated but also cause a loss of money for the organizations, making it important for these measures to be followed properly.
Combating physician burnout with technology
Along with the methods discussed above, technology can also be used to reduce stress and deal with physician burnout. Several technologies are available today to streamline documentation, reach out to patients and support physicians in daily tasks. Three of these technological interventions that can help in mitigating physician burnout are discussed below;
- Electronic data management
Use of data management software helps in easy access to patient information, as automated processes within the EHR reduces the load on physicians. Technology solutions such as natural language processing, clinical decision support systems and machine learning can be used to take dictation, suggest treatments for each patient and predict data patterns, respectively.
- Automated administration using artificial intelligence
Daily administrative tasks take up a lot of physicians time. To save time and energy, medical practices can employ artificial intelligence (AI) tools and softwares. Emitrr provides technology-based solutions for administrative tasks such as patient follow ups, appointment scheduling, SMS marketing, SMS reminders for patient acquisition and retention.
- Telemedicine
Adoption of telemedicine can help in providing healthcare and offload some of physician’s work. By providing remote consultation, physicians can save time and continue to care for patients without burning out. Telemedicine also allows physicians to work from home or take more off time, which can improve their mental health.
FAQs
Having too many administrative chores is the top reason for physician burnout. Administrative chores reduce the capacity of the physician to meet the demands of the job. Of physicians who report burnout, 60% point bureaucratic tasks to as the reason for the same.
Emergency medicine physicians have the highest burnout rate of 65%. Additionally, female physicians (63%) report higher burnout as compared to male physicians (46%).
Younger physicians under the age of 55 are more likely to experience stress, burnout, and emotional distress and are more likely to seek health compared to physicians over the age of 55.
Conclusion
Physician burnout is a serious issue, which puts physical and mental health of doctors at risk. It is crucial to recognize burnout in time and this can be done by keeping an eye out for symptoms such as exhaustion, cynicism towards patients and lack of efficacy. These symptoms are reflected in the physical, mental and behavioral changes exhibited by physicians. Physician burnout is primarily caused by overworking. Physician burnout statistics show that the major causes of burnout include bureaucratic tasks (60%), lack of respect from colleagues (39%), too many working hours (34%), lack of autonomy (32%), etc.
Intervention by healthcare organizations and physicians themselves is required to prevent physician burnout. Measures such as indulgence in physical activities, mindfulness, taking vacations and undertaking stress reduction programs help in managing physician burnout. Technological tools such as artificial intelligence, EHR and telemedicine can also be used to manage physician burnout. While the nature of the medical profession can be stressful, physicians can avoid burnout by using these preventive measures and continue to serve patients better.
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