A burnout epidemic: 25 notes on physician burnout in the US

Here are 25 things to know about physician burnout.

 A brief history of burnout

1. Herbert Freudenberger, a German-American psychologist, was one of the first to describe and study symptoms of professional burnout among physicians and mental health workers in the 1970s. He coined the term "burnout" in his 1974 book, "Burnout: The High Cost of High Achievement."

2. In 2007, HHS described professional burnout as an occupational hazard in medicine that may cause high quality healthcare professionals to leave the field altogether.

3. The first national study of burnout across all U.S. physician specialties occurred in 2011 and was published in Archives of Internal Medicine. The study found 38 percent of physicians experienced burnout compared to 28 percent of workers employed in other industries.

A growing epidemic

4. Fifty-one percent of physicians reported experiencing frequent or constant feelings of burnout in 2017, up from 40 percent in 2013, according to Medscape's annual survey.

5. The specialty group reporting the greatest degree of burnout this year was emergency medicine (59 percent), followed by OB/GYN (56 percent), family medicine (55 percent), internal medicine (55 percent) and infectious disease (55 percent).

6. Physician satisfaction with work-life balance also worsened from 2011 to 2014, according to a 2015 Mayo Clinic Proceedings study. Approximately 48.5 percent of physicians had a satisfactory work-life balance in 2011 compared to 41 percent in 2014.

7. In 2016, physicians were 15 times more likely to experience burnout than professionals in any other line of work, according to a study in U.S. News & World Report.

8. Physicians have a 10 percent to 20 percent higher divorce rate than the general U.S. population, according to U.S. News & World Report.

9. From the first moments of gaining acceptance to medical school, aspiring physicians face the high-intensity culture of medicine. Medical students had a 15 percent to 30 percent higher rate of depression compared to the general population.

Clerical burden

10. Unlike many industries in which advances in technology have improved efficiency, EHRs and other technology in healthcare have intensified administrative burden and complicated processes in the clinical space. Physicians who experienced burnout attributed job dissatisfaction to two major sources: tedious EHR data entry and increased clerical requirements under value-based care.

11. Clinicians complete a majority of administrative tasks on an EHR or other electronic system. Physicians spend, on average, 50 percent of their work day entering data into EHRs and completing clerical work, nearly twice as much as the 27 percent of work hours spent interacting with patients, according to a 2016 study in the Annals of Internal Medicine.

12. Physicians cannot escape clerical requirements even when they are with patients. Physicians reported 37 percent of their time during patient visits is spent documenting in the EHR and completing desk work.

13. Physicians attribute additional time in front of the EHR, in part, to inefficient data entry processes making clinical documentation tedious and time consuming. EHR interfaces requiring physicians to click multiple times to navigate a single medical record have given rise to a condition known as "click fatigue."

14. Click fatigue is directly correlated to the number of mouse clicks the provider must make to use their EHR and related solutions. More clicks correspond to longer time spent on data entry. Internal medicine residents spent about five hours a day entering data for 10 patient records, according to a 2016 study in the Journal of Graduate Medical Education.

15. Excessive hours of EHR box-checking and data entry have taken a toll on U.S. physicians. Providers who use EHRs and computerized physician order entry report lower levels of job satisfaction and higher rates of burnout compared to their counterparts who still use paper, according to a 2016 Mayo Clinic Proceedings study.

Alert fatigue

16. Unfiltered data in the clinical space has given rise to "alert fatigue." This occurs when a physician is exposed to frequent or excessive information that can hobble his or her clinical productivity. Primary care physicians received 79.6 notifications and spent more than one hour responding to EHR alerts on average per day, according to a 2016 Medscape study.

17. While some alerts can be life saving, physicians consider most alerts excessive. Clinicians reported ignoring safety notifications between 49 percent and 96 percent of the time, according to a HarvardMedicalSchool study.

18. Nearly 50 percent of physicians believe overwork, stress and fatigue among their colleagues significantly contributes to medical errors, according to a 2014 study in The New England Journal of Medicine.

Decision fatigue

19. Decision fatigue is the biological effect of continuously flexing one's decision-making muscles. The more choices a person makes throughout the day, the more challenging each one becomes for the brain.

20. Some studies have measured the effect of decision fatigue in physicians. Physicians become increasingly more likely to prescribe antibiotics as their workday progresses, even when antibiotics are not an indicated treatment, according to a 2014 study in JAMA Internal Medicine. Compared to the first hour of work, the probability of assigning a prescription for antibiotics increased by 1 percent in the second hour, 14 percent in the third hour and 26 percent in the fourth hour.

Burnout prevention efforts

21. The problem of physician burnout is well established, but effective solutions are less straightforward.

22. Some medical schools have implemented student wellness programs designed to help young physicians develop healthy habits and attitudes around work-life balance. For instance, New York City-based Albert Einstein College of Medicine's WellMed program provides students with physical, emotional and nutritional support so "students can become better healers and role models for their patients."

23. In Colorado, nonprofit company Lumunos aims to help physicians recapture their sense of fulfillment in medical practice. The program rebuilds collegial bonds among physicians in a workplace to reduce burnout through mutual support and recognition.

24. The American Medical Association and many hospitals have developed and implemented wellness committees. These committees are typically composed of physician leaders who convene regularly to discuss ways to combat burnout unique to their institution.

25. Diverse organizations from graduate students to UX design, or user experience design, companies are working to address problems with EHR interfaces, usability and workflow to more seamlessly integrate with physician workflow. 

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