Physician Burnout Extinguishes Physician Engagement

The healthcare industry is seeing unprecedented levels of physician burnout.

Swamped with increasing regulation and paperwork, long hours and increased productivity pressures, many physicians are being pulled in too many directions and are quickly reaching the point where they have little left to give.

Simultaneously, physician alignment and engagement have experienced a rise in importance. A 2014 HealthLeaders Magazine independent study sponsored by MedSynergies, a hospital-physician alignment company based in Irving, Texas, shows that organizations are becoming increasingly aware of the impact of physician alignment on revenue, care redesign, and efficiency measures, and are utilizing physician alignment and engagement goals strategically to improve performance in these key areas. However, increasing engagement efforts without addressing physician burnout can have adverse effects, according to Kerry McCormick, director of product management at MedSynergies. "Engagement and burnout are at opposite ends of the spectrum," she states. "You can't have an engaged physician if they're burned out."

Ms. McCormick says that although medicine can be an incredibly meaningful and personally fulfilling career, it can also be very demanding and stressful. Physicians are not always good at practicing what they preach and often put their patients' and others needs first, neglecting their own health and personal needs. A 2012 study published in the Annals of Internal Medicine found that nearly half of physicians reported at least one symptom of burnout, such as emotional exhaustion, physical fatigue, depersonalization and detachment. Nearly one third had high markers of depersonalization; 12.4 percent had a low sense of personal accomplishment and 40.2 percent of physicians were dissatisfied with their work-life balance as compared to 23.2 percent of workers in other professions. These symptoms of burnout sometimes lead to less effective patient care and reduced organizational engagement.

Burnout starts early—sometimes even before students are out of medical school— and impacts attitudes and decisions far into a physician's career. A study published in The Archives of Internal Medicine shows that 49.6 percent of medical students reported high levels of burnout. Moreover, according to a study by The Physicians Foundation, over half of the physicians in America are nearing retirement age, and over 60 percent of doctors say they wouldn't recommend medicine as a career to their own children. It's safe to conclude that a physician shortage crisis is not just possible in the near future, it's probable.

Physicians cite a wide variety of reasons they are burned out. The most common is an excess of bureaucratic tasks, followed by spending too many hours at work. Many physicians feel as though they have lost their autonomy either due to increasing scrutiny from payers or from entering into new employment arrangements where they often have little input into decisions that affect their practices. Others feel as though the increasing technology demands of their practices stemming from the Patient Protection and Affordable Care Act are asking too much of them. As a result, many physicians feel as though they are not getting what they signed up for — they are so engaged with an EHR, or clicking through screens of information that they feel like they don't have time to make eye contact or directly interact with their patients anymore. Surprisingly, near the bottom of the list comes typical complains such as difficult colleagues or staff, difficult employers or too much exposure to patients dying, violence and other losses, according to a 2013 report from Medscape.

The good news is that burnout is both reversible and preventable, Ms. McCormick says. The health care industry is beginning to recognize that physician burnout is a serious problem and is starting to take some steps to correct it, she says.

First steps typically include educating physicians on the issue. Some provide employee assistance programs for physicians that are in need while simultaneously developing programs to prevent burnout. Ms. McCormick states that her team is beginning to see organizations include educational programs into their on-boarding and orientation programs. Including physicians' spouses and families into the design of these programs is important because burned out physicians will often carry their work issues into their personal lives at home.

One of the most important things is that physicians must be able to access these services confidentially and there must be no punitive actions for those seeking assistance, Ms. McCormick emphasizes.

Organizations must also address the systemic issues that are leading to burnout. They must look for ways to reduce stress in the work environment and allow physicians adequate time to recharge and address their personal needs. One such tactic is to place physicians in teams where they work with other healthcare providers to address patient care needs. The increasing presence of nurse practitioners and physician assistants may help because it spreads out the work and documentation, she says, reducing the time required for some of these activities so that they can spend more time with their patients.

Hospitals have a vested interest in keeping physicians healthy and employed. There are no exact statistics, but many medical professionals feel as though there is a connection between burnout and more medical errors and less satisfied patients. Burned out physicians are also more likely to be less productive, and as the reimbursement model in the U.S. becomes more value and patient-outcome based, that may reduce reimbursement levels for hospitals and physician practices.

Burnout is also expensive. "If a burned out physician is taking it out on other staff members, healthcare organizations will likely have increased turnover in staff," Ms. McCormick says. "We also see physicians retiring early due to burnout, and the cost of replacing physicians can be staggering if you include lost patients and productivity for practice ramp-up for new physicians."

Instituting any of the measures, either to prevent or alleviate burnout, can potentially save a physician's career and improve relationships between physicians and their employers and peers.

"Organizations strive to engage physicians so they can align on important health care delivery objectives," McCormick says. "It's important that we come together and find solutions that help physicians deal with the numerous challenges they face today and ease their burden. It benefits all of us — most importantly it benefits the patients we serve."

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