Is Physician Burnout Unique?
Why addressing physician burnout means addressing the whole health care system.
A lot has been written of late (and over the past few years) of an alarming trend in health care: physician burnout. Claims of an epidemic of burnout, depression, and high rates of suicide have made headlines more than once. The Lancet has even called it a “global crisis.”
At the same time, it sometimes feels as though this claim of a “burnout epidemic” is being proclaimed about every single profession, not just medicine. For example, in an interview about her relatively new venture, Thrive Global, Arianna Huffington discusses stress and burnout as a worldwide culture and epidemic. Indeed, burnout is even an official ICD-11 diagnosis, according to the World Health Organization. So the question arises: Is there something unique about physician burnout that separates it from burnout in other professions?
Before we answer that question, there is a legitimate question about whether physician burnout is really even on the rise. A 2019 American Medical Association (AMA) survey suggested that work hours are continually increasing for doctors, and along with that increase comes an increase in burnout as well.
At the same time, in 2019, the AMA released the results of another survey conducted between 2014 and 2017 that actually found a decrease in burnout over that time period (although potentially an increase in rates of depression among physicians). It would appear, then, that more research on the true prevalence of physician-specific burnout is needed over time, especially before we start calling it an epidemic. It may also be the case that burnout is more prevalent among certain sub-populations of physicians, such as those in the early part of their careers.
Putting aside the question of whether this “epidemic” is truly an epidemic for a moment, it is still true that physicians seem to be experiencing burnout and depression at high rates, and it’s worth trying to figure out what some of their unique stressors might be. It’s true that frustrations such as long hours, conflicts with administrators, and issues with “customer-facing” interactions (in this case, with patients) are not unique to the medical field. These are the types of frustrations that can be found in virtually any profession and could contribute to burnout.
What is perhaps different when it comes to looking at physicians versus other professional fields is that physicians are now dealing with a constantly and rapidly changing system of care that is increasingly difficult to navigate and increasingly complex. What’s more, this changing system of care may be stripping physicians of a sense of autonomy over health care decisions and, in many cases, places restrictions on the amount of time they can spend with patients due to an increasing pressure to treat more and more people in a shorter and shorter time span.
Physicians often complain about time demands made by electronic health records, for example, and we have written in the past about the strains placed on physicians by prescription prior authorization requests. This kind of pressure may decrease their ability to provide in-depth oversight of patients and perhaps puts too much emphasis on metrics over individualized, customized care. It also may be assigning physicians more administrative, non-medical duties that increasingly detract from the time spent on their core set of duties caring for patients.
Taking all of this into account, advising physicians to take better care of themselves by exercising, doing yoga, and meditating to reduce stress seems vastly misplaced. As some have argued, this kind of approach completely ignores the systemic problem here, which is certainly real. Of course, there are some who argue that the “system” is really a scapegoat, that forcing physicians to pay more attention to metrics (which is probably necessary in an increasingly complex health care landscape) conflicts fundamentally with a medical culture that values autonomy and creativity.
Putting pressure on physicians to adhere to certain metrics means that they often have to follow a series of prescriptive steps, which physicians may resent in part due to their perception that their professional practice is in some ways an art. Some of the metrics represent important advances in improving the public’s health and are, therefore, worth physician time and effort. Nonetheless, the systemic issues in our health care system are real and should probably not be so easily dismissed as a major component of physician unhappiness and dissatisfaction with their work.
Regardless of what we think the exact causes are, and even if physician burnout is not actually on the rise, levels of burnout, stress, and depression in this profession are probably higher than they should be. So what are some possible solutions? Some have suggested that looking to other professions for tactics can be helpful.
For example, some potentially helpful tips include: implementing longer workdays fewer times a week and extending weekends, carving out time during the day specifically for peer support, and having leaders model self-care. In addition, there have been some new approaches implemented specifically in health care settings that might make a difference, including convening a wellness committee with an executive sponsor, creating an improvement team to specifically work on particular frustrations, and involving patients and caregivers in advocating for physician wellness and expressing gratitude when they are particularly pleased with physicians’ work. Yet it’s worth noting that none of these solutions are particularly based on evidence, and at the moment, we don’t really know what would work best.
The problem here is that these solutions once again ignore some of the more systemic issues that may be at the root of physician dissatisfaction. For starters, we actually need more information about the nature of the problem. We need to know not only if it’s actually getting better or worse (and consistently so across a number of years), but also whether this issue is better or worse in certain countries or health care systems.
While it might be difficult or impossible to draw absolute causal links between systemic issues and rates of burnout in such studies, it’s still worth investigating for clues as to what kind of systemic conditions optimize physician satisfaction and performance. In the meantime, we must realize that no single solution will solve this problem, but we do know that if the health care system is the problem, and there is certainly reason to believe it might be a large part of it, then the system needs to be addressed.