The 9 Sources from a Chat on Physician Burnout
Something that cannot be debated is the level of effort put into understanding, diagnosing, and treating the US physician burnout epidemic. Recent efforts to comprehensively assess the matter are overwhelming, and enough to provide foundation for the development of real progress at whatever level.
That effort was celebrated in this week’s MD Magazine® #DocTalk Tweet Chat, hosted by Janae Sharp. The non-profit Sharp Index organization founder led a 90-minute discussion online on the fight to find physician burnout solutions with a few dozen fellow organizers, physicians, and members of the media.
Through the eight-topic chat, a litany of sources documenting everything—from burnout’s origin to individual system’s strategies against it—were shared and dissected. In case you missed the chat, here’s the resources that led it.
The scope of burnout
This September 2018 study, published online in JAMA and covered by MD Mag, detailed a specialty-by-specialty breakdown of resident burnout prevalence. The national study was the first of its kind to focus on resident physicians, and found that urology, neurology, and ophthalmology carried the greatest rates of burnt out residents.
T2 As a healthcare reporter, I’ve come to appreciate the efforts by which researchers assess burnout categorically: how it presents, when does it most frequently present, and even in what specialties? #DocTalk #MedTwitter https://t.co/sXKF16adBy https://t.co/IQo2S6tiXK— Kevin Kunzmann (@NotADoctorKevin) July 24, 2019
It also reported that female residents were at a greater risk for burnout symptoms than their male counterparts, and that 45.2% of all surveyed residents reported having at least 1 weekly symptom of burnout. Symptoms of burnout, investigators found, was associated with a three-fold greater risk of career regret among residents.
The prevalence of burnout among residents in the most affected specialties was consistent with findings assessing burnout in non-resident physicians.
“In general surgery, the writing is on the wall,” Pearl wrote. “The toughest and most interesting procedures—the surgeries that once defined their mastery—have been stripped away inside most clinical settings.”
AJMC, meta-analysis research from JAMA Internal Medicine published in late 2018 showed physician burnout is associated with a two-fold greater risk for patient safety incident involvement among a pool of 40,000 primary care and hospital physicians.
Investigators from the meta-analyses also noted the association between burnout and patient safety incident involvement did not differ significantly across the phases of a physician’s career. Similarly consistent was the byproduct’s effect on the overall healthcare system—both in terms of patient care and costs.
“Physician burnout is associated with a reduced efficiency of healthcare systems to deliver high-quality, safe care to patients,” wrote the researchers. “Preventable adverse events cost several billions of dollars to healthcare systems every year.”
The cost of the issue
They also anticipate that $4.6 billion—the same cost recently marked as the current value of the New York Yankees—is an underestimation.
“There’s been a growing awareness of physician burnout,” Harvard visiting scholar Joel Goh explained. “But as a health care executive, when you’re trying to make a decision you want all the evidence, all the data, in front of you. And if you’re trying to quantify the dollars and cents, addressing this may be worthwhile even from a business point of view.”
Sharp also shared a 2016 article from the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network which detailed how depersonalization, a common byproduct of burnout, is associated with worsened patient interaction and eventually, their treatment.
In healthcare- some claim it leads to worse patient care.— janae sharp (@CoherenceMed) July 24, 2019
I don't know what I think about that- but I know it isn't good for physicians to work in a place they hate.#DocTalk@NatsforDocs @ETSshow @DrMStiegler https://t.co/Oh2SdbOASz
Medical errors, already among the leading causes of death in US healthcare, could continue to rise with the rate of physician burnout. Of course, it’s not only the wellbeing of patients that are risk.
The solutions we know
Over a decade ago, the Cleveland Clinic debuted their Code Lavender program, a holistic care response designed to provide immediate and intensive emotional or spiritual support to at-need physicians and patients—in the same spirit as fire or medical emergencies given different color codes.
Found the article! It was "Code Lavender" they used. Here's the link: https://t.co/vlYmTrlGR1— AJ Montpetit (@ajmontpetit) July 24, 2019
Within 30 minutes of the alert, a team of holistic nurses arrive, offering food and water, Reiki and massages, and a lavender arm band reminding the wearer to relax throughout the day. The clinic originally intended to provide the service for patients and their families, but quickly realized it equally benefitted burnt out personnel.
Others have turned to more clinically-driven responses.
Acknowledging that technology’s role is only bound to increase in medicine, and that problems can become solutions, lends to Lavoie’s belief that tech developers are in the drivers seat to improve healthcare.
“At a minimum, improving the technology that most frustrates doctors – the EHR – should reduce physician dissatisfaction,” she wrote.
All at once, this scholarship attempts to do the following: Aid in reducing medical school or college loan debt; drive future physician interest in efforts to improve the healthcare workplace; and bring attention to physician burnout among the non-healthcare community.
As so much of the #DocTalk chat highlighted this week, major burdens caused by burnout are in the healthcare economy, the state of patient care, and in the overall wellbeing of care providers. Any thoughtful response to the many facets of burnout is enough to warrant hope and inspiration for others to do the same.