Dirty secret about physician burnout: it’s all too real, and patient safety at risk.

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The News:

The American College of Physicians (ACP) recently called for healthcare organizations and other stakeholders to address physician burnout and stress, among other measures, as a means to improve patient safety in ambulatory settings, according to MedPage Today.

“Burnout and stress may affect patient safety in various ways,” wrote the authors of the ACP’s new policy paper, Patient Safety in the Office-Based Practice Setting (pdf).

“Emotional exhaustion, which is linked to standardized mortality ratios among intensive care units, may affect cognitive and physical ability to perform tasks and diminish memory and attention, lessening ability to attend to details and process highly technical information; mental detachment and deficiencies in personal accomplishment may cause individuals to neglect duties or complete seemingly minor but crucial patient safety activities,” the authors continued.

The paper, published last month, went on to support the National Patient Safety Foundation’s recommendations that organizations should strive to improve working conditions and staff resiliency, and that programs should include fatigue management systems, and communication, apology, and resolution skills.

The ACA paper was prompted in large part by new research showing that burnout has led 1 in 5 doctors to plan to reduce their clinical hours. And roughly 1 in 50 plans to leave medicine altogether within the next two years, according to FierceHealthcare.

study of professional satisfaction among 6,880 physicians practicing in the United States conducted by researchers at the Mayo Clinic, American Medical Association and Stanford University indicates that burnout continues to trouble many physicians, who said they were inclined to leave the field within the next two years.

The survey’s results, published in the latest issue of the Mayo Clinic Proceedings, suggest that physician attrition hurts access to care and impedes continuity of care. Given what it costs for healthcare organizations to replace physicians, coupled with an existing shortage of primary care doctors, the authors indicate the healthcare system and society in general should be worried.

Using national data, if approximately a third of the physicians suggesting they might leave the workforce in the next two years in fact do, the authors see a loss equivalent in each year of roughly 4,759 physicians, which amounts to the combined average graduating classes from 19 medical schools.

Burnout’s prevalence among the reasons physicians give for leaving the field has led Kristine D. Olson, MD, of Yale School of Medicine to suggest in an opinion piece published in the same issue that healthcare policymakers sit up and take notice.

“America’s physicians are the canary in the coal mine,” said AMA President David O. Barbe, MD, in a statement.

His organization is pushing decision-makers to take steps to curb burnout before it’s too late, in particular by promoting physicians’ well-being. The study cites administrative fatigue stemming from bureaucratic pressure, as well as dissatisfaction with electronic health record (HER) technology, as the problem’s primary contributing factors.

Olson suggests healthcare providers monitor their physicians’ well-being to detect and act on factors frustrating doctors before they cause downstream effects on patient care. Even before physicians physically leave a practice, she writes, they may withdraw psychologically, exposing patients to a higher risk of medical errors.

Steve’s Take:

Most of these researchers (cited above) are physicians, and it is they who say society in general–that means all of us–should be worried about burnout that leads to attrition. Now, that really worries me; a lot more than before I read these straightforward, unequivocal findings.

So, the physician burnout (PB) issue, with which most of us have become vaguely familiar in recent years, is truly out in the open.

Steve's Take: I don’t know about you, but I want all my #doctors to be happy. Click To Tweet

I’m fortunate to count as friends several physicians who serve on the editorial advisory board of an organization I co-founded some eight years ago called The Physician’s Index for Ethics in Medicine.

What sets these bioethicists apart from my coterie of healthcare providers, such as my primary care doctor, my cardiologist, my dermatologist, pulmonologist and neurologist, is they are brutally frank about the problems in their profession. Problems like the ones referred to in the news items above on PB; along with the routine ethical dilemmas they encounter as clinicians.

According to the Mayo Clinic findings, it’s likely one of my five doctors isn’t happy. But which one? And why?

PB is worsening, but organizations and individuals can counter the trend, speakers asserted at a prestigious conference on the topic. Good leadership and self-compassion are key to tackling the problem, they argue.

“This is not just individuals acting out,” said Lloyd Minor, MD, dean of the Stanford School of Medicine. “This is a systemic issue that we face in the profession.”

The American Conference on Physician Health, which took place Oct. 12-13 in San Francisco, featured a range of speakers, from medical students to experts on PB. They shared personal experiences, presented research and offered tips on coping with stress. The conference’s other co-sponsors were the American Medical Association and the Mayo Clinic.

Tait Shanafelt, MD, the chief wellness officer at Stanford Medicine, noted that nearly half of physicians–45%–currently show at least one symptom of burnout. Not only do burned-out physicians provide lower-quality care, he noted, but replacing physicians who leave because of burnout costs the United States $5 billion a year.

He added that the problem can spiral within an organization: “There’s an infectious component of burnout,”Shanafelt said. Other members of the care team “learn cynicism.”

Conference speakers agreed that administrative requirements–such as entering information into electronic health records, or EHRs, and filling prescriptions–contribute to physician unhappiness. But they also blamed a toxic culture in many health care organizations, along with a tendency among physicians to deny their own suffering.

Abraham Verghese, MD, professor of medicine at Stanford and an award-winning author, discussed one of the most pernicious effects of physician unhappiness: suicide. When he asked conference attendees if they knew fellow physicians who had killed themselves, nearly all raised their hands.

“Every year it takes three medical school classes to replace the physicians who committed suicide,” Verghese said.

Verghese related the story of his friend David Smith, the subject of his book The Tennis Partner, who struggled with addiction before shooting himself. He said that the “loneliness of doctors” enabled Smith’s addiction.

“We rarely expose our emotions,” Verghese said. “There’s a fear of showing weakness.”

Kelly McGonigal, PhD, a health psychology lecturer at Stanford, encouraged conference attendees to practice “self-compassion.”

Noting that while perfectionism “can get people into the medical profession,” McGonigal said that “it can be toxic when paired with a belief system of being hard on yourself.”

Creating a culture in healthcare organizations that encourages physicians’ well-being starts with placing the right people in leadership positions, said Vivek Murthy, MD, a former US surgeon general. Organizations should hire people for the way they treat others, he said, not for their ability to win a Nobel Prize.

“Kindness is spread more quickly than infectious diseases,” Murthy said.

Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association, said organizations can save three to five hours a day of physicians’ work time by simply re-engineering practices. She provided an example of a physician whose two medical assistants take care of the administrative work. They accompany him to patient rooms, where they type information into the EHR; they also renew prescriptions and retrieve lab results.

Bottom Line:

Having a group of physicians/bioethicists from which to hear firsthand about the serious problem leads me to the following conclusion. Many, if not most, physicians have wound up practicing medicine far from the manner they dreamed when they were much younger.

I’m talking way before they entered medical school. Probably more in the vein of such TV series like Dr. Kildare in the 60s, or Marcus Welby, MD, in the 70s. (All right, I’m dating myself.) The same can be said about many of us lawyers.

A few simple equipment fixes–such as using card readers instead of requiring passwords, and having printers in patient rooms–can also shave time off a physician’s day, Dr. Sinsky added.

She’s got the right perspective and can-do attitude, and we all can hope these simple ideas will ameliorate the PB crisis. I don’t know about you, but I want all my doctors to be happy. Well, I can hope.