Physician burnout a threat to docs and patients

Concerted effort needed to address widespread problem

A RECENT STUDY published in Annals of Internal Medicine found that physician burnout costs the US health care system $4.6 billion each year. In addition to the economic strain this puts on an industry desperately trying to combat rising expenses, there is a profound human cost to this epidemic. More than 40 percent of physicians across the country have exhibited at least one symptom of burnout, making them more likely to face depression, leave their practice, or even attempt suicide. This poses real threats to the health of our patients, leading to higher rates of medical errors.

It is increasingly clear that our current delivery system is failing to care for the very people responsible for our collective health and well-being. Few health care organizations have prioritized investment in burnout prevention. Indeed, many lack the resources and plans to begin this work. Regulators, policymakers, health plans and accrediting organizations can forge a clear path toward improving our current situation by coming together to address physician wellness with the same rigor and structure that we apply to patient safety. In that same vein, governing bodies should require burnout performance improvement programs now to help health care organizations stem the tide of this epidemic.

Twenty years ago, hundreds of thousands of preventable, yearly deaths exposed the country to the frightening gaps in the safety of our health care delivery system. These deaths ignited a movement. Large health systems invested millions of dollars to improve patient safety through an overhaul of work processes and organizational cultures, while state and federal oversight bodies and accrediting organizations embraced their oversight roles.

Burnout and the occupational health issues that challenge medical professionals are a result of similar work process shortcomings, which successfully catalyzed the patient safety movement. Last year, we saw the formation of a National Steering Committee for Patient Safety, which convenes voices from health care organizations, policymakers, regulators and advocates to develop a cohesive strategy for reducing harm in patient care. The same can happen to combat physician burnout.

There is a powerful opportunity to align disjointed activities at the state and federal levels. Regulators could coordinate resources with state physician health programs, state medical societies, and licensure boards to promote early detection and interventions to support, rather than punish, struggling doctors, as well as fund additional research into best practices and implementation of clinician wellness strategies. Fortunately, we are beginning to see leadership from the American Medical Association and the National Academy of Medicine promoting research and developing a potential path forward.

By incorporating burnout performance improvement as part of the reaccreditation process, governing bodies are likely to embrace their oversight and funding role(s) to combat burnout. Health systems can improve clinician wellness if they have effective ways of measuring it. The Joint Commission, the National Committee for Quality Assurance, and other state-based departments of health can help by coming together and adopting standardized ways to measure burnout. Together, their leadership will provide an effective frame to guide health care organizations as they progress through this work.

The Centers for Medicare and Medicaid Services (CMS), along with other payers and regulators, can also accelerate improvement by reducing burdensome administrative work that weighs down physicians. Doctors spend about two hours per day documenting in the electronic medical record (EMR) or billing for every hour they spend with patients. Much of this work does not improve patient care or health outcomes, but is done to satisfy regulatory and insurance requirements.

We applaud CMS for beginning to address these issues through its “Patients over Paperwork” initiative to reduce unnecessary administrative tasks. They can further support physicians by making it easier to delegate work that does not need their attention to other capable care providers such as medical assistants, clinical pharmacists, and non-physician advanced practitioners.

The multibillion dollar federal investment in the EMR industry creates a moral obligation for vendors to focus significant resources to make the EMR more navigable, facilitating documentation and other tedious tasks. Improving user interfaces, providing more effective decision support tools, and using artificial intelligence to automate the work of clinician EMR users will all help. We urge voluntary open-sourcing of interfaces to accelerate innovations to reduce burnout, which can vastly improve the doctor-patient relationship and help physicians get back to their jobs of caring for people.

At an organizational level, efforts to prevent burnout must be spearheaded and supported in the C-suite and boardroom. Last year, the National Academy of Medicine called for health care organizations to address physician health and well-being at the executive level.

One such strategy is for large health systems to incorporate chief wellness officers (CWOs) into their executive leadership teams. Policymakers and regulators should follow suit. Health and wellness champions bring important perspectives in assessing how organizational decisions might affect the well-being of employees, along with an understanding of how doable the work expected of physicians actually is.

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In addition, substantive leadership in the wellness domain may provide crucial oversight of wellness initiatives and resources that aim to improve the practice lives of physicians. This engaged leadership should focus on developing easier ways to develop and deploy EMRs, designing team-based approaches of care to support physicians, and facilitating cultural shifts to emphasize clinician wellness through programs such as retreats, mindfulness training and various forms of physician coaching.

The success of initiatives to improve patient quality, safety, and satisfaction exemplifies how we are capable of making quantum leaps forward when all parts of our unwieldy health care ecosystem focus, prioritize, and collaborate on needed changes. With a shortage of up to 120,000 physicians approaching in the next decade, we need all hands on deck to sustain the health and well-being of our workforce, our patients, and our health care system as a whole. Regulators, payers, and elected officials can help us right that ship.

Steve Strongwater, MD, is president & CEO of Atrius Health, the largest independent medical group in New England. Steven Adelman, MD, an associate professor of psychiatry at University of Massachusetts Medical School, is the medical director of Physician Health Services, Inc. and the creator of MedPEP, a podcast that tells the story of a young primary care physician battling burnout.