HEALTHCARE FEEL THE BURNOUT
through the years such as M*A*S*H, St. Elsewhere, ER, Scrubs, House, and Grey’s Anatomy punctured the image of the tireless, infallible doctor. Doctors are still often glamorized, but unlike how they were portrayed in earlier TV classics such as Dr. Kildare, Ben Casey, and Marcus Welby, M.D., their flaws are more commonly dramatized, their personal lives explored more intensely, their anxieties and vulnerabilities more readily acknowledged. Still, it may surprise some that widespread burnout in the health care industry has been a concern for more than a decade. Defined by the American Medical Association as “a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement, and a lack of empathy for patients,” burnout is even a metric that health care organizations track and monitor. For the first time since 2011, the physician burnout rate has dipped below 50 percent among doctors in the U.S., according to a new triennial study by the AMA, the Mayo Clinic, and the Stanford University School of Medicine. Almost 44 percent of U.S. physicians exhibited at least one symptom of burnout in 2017, compared with 54.4 percent in 2014 and 45.5 percent in 2011. And the syndrome has a hefty price tag: Doctor burnout costs the U.S. health care system $4.6 billion a year in physician turnover and reduced clinical hours, according to a study published in the Annals of Internal Medicine in May. Factor in recruiting, onboarding, impact on those covering extra shifts, and loss of revenue or opportunity cost, the cost of replacing a doctor in an organization can be exorbitant. Patients suffer, too. Doctors who leave medicine midcareer cause patients to start over again with a new doctor. Other physicians who cut back their hours — especially in communities with an acute shortage such as Southern Nevada — make it more difficult for patients to obtain timely appointments. And a research review in the British Medical Journal in 2017 concluded that “there is moderate evidence that burnout is associated with safety-related quality of care.” It’s not hard to imagine tired, distracted, and exasperated doctors exhibiting impaired memory, lack of attention, and poor decision-making. Unnecessary testing, misprescribing medications, and errors
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RX TO RELAX Anne Weisman, UNLV School of Medicine’s director of wellness and integrative medicine, encourages medical students to use relaxation techniques to avoid burnout.
in surgery are among the many serious ways patients’ well-being can be affected. “The tide has not yet turned on the physician burnout crisis,” says Dr. Barbara L. McAneny, AMA president. “Despite improvements in the last three years, burnout levels remain much higher among physicians than other U.S. workers, a gap inflamed as the bureaucracy of modern medicine interferes with patient care and inflicts a toll on the well-being of physicians.” The stakes involve more than improving patient outcomes and reducing doctor turnover. More alarming is the estimate that one doctor commits suicide in the U.S. every day — the highest suicide rate of any profession, according to findings presented at the American Psychiatric Association’s 2018 annual meeting. The number of doctor suicides — 28 to 40 per 100,000 — is more than twice that of the general population. The study also showed that some of the most common diagnoses for doctors are mood disorders, alcoholism, and substance abuse. EXHAUSTED DOCS SYMPTOMS OF BURNOUT, applicable to people
in other professions, are most disconcerting as patients await trained medical care in
an exam room, an ER, or surgical suite. In a hospital, the stakes are higher and the causes of stress are stronger. Doctors’ typical stressors, according to Dr. Dike Drummond, a Mayo-trained family practice physician and the founder and CEO of thehappymd.com: having a high level of responsibility and little control over the outcome; encounters with sick, scared, or hurting people with accompanying emotional needs; lack of work-life balance; leadership roles for which they were not trained; the sense that they are the bottleneck in providing health care; isolation behind the exam room’s closed door; confusing financial incentives; a hostile legal environment; and documentation requirements. The doctor burnout dilemma calls for a broader strategy beyond self-awareness and meditation, including building out a proper staff to reduce the stress load on doctors in the first place. Health care organizations are realizing they must find ways to enable doctors to spend more of their time doing what they were trained for — instead of incessant management tasks and cumbersome electronic medical records. It’s a topic that seems to be gaining traction in hospitals and health care organizations, says Dr. Dylan Wint, a neurologist with the Cleveland Clinic Lou Ruvo Center for Brain Health.