If you feel like your doctor just isn’t “into it” anymore, you might be right.
A survey in the Mayo Clinic Proceedings found that more than half of physicians in the United States are experiencing professional burnout.
The survey was conducted in partnership with the American Medical Association (AMA). Researchers compared data collected in 2011 with metrics from 2014. They also compared the data on doctors with American adults working in other fields.
“Burnout manifests as emotional exhaustion, loss of meaning in work, and feelings of ineffectiveness,” Dr. Tait Shanafelt, a hematologist at the Mayo Clinic, said in a statement. “More physicians in almost every specialty are feeling this way and that's not good for them, their families, the medical profession, or patients.”
In the 2011 survey, 45 percent of doctors met the burnout criteria. The highest rates were in general internal medicine, emergency medicine, and family medicine.
In 2014, that number rose to 54 percent of doctors reporting at least one burnout symptom. Their sense of work-life balance was down while work hours were up. Rates of depression remained about the same as in 2011.
Physicians in private practice were 33 percent more likely to experience burnout than professionals in academia. Doctors in emergency medicine, neurology, orthopedic surgery, physical/rehabilitation medicine, radiology, and urology were at greater risk of burning out, Shanafelt said.
It Will Take a Team Effort
Shanafelt told Healthline that the drivers of burnout include excessive workload, inefficiency, loss of control over work, problems with work-life integration, and a lack of meaning in work.
He said burnout is a systemic problem and doctors and health organizations will have to work together to solve it. Although individual remedies such as stress-management programs mean well, he said they aren’t enough.
“Healthcare organizations should focus on improving efficiency in the practice environment, delegate clerical tasks to support staff, and nurture a practice environment that cultivates flexibility and control,” he said.
Long Hours, Red Tape, and Infuriating Technology
Shanafelt noted that more than 40 percent of doctors in the 2014 survey reported working more than 60 hours a week while only about 7 percent of workers in other fields worked as many hours.
The medical field continues to go through unprecedented changes that include higher productivity expectations, consolidation of medical practices, narrowing of insurance networks, and shrinking reimbursements. These all play a role in burnout, Shanafelt said.
“New legislation and associated regulations have increased the clerical burden associated with every patient encounter,” he added. Technology intended to centralize and streamline processes is often more trouble than it is worth. The use of electronic systems and patient portals has “magnified rather than reduced clerical burden,” and are a “frequent source of interruptions and inefficiencies that detract from our interactions with patients.”
Dr. Clif Knight, senior vice president of medical education at the American Academy of Family Physicians (AAFP), agrees.
Knight hears constantly from physicians who say technology has contributed to frustration on the job. Some systems designed around billing and are not very user-friendly. They also require doctors to spend more time on administrative tasks and add to the hours they spend working.
Knight said there is not standardization in medical technology, so different systems may not work well with one another. That creates more work for doctors trying to access patient information from multiple sources and platforms.
“It becomes an obstacle between them and the patient,” Knight told Healthline. “It makes them feel like they’re actually providing lower-quality care than they used to. It really erodes their satisfaction.”
Knight and others said Obamacare doesn’t appear to be that big a factor in doctor burnout despite the fact some surveys show a majority of physicians don’t like the Affordable Care Act. He said the electronic records is a major factor and those were introduced before Obamacare was enacted.
Knight is concerned that burnout will contribute to the existing doctor shortage. “It’s potentially a big problem moving forward,” he said.
There’s no single solution to overcoming burnout but simplifying some of these technology platforms may help. The AAFP communicates with software vendors to hold them responsible for meeting “meaningful use” requirements while making platforms more efficient for doctors.
Focusing on Physician Satisfaction
Another issue is the physician culture, where feeling burned out is seen as weak, Knight noted. Doctors are humans, so they need to recharge like the rest of us. Remedies may include more vacation time and integrating self-care strategies in a way that fits into the doctor’s schedule.
“Part of it is helping physicians with feeling OK with taking care of themselves,” Knight said.
Dr. Christine A. Sinsky, an Iowa-based doctor who serves on the AMA’s advisory panel on physician satisfaction, cited a RAND Corporation and AMA study that found the most important driver of satisfaction for doctors is the ability to deliver quality care and spending enough time with patients.
“I think we need to recognize that clinical excellence depends on operational efficiency and care team well-being. The women and men in healthcare are running out of reserve,” she told Healthline.“We have to transform the environment so health professionals can do the work they have trained for and dedicated their lives to—caring for patients.”
At Brigham and Women’s Hospital in Boston, Dr. Jo Shapiro, leads an initiative that is trying to do just that. She is the director of the Center for Professionalism and Peer Support, whichpromotes clinician resilience and well-being.
“I have personally witnessed the devastating consequences to colleagues when things go wrong in caring for a patient, including feelings of shame, incompetence, fear, anger, sadness, and isolation,” Shapiro said. “By not helping each other deal with this emotional fallout, we risk leaving our colleagues in a state of isolation and pain that can lead to many negative consequences including emotional burnout.”
Her team also works to support professional behavior between all healthcare workers that fosters a more positive environment.
Solutions like the one at Shapiro’s facility are just some ways to prevent and alleviate burnout, something the survey has put in the spotlight.
“In the three-year period 2011 to 2014, we’ve lost ground,” Knight said. “At some point we are going to get to a tipping point. We’ve got to really look at this as a significant warning sign.”