Fix the root cause of physician burnout. Not just the symptoms.

When I hung up my white coat for the last time and left the practice of medicine, the term, “physician burnout” was unfamiliar. It wasn’t until I stumbled across research studies many years later, in my work as a freelance writer, that I finally understood the underlying reasons that I needed to walk away. Today, you can’t read about health care without seeing the term. Does the widespread use of the phrase reflect heightened awareness or a growing problem among doctors?

A recent study from the Mayo Clinic and the American Medical Association (AMA) begins to answer this question. The three-year study of almost 7,000 physicians found that last year 54 percent of physicians surveyed had at least one symptom of burnout, up from 45 percent just three years before. In the meantime, burnout among people working in other professions remained the same.

The researchers make several suggestions about addressing the growing problem among the physician workforce, including: conducting more research to find ways to reduce burnout, improving the work environment, and recognizing that self-help is not sufficient.

The suggestions reflect a growing recognition — and my personal experience — that individual solutions to burnout, such as stress reduction techniques, resilience training, and mindfulness practice, are effective but not sufficient for dealing with the widespread problem among physicians. As part of the background research for a book I’m co-authoring on how health care organizations can prevent burnout, I spoke last week with Wayne Sotile, PhD, founder of the Center for Physician Resilience. He likened the current situation in health care to a five-way intersection with physicians standing at the cross road and no one directing traffic. “It’s as if we’re asking physicians, ‘Please stop getting injured,’ instead of installing a traffic signal to fix the problem.”

I was especially intrigued by this statement given that Sotile’s work is focused on improving the resilience of individual physicians to the effects of stress. If self-help solutions are insufficient, what needs to be done to effectively treat the problem? The answers may lie in understanding the factors that increase the risk of burnout among physicians.

In 2009 Mark Linzer, MD, and his team at University of Wisconsin, identified several factors in the practice environment that increase the risk of burnout, including the work pace or level of chaos, time pressure, lack of control over the practice environment, and discordance between the physician’s values and those of administrators.

With my current understanding, I now recognize that the primary cause of my burnout was constant concern about patient safety while practicing in chaotic work environments. Today, time pressure and documentation requirements may be more important factors. Together, they represent the number one complaint of the burned out physicians that I’ve interviewed over the past two years.

One hospital-based internist told me that it was the hours of required documentation in the electronic health record that pushed her to leave. “If I took the time to actually talk with my patients, which is what drew me to medicine in the first place, it meant I fell behind and then spent hours and hours at home in the evening doing the required data entry.”

National groups and individual health care organizations are beginning to test solutions to prevent burnout. Increasingly, these groups are looking for ways to change the environment in which physicians practice, rather than simply provide self-help strategies. Stanford has launched a time banking program that allows busy physicians to receive credits for delivered meals and help with household tasks in exchange for mentoring and other uncompensated work that is usually tacked onto an already long workday. The AMA recently initiated the STEPS Forward program, which provides access to free resources for self-care and for improving workflow and other aspects of the practice environment to reduce burnout, based in part on Linzer’s research.

At Linzer’s hospital, burnout is measured among all doctors, and his team recommends specific solutions for each department. One department had especially high burnout scores. The team determined that a key stressor for the doctors, many of whom were parents of young children, was inflexible office hours. The physicians often were pulled between the need to stay late with a patient and the need to pick up their child on time from daycare. With a simple policy change, the doctors were able to begin seeing patients earlier and leave work on time. With this and other targeted changes, burnout rates in the department dropped substantially.

Although it is disheartening to learn that burnout is on the upswing, as a physician who left her chosen profession and has interviewed scores of burned out physicians, the new research findings substantiate both the magnitude of the problem and the importance of fixing the root cause — a faulty system — rather than the symptoms alone. Also, perhaps increased attention to the problem will remove the stigma attached to burnout: None of the doctors I’ve interviewed would speak publicly about their experience. Addressing physician burnout in ways that are truly effective will benefit doctors and the patients they serve.

Diane W. Shannon is an internal medicine physician.  A version of this article originally appeared in WBUR’s CommonHealth.

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