We are in the midst of an epidemic of physician burnout, depression and suicide. Although the causes are debatable, there can be little doubt that increasing demands for financial performance and patient satisfaction, decreasing autonomy, and physicians’ individual liability for systemic risk management decisions in a majority of practice settings are significant contributors to these adverse outcomes.
At the same time physician burnout, depression, and suicide rates have been rising; tremendous progress has been made in both the culture of safety and reduction of iatrogenic harms in large U.S. health care organizations over the past 20 years. A key driver of these improvements has been CMS-mandated public disclosure of patient safety and satisfaction data for hospitals. Although much work remains to be done, this mandated disclosure has been highly successful at forcing organizations to address and reduce systemic safety risks.
Physicians have been at the “sharp end” of many systemic changes wrought by public disclosure of safety and performance data, yet the well-being of physicians themselves has never been a focus of these data. I propose that the most promising strategy for reducing physician burnout, depression and suicide is to apply the same data-driven approach to these outcomes that has been successfully used to improve patient safety: Health care systems should track and publicly disclose data on physician satisfaction, burnout, and suicide just as they disclose HCAHPS scores, hospital-acquired infections, and other required metrics.
Undoubtedly some health care administrators will object to this proposal, arguing that physician burnout is a self-care issue and depression is a licensing matter. However, there is growing evidence that burnout is a precursor to depression. Moreover, we know physician burnout correlates inversely with the quality of patient care, and we know some health care organizations are better at preventing burnout than others. For organizations that are ahead of the curve in these areas, publicly posting the data would offer a competitive business advantage in the form of improved recruitment and retention for both physicians and patients. For those who are behind the curve, it would provide a needed incentive to begin remediating the problem.
Some may also argue that it is impossible to know whether suicide was the cause of a doctor’s death, or that protecting the privacy of doctors who commit suicide precludes disclosing suicide rate information. These arguments are no more credible than claiming we can’t really know whether a patient died from iatrogenic causes, or that hospital mortality rates must be suppressed to protect the privacy of patients. The fact is that health care systems are excellent at gathering data when their reimbursement depends on it. Furthermore, there are some health care systems that appear to have a problem with recurrent physician suicides. In this data-driven age, those organizations can be held publicly accountable while still protecting the privacy of the deceased.
I challenge progressive health care organizations to begin collecting and publicly disclosing physician satisfaction, burnout, and suicide rates voluntarily. I further challenge the Centers for Medicare and Medicaid Services and The Joint Commission to take action by requiring hospitals, training programs and other health care organizations to gather and disclose physician satisfaction data, burnout rates and suicide rates within their systems just as they do for hospital readmission data, postsurgical complications and other important quality metrics. Their doctors’ and their patients’ lives depend on it.
Joshua Sonkiss is a psychiatrist.
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