Burnout: Don’t blame the clinicians; blame the system

Physician burnout is the depression of the medical world. We are aware of its presence and the detriment it can cause, but yet, we don’t really like to talk about it. The problem is, just like depression, if we don’t talk about it or seek to address it, it persists and leads to a number of unwanted outcomes including decreased productivity, decreased patient satisfaction, and increase in medical errors. And if you are one of those, who thinks this only occurs to a select few, I want you to rethink that. Most statistics suggest that 50 percent of physicians have experienced burnout at one time or another. Thus, you have more than likely already met a burnt out physician. That physician who was always pleasant, but now is receiving complaints from patients about their professionalism or behavior. The physician who was always vocal and passionate, but now you rarely hear a word from. And then there’s the physician who just seems tired and quite frankly, depressed. You have met one of us.

Maybe you didn’t put it all quite together at the time, but you have. It is a topic on the forefront of my mind in daily practice as a primary care provider and having experienced it firsthand; I have made increasing efforts over the last several months to push for acknowledgment of it as a problem that needs to be addressed.

What I find happens when the topic is brought up, however, is no one likes to talk about it. I get some nods, and people agree that it occurs within our healthcare system, but no one really wants to do anything about it. If anything, we allow our physicians to fester in their burnout until it leads to a poor patient outcome, a physician leaving medical practice or cutting down on hours, or at its worse, physician suicide before we take any action to improve physician wellness.

We need to make an effort to make it a widespread practice to look for signs of physician burnout before it becomes a problem. Models of how this can be done have been adopted by major healthcare institutions but have yet to reach a majority of physicians. We often times screen our patients for depression with scales such as the PHQ-9 at routine annual visits. Something similar should be done for physicians on an annual basis as well as education to help physicians to be aware of signs of burnout in themselves.

After we identify burnout and the extent of the problem, we next need to address it. What ways can we support physicians and at the same time support the “productivity” needs of hospital administrators? There needs to be a balance. Systems that work to improve workflow and lessen the burden of physician tasks will allow for better physician support and overall satisfaction. Other tactics that have been tried include the idea of “trading time.”

Perhaps clinical time is traded for non-clinical time such as committee time or volunteering efforts that bring awareness to the organization. This can help provide more meaning and fulfillment for a physician. Included in this, is also the idea of giving providers back “time” by helping them with support services at home. For instance, a pilot program at Stanford allowed physicians to trade in time spent on committees with in-home services such as cleaning and meal delivery.

We often hear that our medical system is broken. A large part of this is that our providers are broken. Until we start to make conscious efforts to put the pieces back together for our physicians, we will continue in this vicious cycle of provider dissatisfaction, poor clinical outcomes, and patient dissatisfaction. Furthermore, please don’t try to improve the situation solely by giving us methods to cope better or to be stronger individuals. Most times, it is not the individual that is the problem; it is the system. Besides, you probably realize by now, it is the strongest of us that often takes the biggest fall.

Anh Le is an internal medicine-pediatrics physician.

Image credit: Shutterstock.com

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