It’s become impossible for the leaders of patient care organizations to escape the subject of physician burnout; that issue has become the subject of innumerable articles, blogs, research reports, and discussion panels at the most prestigious and high-profiles across the U.S. And that level of prominence is for good reason: if significant numbers of physicians decide that practicing medicine is simply too stressful an endeavor, the U.S. healthcare system is headed for a real disaster: with the Baby Boomers aging and levels of chronic disease exploding, American society will lack the supply of doctors needed to care for patients, healthcare system-wide.
Anecdotally speaking, the stories have become omnipresent. But how accurately are studies, surveys, and reports conveying the phenomenon? And what are the latest trends? Well, as Healthcare Innovation Managing Editor Rajiv Leventhal reported on Feb. 22, “A study recently published in the February issue of Mayo Clinic Proceedings, conducted by researchers from the AMA, the Mayo Clinic and Stanford University School of Medicine found 44 percent of U.S. physicians exhibited at least one symptom of burnout in 2017, compared with 54 percent in 2014 and 46 percent in 2011. In comparison, the overall prevalence of burnout among U.S. workers was 28. percent in 2017, similar to levels found in 2014 (28 percent) and 2011 (29 percent).”
That study, published under the title “Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017,” and authored by a team of eight researchers led by Spencer A. Bezalel, M.D., was a significant nationwide study, encompassing 5,197 surveyed completed by practicing physicians nationwide (out of 30,456 physicians who had been solicited to participate), and with a secondary survey of 248 physicians who had been contacted after not responding during the first round. As the researchers reported, “When assessed using the Maslach Burnout Inventory, 43.9 percent (2147 of 4893) of the physicians who completed the MBI reported at least one symptom of burnout in 2017 compared with 54.4 percent (3680 of 6767) in 2014 and 45.5 percent (3310 of 7227) in 2011. Satisfaction with work-life integration,” the authors wrote, “ was more favorable in 2017 (42.7 percent) than in 2014 (40.9 percent), but less favorable than in 2011 (48.5 percent). On multivariate analysis adjusting for age, sex, relationship status, and hours worked per week, physicians were at increased risk for burnout… and were less likely to be satisfied with work-life integration… than other working US adults.”
Drilling down a bit, survey respondents were probed for symptoms of burnout (as “measured using the emotional exhaustion and depersonalization scales of the Maslach Burnout Inventory (MBI)), symptoms of depression, and for their evaluation of “work-life integration,” based on the degree to which they agreed with the statement, ““My work schedule leaves me enough time for my personal/family life.”
The researchers noted in their Mayo Clinic Proceedings article that “A more nuanced picture emerged when comparing differences in burnout by specialty at each time point (2011, 2014, 2017), with some specialties experiencing minimal change in the proportion with burnout during the interval (e.g., obstetrics and gynecology) and most hitting a peak in burnout in 2014. For some specialties, the proportion burned out in 2017 was lower than in 2011 (e.g., anesthesiology, emergency medicine, orthopedic surgery) whereas for others the proportion with burnout remained higher in 2017 than in 2011 (e.g., dermatology) even though it was lower than in 2014.”
Speaking qualitatively about these findings, the researchers wrote, “The current prevalence of burnout among US physicians appears to be lower than in 2014 and near 2011 levels. This trend is encouraging and suggests improvement is possible despite the numerous contributing factors and complexity of the problem. Although the improvement is good news, symptoms of burnout remain a pervasive problem, and its prevalence among physicians continues to be markedly higher than in the general US working population, even after adjustment for differences in hours worked, age, sex, and relationship status. Notably, the improvement in burnout among physicians has not been realized equally across all specialties, as levels remain higher than in 2011 for many disciplines.”
Looking at the recent landscape of factors in physician practice, the authors wrote, “It is possible that 2014 was a particularly challenging time because of consolidation of hospitals and medical groups, a number of new regulatory factors, increasing EHR [electronic health record] penetration, and increased administrative burden. The situation may be improving as physicians and organizations adapt to the new practice environment. It is also possible that the prevalence of burnout improved due to burned out physicians leaving the workforce or reducing clinical effort.9 It should be noted, however, that many large-scale efforts have been initiated at the national level to address this issue.18, 19, 38, 39, 40, 41 Even though they are still in their early stages, these efforts may have already made a difference: people are talking about the problems, individuals recognize that they are not alone, and the visible leadership by influential national organizations and accrediting bodies (eg, National Academy of Medicine, AMA, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, the Joint Commission, American College of Physicians, Accreditation Council for Continuing Medical Education) engaging regulators, payers, and other organizations may provide optimism for meaningful change. Many organizations have also made substantive efforts to improve the efficiency of the practice environment through better team-based care, documentation assistance, and streamlined workflows.” Meanwhile, the researchers remain concerned about physician burnout in general, essentially concluding that we as a healthcare system aren’t out of the woods yet.
So what can CIOs, CMIOs, and other informatics leaders in patient care organizations take from all of this? A lot, actually. For one thing, this study is one of the most comprehensive of its type so far, in terms of conceptual scope, number of participants, and analysis. And that’s very important, as most previous analyses were have generally been based on quick online surveys, with fairly superficial analysis.
More substantively, this study validates a lot of what has been known, but adds intriguing glosses on top of it. My sense is that these researchers have hit on something important: absolutely, most physicians have been getting up on the wrong side of the bed for the past several years, when it comes to EHRs and for physician documentation for everything around value-based care delivery and payment, as well as more broadly, in relation to all the administrative burdens they face now. But might physicians in practice be beginning to turn the corner in terms of their acceptance of working with technology? The answer seems to be a qualified yes.
And so now more than ever is the time for CIOs, CMIOs, and all healthcare IT leaders to redouble their efforts to improve the clinician end-user environment, in order to help physicians adapt fully to the emerging world in which they will all have to work for the foreseeable future, unless they leave the field or retire. So as we move into this new world, one in which we are on the verge of truly transformative open APIs, now is a time of great opportunity for informatics leaders to help move the entire industry forward in this area, one end-user encounter at a time.
