July 5, 2018

The depersonalization, emotional exhaustion and reduced feelings of accomplishment that characterize the phenomenon known as physician burnout—and that remain endemic in healthcare—call for a combination of organizational and individual interventions, a review published in June issue of the Journal of Internal Medicine reports.

“Both individual‐focused and structural or organizational solutions are required to address physician burnout, and a growing body of evidence confirms that both approaches can be effective,” according to researchers from Mayo Clinic and Stanford University.  “Importantly, not only do both categories of approaches offer at least modest benefit, but both are necessary, and addressing physician burnout should be viewed as a shared responsibility across healthcare systems, organizations, institutions and individual physicians.”

Current estimates point to a burnout prevalence rate of approximately 50 percent among physicians. This simmering public health crisis negatively impacts patients and healthcare organizations as well as individual physicians. Driving factors include excessive workloads, inefficient work processes, clerical burdens, work–home conflicts, lack of input or control for physicians with respect to issues affecting their work lives, and problems with organizational support structures and leadership culture. On an individual level, burnout prevalence tends to be higher among younger physicians and female physicians, the authors note.

Why is Physician Burnout Important?  The Impact on Patients, Systems and Physicians

Source:  Journal of Internal Medicine, June 2018.

Although more longitudinal and other studies are needed, evidence indicates the following strategies can yield at least moderate reductions in burnout, according to the review.  These interventions work best when they are aligned with specific causes, such as excessive workloads or loss of meaning from work.

Organizational-level solutions

• Fair productivity targets
• Duty hour limits
• Appropriate distribution of job roles
• Optimized electronic medical records
• Nonphysician staff support to offload clerical burdens
• Appropriate interpretation of regulatory requirements
• Respect for home responsibilities in setting schedules for work and meetings
• Include all required work tasks within expected work hours
• Support flexible work schedules, including part-time employment
• Physician engagement in establishing work requirements and structure
• Physician leadership and shared decision-making
• Promote shared core values
• Protect physician time with patients
• Promote physician communities
• Offer professional development opportunities
• Leadership training and awareness around physician burnout

Individual-level solutions:

• Part-time status
• Efficiency and skills training
• Prioritize tasks and delegate work appropriately
• Reflect on life priorities and values
• Attention to self-care
• Stress management and resiliency training
• Positive coping strategies
• Mindfulness
• Reflection/self-awareness of most fulfilling work roles
• Engagement in physician small-group activities around shared work experiences

“For medicine to fulfil its mission for patients and for public health, all stakeholders in healthcare delivery must work together to develop and implement effective remedies for physician burnout,” the authors conclude.