August 27, 2018

In looking ahead at the program for ANESTHESIOLOGY^® 2018 in San Francisco, we saw that the meeting will include a featured session on physician burnout led by Elizabeth Rebello, MD, FASA, and Christina Maslach, PhD. Their talk will delve into the causes of burnout and how to channel those insights to develop effective solutions, create work environments that prevent the problem from taking hold and systematically evaluate programs to identify best practices.

We can see why ASA chose to explore this topic this year. All evidence indicates that burnout remains a serious issue across healthcare—certainly among anesthesiologists and nurse anesthetists—and that the problem negatively impacts not only clinicians’ lives but also the quality and safety of care. In a comprehensive article for the ASA, Shena J. Scott, MBA, FACMPE, cites a NEJM Catalyst Insights Survey that echoes findings by Medscape and others showing that physician burnout levels continue to hover at about 50 percent. (For more information, see our eAlerts here and here and our Communiqué article here.)

Ms. Scott also notes the finding that 65 percent of physicians acknowledge burnout as a problem, but only 35 percent believe it impacts someone they know. “Truth be told, I would guess that every single person reading this article knows somebody who is experiencing these symptoms, someone for whom virtually every day is ‘just another bad day,’” she observes.

A review article published in the June issue of the Journal of Internal Medicine argues that both organizational and individual interventions are needed to tackle and remedy the depersonalization, emotional exhaustion and reduced feelings of accomplishment that are the hallmarks of this pervasive condition.

“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.”

As others have done, the article stresses that 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.

The authors report that more longitudinal and other studies are needed, but that evidence so far indicates the following strategies can yield at least moderate reductions in burnout, and that 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.  We look forward to learning more about this important issue in October.

With best wishes,

Tony Mira
President and CEO