Physician Burnout: A Leading Indicator of Health Performance and "Head-Down" Mentality in Medical Education-I/In Reply

• Published in: Mayo Clinic proceedings Vol. 93; no. 4; pp. 544 - 547
• Main Authors: Kaushik, Prashant, Olson, Kristine D
• Format: Journal Article
• Language: English
• Published: Rochester Elsevier Limited 01.04.2018
• Subjects: Activities of daily living; Burnout; Editorials; Electronic medical records; Health care policy; Health education; Job satisfaction; Medicine; Physicians; Primary care; Professionals; Systematic review; Web sites; Work life balance; Yoga; United States > US
• ISSN: 0025-6196

[...]without undermining the need for transformation of the health care system, a more pragmatic, quick, and sustainable approach to address this issue should be geared toward providing physicians at any level of their career anywhere on the planet with a "tool bag" for self-care. Stressors have been identified as lack of value-alignment with leadership, lack of control over workloads, working at a hectic pace in a chaotic inefficient atmosphere, and ineffective teamwork1 to manage time-consuming administrative and regulatory tasks,2 expanding requirements to accomplish more during shorter visits with patients who have more complex comorbidities, and restrictions to and reimbursements for goods and services.3 The electronic health record has become omnipresent at patient encounters, altering workflow, prompting and tracking metrics, and linking stakeholders. Electronic health records compelled computerized physician order entry and increased clerical burdens,4 made clerical work possible 24-7, and became a common and formidable stressor.1 Physicians reported a lack of time for the more meaningful aspects of work-patient care, scholarship, administration.5 They express discrepancies between what they expected of their careers and their actual work life.6 They reported stress tied to threat of liability, educational debt, and lack of work-life balance.7 The work itself entails managing illness and injury, preventing death and disability, easing suffering. "1 Eighty-six percent of physicians felt that their perspectives were not taken into account in crafting health care legislation,10 which also accelerated the vertical integration of physicians into large hospital organizations as employees.11 Now, the "quadruple aim" recognizes physicians' wellbeing as a reflection of their perspectives on system performance and quality care for patients.12 Pioneering health care organizations have recognized the value of engaging physicians' perspectives13,14 and are discovering it can generate innovation and efficiency15 and higher-quality care at lower costs with better satisfaction scores for patients and physicians.16,17 Physicians' satisfaction is closely tied to their sense of agency to produce high-quality patient-centered care, in collaboration with the clinical team, colleagues, and leadership.18,19 Physician partnership also facilitates the organizations' priorities.19,20 Vanguard organizations are creating a culture of wellness (mission-aligned leadership, teamwork, collegiality, for meaning in work), managing the bureaucratic machine away from the clinical arena, partnering with clinicians to improve workplace efficiency to support clinical work, and facilitating work-life balance and personal resiliency.13,14,21-23 Such organizations measure and monitor the wellbeing of the physician workforce via wellness metrics, the withdrawing behaviors or their adverse effects, or the presence of stressors via surveys such as Mark Linzer's Mini Z survey.13 Dr Kaushik's letter makes the important point that when burnout is pervasive in the workforce, organizational change can be difficult, and self-care and personal resiliency is required.