The 9 Sources from a Chat on Physician Burnout

The entire makeup of physician burnout—how it manifests, who it affects, what the best improvements are—is a debated subject. It contains too many variables and factors to be associated with any consensus, aside that it’s become a major burden on US healthcare with no single feasible resolution.

Something that cannot be debated is the level of effort put into understanding, diagnosing, and treating the US physician burnout epidemic. Recent efforts to comprehensively assess the matter are overwhelming, and enough to provide foundation for the development of real progress at whatever level.

That effort was celebrated in this week’s MD Magazine® #DocTalk Tweet Chat, hosted by Janae Sharp. The non-profit Sharp Index organization founder led a 90-minute discussion online on the fight to find physician burnout solutions with a few dozen fellow organizers, physicians, and members of the media.

The scope of burnout

T2 As a healthcare reporter, I’ve come to appreciate the efforts by which researchers assess burnout categorically: how it presents, when does it most frequently present, and even in what specialties? #DocTalk #MedTwitter https://t.co/sXKF16adBy https://t.co/IQo2S6tiXK

— Kevin Kunzmann (@NotADoctorKevin) July 24, 2019

Through the eight-topic chat, a litany of sources documenting everything—from burnout’s origin to individual system’s strategies against it—were shared and dissected. In case you missed the chat, here’s the resources that led it.This September 2018 study, published online in JAMA and covered by MD Mag, detailed a specialty-by-specialty breakdown of resident burnout prevalence. The national study was the first of its kind to focus on resident physicians, and found that urology, neurology, and ophthalmology carried the greatest rates of burnt out residents.

It also reported that female residents were at a greater risk for burnout symptoms than their male counterparts, and that 45.2% of all surveyed residents reported having at least 1 weekly symptom of burnout. Symptoms of burnout, investigators found, was associated with a three-fold greater risk of career regret among residents.

It's everywhere! @forbeshealth https://t.co/vnfXuAtiqs@harvardnews https://t.co/jKLal2NQSS@medpagetoday https://t.co/V6cT5CUVL8#DocTalk

— Kevin Shah MD (@KevinShahMD) July 24, 2019

The prevalence of burnout among residents in the most affected specialties was consistent with findings assessing burnout in non-resident physicians.This Forbes contributor column from Robert Pearl, MD, further details the associations between specialties—and their inherent personnel hierarchies—and burnout. He explained how specialists including urologists and surgeons have seen the value of their role recently diminish with the rapid advancement of treatment technology, reducing their rate of patient cases and minimizing their career satisfaction.

“In general surgery, the writing is on the wall,” Pearl wrote. “The toughest and most interesting procedures—the surgeries that once defined their mastery—have been stripped away inside most clinical settings.”

T1 Patient care is impacted by burnout. #PhysicianBurnout Associated With Poorer Patient Outcomes https://t.co/vud4XpbYVy #doctalk

— ShereeseM, MS/MBA (@ShereesePubHlth) July 24, 2019

In this article from MD Mag sister publication AJMC, meta-analysis research from JAMA Internal Medicine published in late 2018 showed physician burnout is associated with a two-fold greater risk for patient safety incident involvement among a pool of 40,000 primary care and hospital physicians.

Investigators from the meta-analyses also noted the association between burnout and patient safety incident involvement did not differ significantly across the phases of a physician’s career. Similarly consistent was the byproduct’s effect on the overall healthcare system—both in terms of patient care and costs.

The cost of the issue

It's hard to measure.@HarvardHBS did some work on this #docTalk

The personal cost can be really high. https://t.co/18vYtorTaq

— janae sharp (@CoherenceMed) July 24, 2019

“Physician burnout is associated with a reduced efficiency of healthcare systems to deliver high-quality, safe care to patients,” wrote the researchers. “Preventable adverse events cost several billions of dollars to healthcare systems every year.” Sharp shared this recent report from Harvard Business School which estimated the annual billing cost from physician burnout—as calculated by reduced hours, physician turnover, and personnel-related expenses—is approximately $4.6 billion.

They also anticipate that $4.6 billion—the same cost recently marked as the current value of the New York Yankees—is an underestimation.

In healthcare- some claim it leads to worse patient care.

I don't know what I think about that- but I know it isn't good for physicians to work in a place they hate.#DocTalk@NatsforDocs @ETSshow @DrMStiegler https://t.co/Oh2SdbOASz

— janae sharp (@CoherenceMed) July 24, 2019

“There’s been a growing awareness of physician burnout,” Harvard visiting scholar Joel Goh explained. “But as a health care executive, when you’re trying to make a decision you want all the evidence, all the data, in front of you. And if you’re trying to quantify the dollars and cents, addressing this may be worthwhile even from a business point of view.” Sharp also shared a 2016 article from the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Network which detailed how depersonalization, a common byproduct of burnout, is associated with worsened patient interaction and eventually, their treatment.

Medical errors, already among the leading causes of death in US healthcare, could continue to rise with the rate of physician burnout. Of course, it’s not only the wellbeing of patients that are risk.

T7 Fiscally? I can’t imagine. But as @CoherenceMed told me and @byMattHoffman last year, the ultimate cost of life is a reality. https://t.co/jLNR4HmaSF https://t.co/R39IEYsypA

— Kevin Kunzmann (@NotADoctorKevin) July 24, 2019

The solutions we know

Found the article! It was "Code Lavender" they used. Here's the link: https://t.co/vlYmTrlGR1

— AJ Montpetit (@ajmontpetit) July 24, 2019

This 2018 MD Mag feature told the story of Sharp’s personal connection to physician burnout and the overwhelming scope of healthcare suicides in the US. The currently estimated count of 400 annual physician suicides in the US is widely considered to be short of the true total. Over a decade ago, the Cleveland Clinic debuted their Code Lavender program, a holistic care response designed to provide immediate and intensive emotional or spiritual support to at-need physicians and patients—in the same spirit as fire or medical emergencies given different color codes.

Within 30 minutes of the alert, a team of holistic nurses arrive, offering food and water, Reiki and massages, and a lavender arm band reminding the wearer to relax throughout the day. The clinic originally intended to provide the service for patients and their families, but quickly realized it equally benefitted burnt out personnel.

Here’s one that @CoherenceMed @RasuShrestha @gnayyar and I worked on that speaks to solutions across many HCO perspectives — payer, hospital, physician. https://t.co/uFSeV4lvDB

— Heather Staples Lavoie (@HSLavoie) July 24, 2019

Others have turned to more clinically-driven responses. Geneia president Heather Lavoie shared her involvement in an Inside Digital Health panel series focused on using technology to combat burnout. As Lavoie noted, burdensome health technology such as current electronic health records (EHRs) have been shown to drive burnout.

Acknowledging that technology’s role is only bound to increase in medicine, and that problems can become solutions, lends to Lavoie’s belief that tech developers are in the drivers seat to improve healthcare.

“At a minimum, improving the technology that most frustrates doctors — the EHR – should reduce physician dissatisfaction,” she wrote.

Don't forget that we are giving away a scholarship to help physicians- it's starting small but if enough people donate we can do great thingshttps://t.co/xmT35FtjV1

#doctalk

— janae sharp (@CoherenceMed) July 24, 2019

The Sharp Index Scholarship program will provide $1000 to a medical student or resident with expressed interest in improving physician wellbeing. Another scholarship of equal value will be given away to a non-medical student also with interest in improving physician lives.

All at once, this scholarship attempts to do the following: Aid in reducing medical school or college loan debt; drive future physician interest in efforts to improve the healthcare workplace; and bring attention to physician burnout among the non-healthcare community.

As so much of the #DocTalk chat highlighted this week, major burdens caused by burnout are in the healthcare economy, the state of patient care, and in the overall wellbeing of care providers. Any thoughtful response to the many facets of burnout is enough to warrant hope and inspiration for others to do the same.