Finding solutions for physician burnout

Physician burnout: ©N Felix -stock.adobe.com

According to the American Medical Association (AMA), physician burnout has dipped below 50% for the first time since the COVID-19 pandemic began. Although this update is hopeful for the state of health care, the remaining percentage (48%) is still quite high, suggesting that more needs to be done to decrease physician burnout.

American culture expects physicians to see as many patients as possible, take limited paid time off and work longer hours. Its expectations have normalized stress and mental decline, as well as instilled a mentality that burnout is not acceptable.

“Burnout is not due to a lack of resilience,” says Kathryn Godfrey, Ph.D., director of the Center for WorkLife and Well-Being at ChristianaCare. “There are things we can do on a personal level, team level [and] organizational level — on every layer of the ecosystem.”

There have been a multitude of drivers responsible for physician burnout both in the past and the present. Tara Oakman, senior vice president of strategic initiatives at the Rippel Foundation and author of the research paper “Physician Burnout Will Burn All of Us,” says politicization of the health care system; barriers to physicians of color, women and physicians with disabilities; and the pressure to see and bill more patients daily are a few of the major stressors for physicians.

“There’s the pressure to bill at the highest rate,” Oakman says. “It’s just this pressure to be about the money rather than the patient care. They’re being squeezed there, then they’re also being squeezed because patients have more affordability issues [and] greater challenges. Physicians are [also] often the face of hospital systems that are putting people into medical debt. They’re sort of caught in the middle, and I think that’s one of the major contributors [to physician burnout].”

Autonomy is another area of concern for physicians, with many feeling like they lack control over situations in their practices. This, combined with a lack of financial literacy among physicians, is a significant factor that is increasing stress, anxiety and other mental health issues among staff.

“When you’re able to spend time with your patients and do good, people are like, ‘I’m great. I can take the rest of it,’” says Anjalee W. Galion, M.D., section chair for the Children’s Hospital of Orange County. “The real challenge is that’s what you want to do. That’s what you’ve been trained to do and told is the most important, but then you are also expected to manage the financial realities of our practice [and] understand the work [relative value unit] burden. You don’t have the autonomy or the agency to change the issues that directly relate to that. Those small things on an everyday level really chip away at the expectation versus the reality of practicing medicine.”

Another key driver of burnout has been dealing with electronic health record (EHR) systems and how they contribute to the digital landscape of health care. Galion says EHRs have developed into a more layered problem for physicians, causing a lack of boundaries in terms of both clinical and personal time. “I think we’re not necessarily citing it as a single factor because now it’s so layered in terms of how it contributes to the digital landscape and how the digital world is impacting people’s burnout,” Galion says.

With many physicians and medical staff, Galion says they have different EHR systems, with most not interacting with each other. The average physician has more than four ways of communicating with patients, making stress with the EHR higher when trying to combat patient needs. Workers are often managing their own patients and even helping to cover other physician’s patients at times.

To combat problems with EHR systems, Heather Spies, M.D., physician director of clinical experience and well-being at Sanford Health, says she’s seen more initiatives in her own day-to-day that have helped improve their efficiency, particularly through the use of artificial intelligence (AI).

“One thing we use is a generative AI tool that can prepopulate some responses, pulling out the key question that the patient might have, then getting the physician started with the message,” Spies says. “The physician has to edit it, add their medical advice and finish it before sending it, but it takes away some of that burden, especially that cognitive burden that adds up throughout their day. They’re making hard clinical decisions minute to minute, day after day, hour after hour, all day long.”

Sanford Health has also used AI to categorize patient-initiated messages for concerns they may have with things like prescription refills, scheduling appointments and work or school doctor’s notes, as well as AI-enabled software with ambient listening tools. This software allows for conversations between a physician and a patient to be transcribed and recorded into the EHR in real time.

Similarly, ChristianaCare conducted a study to understand the cognitive load of physicians, where Godfrey and other researchers observed physician outpatient appointments and discussed certain pain points physicians were facing. Through this, Godfrey adds that she and her team were able to work through specific pain points, such as stress and lack of support with technology, and create focus groups to identify solutions. She says practices who try this may see a decrease in burnout.

Other solutions are now being integrated to help combat stress that physicians face when fitting patients into their schedules. Elizabeth Goelz, M.D., chief wellness officer for the medical staff at Hennepin Healthcare, says customizing the standards of practice for each physician can help ease strict control over their schedules. She also recommends that physicians join state medical associations to create standards of well-being in the state they practice in for their health care organization.

Oakman also says organization is also another recommended solution to decrease physician burnout. “One of the biggest things is how they can grow their power to have influence over the system,” she says. “One of the best ways to do that is to organize, and we’re seeing much more of that in health care systems — more physician organizing and strikes. There has to be a way to grow their power and influence.”

Getting involved in leadership has also helped spark a conversation about physician burnout in the US, with Spies citing Sanford Health’s Sanford Rises cohort as an example of bringing together up-and-coming clinician leaders to find more adaptable solutions. “When you invest in the growth of yourself and your colleagues, you’re learning ways to communicate,” Spies says. “There’s going to be hard conversations, but you’re finding ways to communicate the intent of what needs to be changed and affecting change more when you are learning ways to bring those things to the table and all the way up to the top executive level. Investing in leaders so everybody can participate in making things better is one of the key factors and investments.”

Godfrey is hopeful that physician burnout is improving, especially as it becomes integrated more into the national conscious. “I’m feeling hopeful that things are moving in the right direction,” Godfrey says. “One of the silver linings, perhaps from the pandemic, is that … health care professional burnout has become more of a national talking point [and is] more on the minds of our communities and our government health care organizations. It’s been more of a public dialog and is something that a lot more health care organizations, governments, regulators and payers are all thinking about. We’re all trying to identify solutions.”

Meanwhile, Oakman says physician burnout is a legitimate public health threat, and that change will come down to policy and practice changes in the US. She also says physician burnout has become a threat in the US because many physicians and medical staff tend to overlook the issues they’re facing. By paying attention to physicians’ needs and looking at various solutions, Oakman says the problem can be further addressed.

Through advocacy, education and networking, Galion says physician burnout will be taken more seriously, especially when doctors come together. “If we each talk to our congressman — yes, that’s powerful,” Galion says. “But what if we go as a bloc of [more than] 1 million physicians who are represented? That’s a different conversation.”