Physician burnout becoming better known, but solutions slow to develop

Physician burnout is becoming better known, but seemingly little has been done in the last year to relieve it, according to a new survey by The Physicians Foundation.

Gary Price, MD, MBA
_{The Physicians Foundation}

The “2022 Survey of America’s Physicians” continues the Foundation’s series of checkups on the state of physician well-being and the solutions needed to improve it. Those steps are not a secret, but they are not making a difference for burnout, an existing problem that went from bad to worse during the COVID-19 pandemic.

The findings were published Sept. 15, two days before National Physician Suicide Awareness Day.

Among the survey’s key findings:

• Six in 10 physicians often have feelings of burnout, compared to four in 10 in 2018. The same amount felt inappropriate feelings of anger, tearfulness or anxiety.
• At least 1/3 have felt hopeless or that they have no purpose.
• Half have withdrawn from family, friends, and coworkers.
• More than 1/3 have checked in with a colleague who they suspected was experiencing mental health distress.

The results were “very disappointing,” said Foundation President Gary Price, MD, MBA.

“I think we’ve successfully turned the public’s and our politicians’ attention to this problem in delivering health care, and we’ve made physicians aware of it,” Price told Medical Economics. “But unfortunately over the course of the year, we have not moved the needle on the number of physicians who are suffering these symptoms.”

In the workplace

While there may be some common characteristics, physicians recognize the differences between burnout and depression that could lead to suicidal ideation.

They must be treated differently, but the good news about burnout is that workplace characteristics are identifiable, Price said.

“In health care with physicians, we have identified key factors that lead to this,” he said. “The challenge has been beginning to effect change in the system.”

In the survey, 36% of physicians strongly or moderately agreed with the statement: “My workplace culture prioritizes the well-being of its physicians.”

Workplace changes, not mental health care, rank as four top actions that physicians consider very helpful or somewhat helpful.

• 89% supported removing low-value work, such as reducing electronic health record (EHR) clicks and inbox notifications
• 87% supported giving physicians more flexibility and autonomy to adjust quality and patient experience goals
• 85% supported eliminating insurance approvals such as preauthorizations
• 83% supported eliminating mandatory training requirements

Regarding those top four workplace actions, independent physicians may be somewhat better off than employed physicians. Larger proportions of employed physicians than independent physicians indicated that their practices, employers, or health systems rarely or never took actions to improve those, the survey said.

Citing his own experience with EHR, Price described once needing 15 separate clicks to navigate 15 screens to prescribe aspirin. That process has been streamlined, he added, but larger scale changes to address burnout in health care have been much slower.

“I think there’s a lot of inertia in the system as large and as complex as our health care system,” Price said. “Any significant change requires the actions of multiple people. And the very first challenge is to recognize that there’s a problem and then try to figure out what solutions can be made.”

Physicians’ mental health

In the survey, 80% of physicians reported there is a stigma surrounding mental health and seeking care for it, while 78% reported knowing warning signs to look for in themselves and in colleagues who may be suicidal.

Just 31% of physicians believe suicide prevention resources for physicians exist and are easy to access, but 80% of physicians supported eliminating credentialing questions about prior mental health care and ensuring adequate mental health care outside employee assistance programs.

Confidential therapy (65%) and peer-to-peer support groups (57%) were rated as the most helpful resources for physicians’ mental health. Based on the survey results, it’s clear physicians turn to family, friends and colleagues for support during the pandemic and in the past year.

“With physicians having one of the highest suicide rates of any profession, we must do more to get the mental health resources in their hands and wellbeing workforce solutions implemented in every practice environment,” said Shekhar Saxena, professor of the Practice of Global Mental Health in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health.

Saxena is part of the #FirstRespondersFirst initiative, which has joined with The Physicians Foundation and the Dr. Lorna Breen Heroes’ Foundation to raise awareness through National Physician Suicide Awareness Day, and continually. They have published evidence-based suicide prevention resources and a Healthcare Workforce Rescue Package available for physicians, health care systems and the general public.

“There is no excuse for not acting on this critical issue,” Saxena said.

National Suicide Prevention Week is Sept. 4-10 and National Physician Suicide Awareness Day is Sept. 17, 2022. If you are in crisis, please call the National Suicide Prevention Lifeline at 988, or contact the Crisis Text Line by texting TALK to 741741.