The Ripple Effects of Physician Burnout

Six years after completing my family medicine residency, my professional partner and I had a well-established, suburban family practice. We had started the business from the ground up, had a growing list of patients, and a dedicated staff of professionals who helped to deliver high-quality, patient-centered care. The passion for our collective success drove me to work long days. I left for the hospital before 6:00 am each day and more than 12 hours later, would sit in the car in my driveway finishing phone calls before going into the house.

I was starting to miss family events and outings. I didn’t have the time to attend parent-teacher meetings. In addition to spending time seeing patients and completing charts, I was calculating payroll and paying bills. I was burning out. It was then that I recalled a years-earlier conversation with an older physician early one morning while making rounds. He said, “I woke up 20 years later and found my kids had moved out, and I didn’t know them.”

Fast forward 20 years and multiple role changes, and I find myself once again contemplating the silent epidemic of physician burnout, but this time from a different perspective. Defined by the Agency for Healthcare Research and Quality as a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment, physician burnout in this age of increased provider demand has reached epidemic proportions. A Medical Economics article from September 2021, addressed the alarming fact that four out of five physicians report they are burned out right now.

Physician burnout can be devastating enough on its own, but challenges like burnout seldom present in a vacuum. This sense of exhaustion can include side effects that extend beyond the individual, compromising relationships with colleagues, family, and friends. It can be a very dark place with seemingly no escape. The side effects of burnout can manifest as outbursts of anger or a retreat into oneself. It can consume the individual and lead to unhealthy physical manifestations of over or under-eating and a sedentary lifestyle, each of which can perpetuate the situation.

To the weight of patient care, we add an ever-increasing burden of administrative tasks, EMR clicks, quality measures and dashboards, and we soon find ourselves working evenings and weekends just to keep up. In the last two years, we have piled onto that workload the need to learn telehealth and operate with fewer staff, as many of our nurses and assistants are pulled to testing and vaccination clinics or experience work fatigue themselves. A Hospital IQ study suggests that 90% of nurses are considering leaving the profession. An increase in burnout, overall, has the potential to perpetuate as others also struggle to take up the slack.

Burnout is not limited to health care providers. It is present in nearly every industry, profession, socioeconomic class, and it knows no age limit. We see it in children and adolescents as well. In clinical practice, we attempt to treat the effects in our patients. But in health care, the recommendations and treatment plans we are able to lend to others are often missed when it comes to ourselves.

In addition to the toll burnout has on our physicians and medical workforce, there are many resultant consequences on health care delivery. When we are not able to bring an invigorated care team to be present in a patient encounter, high quality patient-centered care suffers.

The past decade has seen tremendous steps forward in the transition to value-based care. From continued innovation within ACOs around technology to programs that are designed to prevent illness and promote wellness and higher quality care, our approach to the practice of medicine has evolved. In partnership with CMS and commercial payers, health systems and physicians have built incredible population health programs over the years. Patient-centered care has come so far from its foundations only to see it take a back seat recently. With burnout at all levels of healthcare, we run the risk of taking a step backward in our move toward value. We must come together to address this problem.

Prevention is the key to combating burnout

The solution is threefold and includes emphasis on the system, the practice, and the individual. The future of our nation’s health care will be wed to value-based care methodologies. These approaches are patient-centric and place an emphasis on preventative care. Engaging patients to collaborate with their care team to prevent illness and admissions has been demonstrated to improve care outcomes. Effectively reducing the rates of physician burnout will follow the same method, by preventing the causes of burnout to actualize.

The system level

At the health system level, the C-suite plays a critical role. From the CEO to the CMO, the probabilities of physician burnout must be discussed and proactively addressed. Increased pay is not always the answer. Strategic steps such as rounding with individual providers and active listening can empower the stressed workforce to communicate their concerns and the challenges they are facing. While there may not always be an easy solution, it is important for management to listen and understand the problem. Make small changes immediately when able and involve a team to address the bigger concerns.

Much like taking a patient history, the answers present themselves when we are open to listening. Beginning meetings with a patient success story can help remind and renew the shared connection to the purpose of patient care and the difference being made in the lives of those we are treating. Other steps include improving the culture to ensure providers are being heard. Making counseling and behavioral health readily accessible and without the concern of stigma, and enabling support groups, is important.

The practice level

At the practice level, team-based care initiatives can significantly reduce the burden placed on physicians. A growing body of research supports team-based care being associated with improved patient outcomes, reduced adverse effects, and decreased readmissions. Involving providers at all levels of the practice, including development of workflows to address quality of care and documentation burdens can help the entire team balance the responsibilities. Standing orders and protocols help to reduce the volume of messages providers are inundated with throughout the day. Advanced Practice Practitioners can ease physician demand by leading or co-leading the clinical team. Chronic Care Management programs are great ways to engage patients in self-management and ensure that high risk patients are managed before an exacerbation necessitates provider attention.

The personal level

At the personal level, addressing burnout by taking it out of the proverbial closet and removing any concerns of stigma is a key step. Creating peer support groups and encouraging individuals to take advantage of counseling and therapy opportunities is also helpful. Physicians may be hesitant to utilize local counseling services and making online or off-site options available may help with the comfort of the physicians. Offering nutrition and exercise support for physicians and staff may encourage healthier habits and help alleviate stress in the workplace as well as taking time off.

There is no question that the last two years have taxed our profession in ways that we are only starting to understand. The COVID-19 pandemic has exacerbated the rates of physician burnout, but the issue long predates the current public health emergency. Physicians and all health care providers have always borne the heavy weight of patient care and expectations. Some of us chose this profession and for some, the profession chose us. Either way, clinicians are called and compelled to alleviate the physical and emotional suffering in our patients and their families. A side effect of our work and patient expectations can lead to burnout – especially in turbulent times. Burnout is the strongest indicator of clinicians’ likelihood to leave their organizations. If we want to maintain our healthcare workforce and keep them engaged, we must put in measures in place to help prevent work fatigue.

As we have learned with value-based care, prevention and engagement are key to effectively improving patient’s health outcomes. The same will prove to be true with provider’s health outcomes.

Fred Wallisch, MD is the Medical Director of ACO programs for Caravan Health, part of Signify Health. He is responsible for clinical oversight of all ACO activities including collaboration with physician leadership on data driven, value-based care strategies to improve patient outcomes, quality of care and utilization metrics to drive client success. He is Board-Certified in Family Medicine and received his Bachelor of Science degree in Chemistry from Rockhurst College in Kansas City, and his medical degree from the University of Kansas Medical Center. Dr. Wallisch completed his Family Medicine residency at Deaconess Health System in Evansville, IN.