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Healing our Healers: Part One

By now, we’ve all heard it: our nation’s physicians are burned out. Depleted. Exhausted.

February 26, 2018
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By now, we’ve all heard it: our nation’s physicians are burned out.

Depleted.

Exhausted.

Provider burnout has reached epidemic proportions in the United States, with more than 50 percent of physicians expressing symptoms of the condition. And while it’s relatively normal to feel a little bit “over” your job at times, especially if the work is stressful, fast-paced, repetitive, or frustrating, experts agree that physician burnout is on its own a type of professional exhaustion that carries much higher stakes. Physician burnout can have negative impacts on patient outcomes and devastating impacts on providers and their well-being, their careers, and their personal lives.

Over the next two articles, Pinnacol will bring you the voices of local experts who have studied this issue and who can help providers recognize and combat burnout.

For this article, we interviewed Debra Parsons, MD, president-elect, Colorado Medical Society; Doris C. Gundersen, MD, PC, medical director, Colorado Physician Health Program, University of Colorado; and Deborah Saint-Phard, MD, founder and director, CU Women’s Sports Medicine, UCHealth.

What is physician burnout?
There is a reliable tool for measuring and assessing provider burnout called the Maslach Burnout Inventory (MBI). The MBI is well-validated and is used by educators, human-services professionals, and others to identify the condition and its severity. The MBI for medical professionals measures burnout based on responses to three scales:

  1. Emotional exhaustion or “feelings of being emotionally overextended and exhausted by one’s work”
  2. Depersonalization or “unfeeling and impersonal responses toward recipients of one’s service, care treatment, or instruction”
  3. Personal accomplishment or “feelings of competence (or incompetence) or achievement (or lack of achievement) in one’s work”

Dr. Saint-Phard is quick to emphasize that burnout is a serious issue among many types of healthcare workers, not just physicians.

“Burnout has been measured now in more than two generations of physicians,” Dr. Saint-Phard said, “and it’s escalating,” which concerns her and other experts greatly.

Colorado Medical Society president-elect Dr. Parsons sees physician burnout as a looming perfect storm. “Now that we’re able to quantify the problem, it’s not only astounding and shocking, but it’s not in parallel with other professions.”

Studies show that more than 50 percent of practicing physicians exhibit symptoms of burnout. Among the most burned-out specialties reported recently by researchers were emergency medicine and primary care specialties. A 2012 study reported that Occupational Medicine specialists were among the least burned out of physician groups.

Physicians generally expect things to be worse or about the same over the next 2-3 years; just 13 percent are optimistic.
Colorado Medical Society strategic planning, 2017

Dr. Parsons detailed the Colorado Medical Society’s devotion to proactively addressing burnout among physicians in Colorado. They survey physicians every few years to gauge professional satisfaction. Based on 2017 survey results, physicians expect that the future of medicine will be worse or about the same. A small minority was optimistic.

The impacts
Local burnout expert Dr. Doris Gundersen affirms that “when physicians burn out, they may leave the profession altogether,” compounding a nationwide physician shortage that already affects timely access to health care. It is also costly to replace a physician (Gundersen estimates the cost could range from $100,000 to $200,000). Aside from the monetary cost, Gundersen asserts, “A physician who leaves the profession early due to burnout is a loss to society.”

Aside from the hassle of recruiting and hiring and training new providers, burnout symptoms most definitely can extend to the patient/provider relationship, contributing to poor medical decisions and lack of empathy toward patients.

“New data shows that patients of burned-out doctors are less adherent and have lower satisfaction scores,” said Dr. Saint-Phard.

“On the financial side, their efficiency and productivity goes down. This also affects others and contributes to loss of morale, which causes more turnover,” said Dr. Parsons. Sources also cited increased malpractice risk and cost as another financial consequence of physician burnout.  

A 2015 study from the Mayo Clinic found that more than 7 percent of nearly 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers. About 400 a year go through with it.

Why are our physicians burned out?
The experts we interviewed all cited the current state of the health care system as a major driver, but unique aspects of doctoring also contribute to this problem.
“It’s most certainly a combination of things. The fact is, we come into medical school and residency better adjusted than our peers in other professions. We are doing this to physicians somewhere along the way,” said Dr. Saint-Phard.

“For physicians, they have lost a great deal of autonomy, meaning that they are overburdened with administrative responsibilities and increasing regulatory demands, and they have less authority in determining health care decisions for their patients compared with previous decades,” said Dr. Gundersen. “More physicians are becoming employed rather than managing their own practices, which means they have to adapt to organizational designs and procedures that may conflict with the way they would [prefer to] approach patient care.”

“The profession is different from any other profession,” said Dr. Parsons. “Art and science is blended uniquely in medicine, and we need a strong community of providers from which to seek support and autonomy to do what is best for the individual patient.”

How can you spot physician burnout?

According to Dr. Gundersen, physicians who experience burnout may appear fatigued, depressed, irritable, and cynical. They may detach from friends and colleagues. In severe cases, symptoms of burnout can negatively impact a physician’s ability to skillfully and safely practice medicine. Physicians with burnout may be perceived as uncaring, lacking empathy, and impatient. They may demonstrate a loss of efficiency, show up late, or miss work frequently. Often, peers are the first to identify burnout in colleagues.

Dr. Gundersen continued, “It is not unusual for a physician who is labeled as ‘disruptive’ to have an underlying mental health problem, including burnout, which calls for treatment, not punitive measures.”

On the flip side, engaged doctors display resilience, enthusiasm, energy, and pride. Our second article will focus on the solutions and resources for physician burnout, but there are a few valuable resources for providers that we want to highlight right now:

DIMENSIONS: Work & Wellbeing Toolkit for Physicians: developed by the University of Colorado Anschutz Medical Campus, School of Medicine, Behavioral Health and Wellness Program, September 2014.

Physician Burnout: Integrated Strategies for Diverse Stakeholders, The Westin Riverfront Resort & Spa at Beaver Creek, Avon, Colo. Hosted by the University of Colorado School of Medicine.

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