Understanding the Causes and Consequences of Physician Burnout

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It’s no secret that physicians work long hours not only for the direct benefit of their patients, but out of necessity to keep their practices afloat. Arduous insurance billing and out-of-date-technology, such as clunky EHRs, are just a couple of the many culprits that keep doctors at the office. Unfortunately, COVID-19 has demanded additional resources from healthcare workers, not simply in terms of patient volume, but regarding learning curves and adjustments to reimbursement changes, telehealth delivery, safety protocols and more. All of these factors are correlated with a higher rate of physician burnout, a condition that already merited significant attention pre-pandemic.

The consequences of physician burnout extends beyond providers’ mental health, although that alone warrants resources. (In fact, depression is more common among physicians than any other profession. The rate of depression for those in residency training for general surgery is 40%). From a patient care perspective, “physician burnout doubled the risk of adverse patient safety incidents and led to poorer overall quality of care and decreased patient satisfaction”, according to an American Journal of Medicine report. The same report also indicated that the decrease in productivity due to burnout could heighten the shortfall of physicians beyond the currently estimated 45,000 to 90,000. Burnout among primary care clinicians is also correlated with higher rates of turnover, placing additional financial burdens on healthcare systems as well.

There is no single definition of burnout that all healthcare researchers and providers can agree upon. In fact, a review of 182 studies found at least 142 unique definitions. What is widely accepted, however, is that this condition can take many different forms, and there are various types of burnout that have a myriad of symptoms. Some of these include:

  • Emotional exhaustion: Emotional energy levels are extremely low, which oftentimes leads to lower levels of physical energy and a perpetual feeling that one cannot continue for much longer in this state.
  • Depersonalization: This is also known as “compassion fatigue”, and it is difficult to find the bandwidth to be emotionally present and available for loved ones.
  • Moral distress: Any procedures that a healthcare provider feels is unethical can lead to stress. A sense of helplessness and perceived inability to do what they feel is right can cause this type of burnout.

To add to the complexity, certain specialties tend to have higher rates of burnout than others. For example, according to a Medscape survey, some of the specialties with the highest rates of burnout include neurology, urology and family medicine. Those with the lowest percentages include public health, orthopedics and psychiatry.

Just like burnout varies by symptom and specialty, its causes are not fixed either. However, an undue amount of administrative work and unreliable electronic health record systems typically make the top of the list. One survey cites insufficient reimbursement, lack of autonomy and too many hours at work as contributors as well. But the statistics on the burnout caused by EMR platforms is hard to ignore. According to the same American Journal of Medicine report, “primary care physicians spend on average about 2 hours interacting with an EMR for every hour of patient contact, including 4.5 hours during the clinic day and an additional hour and a half in the evening. Even when in the examination room with a patient, they spend 37% of their time interacting with the EMR rather than the patient.” In addition, more hours spent working in EMR charts have also been correlated with higher rates of burnout among primary care doctors and psychiatrists.

Thankfully, newer digital technologies that complement mobile, cloud-based EHR systems, such as scribes, can improve the user experience, but there is much work to be done. The effects of burnout due to COVID-19 are also hard to overstate. A Medical Economics study noted that 65% of physicians reported that COVID-19 has increased their feelings of burnout. Add the financial anxieties of staying in business and staff safety concerns, and it’s easy to see how the pandemic has only exacerbated the condition.

There have been several studies that attempt to identify individual-level solutions that are successful in combating burnout. Some of them, such as meditation, stress management coaching and mindfulness training, have shown modest, but not insignificant, improvements. However, many experts agree that in addition to these practices, systemic improvements, including technological changes, must occur as well. Specifically in regards to EHR systems, challenges such as poor interoperability, excessive data entry and “death by 1,000 clicks” are rampant. Using a reliable, cloud-based EHR that also provides virtual care technology can be a powerful tool that prevents burnout.

Mobility, ease-of-use and customization are all factors that are ranked highly by providers when it comes to EMR platforms, and they’re important indicators for healthcare tech companies to acknowledge when building and maintaining their products.