Wanda Lipscomb considers a study that details burnout among medical professionals as a “call to action” to drive change and prevent the shortage of care providers from worsening.
The National Academy of Medicine study quantifies and raises awareness about what’s been a mounting concern for years in health care: that the medical profession suffers from an alarming rate of burnout caused by high stress, high demands, high patient caseloads, long hours and a lack of resources.
“Physician burnout is a much bigger issue than I think a lot of us thought it was,” said Lipscomb, the associate dean for student affairs at the Michigan State University College of Human Medicine in Grand Rapids.
Reducing burnout among health professionals and improving their overall well-being “has to become a movement of sorts,” said Lipscomb, who served on the National Academy of Medicine committee that produced the report.
“We’re hoping that the release of the report will stimulate a national conversation, a national call to action,” she said. “We need our clinicians to be well, positive and energized.”
The National Academy of Medicine characterizes burnout as emotional exhaustion, detachment, and a low sense of personal accomplishment. The study concluded that “current understanding suggests that burnout is a growing public health concern among all types of clinicians and learners.”
The Academy estimated that 35 percent to 40 percent of practicing physicians and nurses experience symptoms of burnout. The rate was even higher — 45 percent to 60 percent — among medical students and residents.
Those rates and the potential for burnout to drive professionals out of practice pose a barrier to the triple aim of health care providers for better care, improved population health and lower heath care costs, Lipscomb said. The problem potentially could worsen the nation’s shortage of doctors, she said.
“The consequences of having such a large percentage of the health professions’ workforce experiencing burnout, ultimately, we feel that impacts patients, it impacts health care organizations, and ultimately it will impact society if we have workforce shortages that come along because of that burnout,” Lipscomb said. “We know that we have a physician shortage that’s going to come just because of a large number of physicians who will be retiring, but if you add to that physicians who choose not to practice as many years as senior physicians practice, then that could obviously really increase the shortage.”
To stem and reverse the problem, the National Academy of Medicine offered six recommendations. They focus on improving the overall well-being of medical professionals by:
• Creating a better work environment by addressing burnout through training at the early stages of a professional’s career, including implementing pass/fail grading at medical schools.
• Reducing tasks that do not improve patient care.
• Easing the stigma and improving recovery services.
• Improving the use and relevance of information technology so it’s more intuitive, user-friendly and less burdensome, and “doesn’t distract from patient care,” Lipscomb said.
• Creating “positive work environments” that promote “high-quality care, job satisfaction and social support.”
• Creating a national database to gather more data on how to reduce burnout.
Problems with burnout go beyond physicians and can affect professionals across the care continuum, Lipscomb said.
“Burnout doesn’t just affect physicians. It affects all of the clinicians that are working in that system,” she said. “If you think about going into a hospital, you have your physicians, but you also have your nurses, your pharmacists, you have your psychologists and social workers. Everybody’s working in that ecosystem, and having health organizations look at how burnout impacts that ecosystem is something that we think ultimately will improve care.”
Addressing the “really complex” problem of physician burnout starts with changing the culture within the medical profession, said Dr. Kristen Brown, president of Mercy Health Physician Partners that employs more than 700 doctors and advanced practitioners across West Michigan.
For too long, many physicians have focused too much on work and not enough on finding a work-life balance, Brown said. The culture within the profession “is working against us,” allowing the drivers of burnout to overwhelm the inherent resilience of medical professionals, she said.
“Health care providers are highly resilient people. To get through medical school requires a lot of resilience, but we have a system that has relied on physicians to put their patients first, which means before their family (and) before their health, and that they’ll work all hours to do the job. In trying to do the right thing, we don’t take good care of ourselves,” Brown said. “We haven’t done enough as a system (to focus attention) on what’s broken and causing a lot of the burnout and the distress that our health care providers feel.”
Brown recalls serving her medical residency 20 years ago at Mercy Health Saint Mary’s in Grand Rapids. At the time, there was no limit on how many hours medical residents worked consecutively or how many hours they worked in a week. Those limits are now in place.
“As a culture, our health care professionals will shame the younger doctors and say, ‘Well, when I was young, we worked 48 hours straight with no sleep,’” Brown said. “Sometimes we get in our own way with an old culture and the old systems that just rely on the physicians’ willingness to work and work and work.”
Mercy Health’s burnout rate “is consistent with national trends,” she said.
One way to ease pressure on physicians is to ease their caseload by having advanced practitioners take over more duties for patient wellness and basic primary care “so that the physicians don’t have to do everything,” Brown said. Physicians who are taught in medical school to be “the end all person responsible” for patient care need to learn “to trust their team” and colleagues to take on those duties, she said.
The cultural issue in the profession piles on top of heightened demands from insurers to meet quality metrics and report data, government regulations, and systemic issues, all of which contribute to burnout.
Mercy Health’s parent company, Livonia-based Trinity Health, now has a wellness officer whose role is to find ways in the system and alter care processes to reduce burnout rates, Brown said.
“It’s a huge problem and it’s something I think about every day, and have for the last five or six years: How do we start addressing it?” she said.
Metro Health-University of Michigan Health in Grand Rapids also has been putting more attention on care teams that help physicians better manage high caseloads, said president of the Medical Group and Chief Population Health Officer Rakesh Pai. For instance, dieticians rather than a doctor can work with diagnosed diabetics to improve their eating habits, or a pharmacist can work with patients on questions about their medication and compliance, Pai said.
“Physicians have always felt like all of that was on them,” he said.
Nurse practitioners and physician assistants also are handling more of the primary care load.
As well, health systems need a governance structure so physicians “drive the agenda” and have a voice in the operations and decisions that affect how they practice, Pai said.
“That’s really important to mitigate them feeling like a tiny cog in a big machine,” he said.
Metro Health employs about 160 doctors and 125 physician assistants and nurse practitioners.
High burnout rates among doctors occur as the U.S. is starting to experience the “very beginning of a very significant physician shortage” as the population ages and incidence rates of chronic illnesses increase, Pai said. Those forces heighten the need to change the profession and reduce burnout rates, he said.
“It’s sort of a challenging time to be dealing with provider burnout,” said Pai, who also cites the need for cultural change within the profession.
Pai believes a younger generation of medical professionals will drive some of the needed cultural change. Students coming out of medical school, residencies and fellowships today insist on a better work-life balance than prior generations, he said.
Medical practices and health systems that don’t work to offer a better work-life balance may struggle to attract and retain young physicians, Pai said.
“They are very willing to be about the patient, but they are going to do that a little bit more on their terms and they are not going to sacrifice everything for this job. That’s very clear,” Pai said. “They’re not going to sacrifice too much on either side. They want it just right.
“For the next five to seven years, this is going to be the group coming out and we’d better meet their demand to attract them. Otherwise, we’re not going to have physician talent grow within our delivery system.”
Implementing new models
Medical schools also need to figure out how to ease the burnout among students, Lipscomb said.
At MSU, the College of Human Medicine four years ago implemented a new curriculum that in part was designed to reduce burnout among medical students. The curriculum instituted a pass/no pass system that replaced grades with a set of abilities students are expected to achieve, Lipscomb said.
The College of Human Medicine also has an assistant dean for student wellness and engagement, a student health advisory committee, and a director of wellness and resiliency to address the problem.
Another change has been eliminating the “endless number of exams” for medical students to take that made it “almost like they were on a treadmill like mice, running to the next exam,” Lipscomb said.
“We’re training our students in a different kind of way,” she said. “Because we recognize the importance of the wellness of our students and clinicians, the college is actively focused on creating a culture of caring and improving the work and learning environment.”