How does burnout affect physician productivity? A systematic literature review

The Wicked Problem of Physician Well-Being.

1. Paria M. Wilson, MD, MEd* 2. Maneesh Batra, MD, MPH† 3. Kathi J. Kemper, MD, MPH‡ 4. John D. Mahan, MD‡,§ 5. Betty B. Staples, MD¶ 6. Janet R. Serwint, MD** 1. *Division of Emergency Medicine, Children’s Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA 2. †Department of Pediatrics, Division of Neonatology, Seattle Children’s Hospital and the University of Washington, Seattle, WA 3. ‡The Ohio State University, Columbus, OH 4. §Department of Pediatrics, Division of Nephrology, Nationwide Children’s Hospital and The Ohio State University, Columbus, OH 5. ¶Department of Pediatrics, Duke University Medical Center, Durham, NC 6. **Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD * Abbreviations: EHR: : electronic health record OR: : odds ratio SMART: : Stress Management and Resiliency Training > Every once in a while in Pediatrics in Review , Editors-in-Chief Bob Haggerty and Larry Nazarian would advise readers to care for themselves. They offered commentaries on such subjects as how to transition to retirement or part-time practice, taking time to reflect on the joy of pediatrics, and stepping out of the office to partake in community events. In the spirit of Dr Haggerty’s and Dr Nazarian’s hope that readers take care of themselves, Pediatrics in Review offers the following review. > > —JZ Clinicians and trainee physicians should be aware of the components of wellness and how to foster them in their daily practice. Interventions have been aimed at the individual and organizational levels. After …

Broad System Factors Influence Physician Wellness, Patient Care

Burnout has been a recent trending topic not only in the health care setting but in the general workplace as well. A PubMed search for “physician burnout” shows over 300 publications per year since 2016, whereas fewer than 100 papers per year were published before 2008. In this context, the book Transforming the Heart of Practice is a relevant read for both health care workers and administrators alike. The book consists of 28 chapters divided into 6 large sections, addressing general physician well-being, burnout, and interventions for prevention and treatment. Both paperback and eBook versions are available. This is a review of the eBook, but the paperback version appears essentially the same when looking at online seller previews or samples of the paperback. The editors of the book are Dr Dianne E. McCallister and Dr Ted Hamilton. Dr Dianne McCallister is a board-certified Internist at The Medical Center of Aurora in Colorado. She received her MD and MBA from the University of Denver. Dr McCallister has been at the Medical Center of Aurora since 2013 and serves as the Chief Medical Officer and Patient Safety Officer. She pioneered a comprehensive Physician Wellbeing and Engagement program at the hospital, which has led the facility to become the first of 4 hospitals in the United States to receive the Medicus Integra Award from the Coalition for Physician Wellbeing. Of note, Physician Satisfaction at the Medical Center of Aurora has shown a significant increase across all metrics in the time she has been there. Dr Ted Hamilton is a graduate of the Loma Linda University School of Medicine. He completed residency training in family medicine at Florida Hospital and earned an MBA from Rollins College Crummer Graduate School of Business. Dr Hamilton is currently the vice president of Adventist Health System, FL. He is committed to working with hospitals to improve the quality of patient care as well as physician satisfaction by reducing burnout through enhanced balancing of personal and professional lives. He believes the most important step in treating the epidemic of burnout is acknowledgment and an actionable plan. Under his direction, a physician support services (PSS) department was created at Adventist which has helped as many as 1000 physicians at the health system over the years. Dr Hamilton is a pioneer in the field and has authored several papers on the topic of physician well-being and burnout. Part I delves into the general problem of physician burnout. The first 3 chapters explore the reasons for increasing rates of burnout, the current body of research on this topic, and the effects of burnout on physicians and on patient care. Part II describes the workplace culture and environment requisite for promoting physician well-being. These consist of factors such as an environment of accountability, respect, and trust. One of the highlights of this section delineates the importance of physician integration and the obligation to create achievable avenues to raise and address physician concerns. Part III equips health care organizations with specific ideas and guidelines for implementing programs for physician well-being. One extremely interesting and enlightening chapter examines common physician characteristics and correlates how these should be considered when creating physician wellness programs. In summary, the first 3 parts are most pertinent for readers who want to learn about physician well-being, burnout, and possible solutions. Parts IV–VI expound on these topics with vignettes from home and hospital that the authors have deemed effective and successful initiatives and programs. Part VI consists of a relatable compilation of personal accounts from physicians, chronicling their work in relation to family, pregnancy, and childcare. The final chapter closes with the dark consequences of burnout which include mental illness, substance abuse, and domestic violence. Overall, the book presents the topic in an organized and easy-to-read format that helps elucidate the distinct issues concerning physician well-being and burnout. The main merit of this book stems from the numerous personal anecdotes and experiences within various health care organizations, providing pearls and lessons for creating and implementing successful physician wellness programs. This compelling book could serve as a primer for beginners embarking on a journey to explore wellness. Moreover, it also serves as a comprehensive overview for veterans in the field in search of a cohesive synopsis of the increasingly important topic. Luis E. Tollinche, MD, FASAHoward Teng, MDCindy B. Yeoh, MD, FASADepartment of Anesthesiology and Critical Care MedicineMemorial Sloan Kettering Cancer CenterNew York, New YorkDepartment of AnesthesiologyWeill Cornell Medical CollegeNew York, New York[email protected]

Primary care physician (PCP) burnout is prevalent and on the rise. Physician burnout may negatively affect patient experience of care. To identify the direct impact of PCP burnout on patient experience in various domains of care. A cross-sectional observational study using physician well-being (PWB) surveys collected in 2016-2017, linked to responses from patient experience of care surveys. Patient demographics and practice characteristics were derived from the electronic health record. Linked data were analyzed at the physician level. A large non-profit multi-specialty ambulatory healthcare organization in northern California. A total of 244 physicians practicing internal medicine or family medicine who responded to the PWB survey (response rate 72%), and 30,701 completed experience surveys from patients seeing these physicians. Burnout was measured with a validated single-item question with a 5-point scale ranging from (1) enjoy work to (5) completely burned out and seeking help. Patient experience of patient-provider communication, access, and overall rating of provider was measured with Clinician & Group Consumer Assessment of Healthcare Providers & Systems (CG-CAHPS) survey. Patient experience scores (0-100 scale) were adjusted for age, gender, race/ethnicity, and English proficiency. Physician burnout had a negative impact on patient-reported experience of patient-provider communication but not on access or overall rating of providers. A one-level increase in burnout was associated with 0.43 decrease in adjusted patient-provider communication experience score (P < 0.01). Data came from a single large healthcare organization. Patterns may differ for small- and mid-sized practices. Physician burnout adversely affects patient-provider communication in primary care visits. Efforts to improve physician work environments could have a meaningful positive impact on patient experience as well as physician well-being.

Physician burnout in the United States has reached epidemic proportions and is rising rapidly, although burnout in other occupations is stable. Its negative impact is far reaching and includes harm to the burned-out physician, as well as patients, coworkers, family members, close friends, and healthcare organizations. The purpose of this review is to provide an accurate, current summary of what is known about physician burnout and to develop a framework to reverse its current negative impact, decrease its prevalence, and implement effective organizational and personal interventions. I completed a comprehensive MEDLINE search of the medical literature from January 1, 2000, through December 28, 2016, related to medical student and physician burnout, stress, depression, suicide ideation, suicide, resiliency, wellness, and well-being. In addition, I selectively reviewed secondary articles, books addressing the relevant issues, and oral presentations at national professional meetings since 2013. Healthcare organizations within the United States were studied. The literature review is presented in 5 sections covering the basics of defining and measuring burnout; its impact, incidence, and causes; and interventions and remediation strategies. All US medical students, physicians in training, and practicing physicians are at significant risk of burnout. Its prevalence now exceeds 50%. Burnout is the unintended net result of multiple, highly disruptive changes in society at large, the medical profession, and the healthcare system. Both individual and organizational strategies have been only partially successful in mitigating burnout and in developing resiliency and well-being among physicians. Two highly effective strategies are aligning personal and organizational values and enabling physicians to devote 20% of their work activities to the part of their medical practice that is especially meaningful to them. More research is needed.

Burnout is characterized by emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. There are both personal and professional consequences of physician burnout. Increasing evidence suggests that physician burnout can adversely affect patient safety and quality of patient care and even contribute to medical errors and, furthermore, that the organizational and practice environment has an important critical role in whether physicians remain engaged or burned out. Most institutions operate under the erroneous framework that burnout and professional satisfaction are solely the responsibility of the individual physician. Extensive research now indicates the well-being and professional satisfaction of physicians have a profound effect on their quality of care and patient adherence with treatment recommendations and satisfaction with medical care. Therefore, there is both a moral and ethical imperative to address physician burnout. In addition, there is a strong professional and business case to reduce physician burnout and promote physician engagement. The leadership qualities of physician supervisors also impact the personal well-being of the physicians they lead in their healthcare organization. The Mayo Clinic experience has demonstrated that sustained and comprehensive efforts by the organization to reduce burnout and promote engagement can make a difference. Mentorship has also been recognized as a key element of career satisfaction because it has a very important influence on career guidance, physician productivity, and personal development. Although it is important for all surgeons to address the issues of personal wellness, it is particularly important for those who are at increased risk based on combinations of high workload, specific surgical specialty, practice environment, age, family responsibilities, and work-home conflict resolution that, in the aggregate, span a spectrum of risk for burnout, depression, and lower mental quality of life. Physicians must be guided from the earliest years of training to cultivate methods of personal renewal, emotional self-awareness, connection with social support systems, and a sense of mastery and meaning in their workplace practice environment.

Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. From 2000 to 2005, 22-32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

A Review of Learner Impact on Faculty Productivity

Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors

Leah Dickstein, APA Leader and Mentor to Many, Dies

BackgroundThe socioeconomic impact of rare diseases has been mostly studied at the macrolevel, but evidence at the microlevel is lacking, which overshadows health-related social inequalities affecting people with rare diseases, namely, health selection effects.AimThis study presents an overview of employment and work ability in individuals living with rare diseases, two factors related to health selection effects.MethodsA systematic literature review was conducted using the PRISMA checklist. Three electronic databases, PubMed, Embase, and Web of Science, were searched from 2013 to 2023. Eligible studies needed to investigate at least one work-related outcome measuring employment or work ability in individuals living with rare diseases and to compare it with a control group. Indeed, including only studies with matched or standardized control groups is essential for ensuring the reliability and validity of research findings.ResultsOf the 7,694 abstracts identified, 44 studies, including 34 rare diseases, met the inclusion criteria. Administrative databases were used to collect work-related data in 48% of the studies, and 73% of the studies employed matching methods for comparison. Overall, 52% of the studies focused solely on employment, 14% focused solely on work ability and 34% included both categories. Individuals with rare diseases were less likely to be employed or more likely to be unemployed than controls in 68% of the studies and 87% of the studies reported that individuals with rare diseases were more likely to be work disabled. Regarding work ability, 90% of the studies reported more missed work time in cases than in controls, and more perceived impairment at work was found in 100% of the studies.Discussion/conclusionThese results show that individuals with rare diseases tend to have poor work outcomes, but methodological limitations hamper the understanding of health selection effects. Implications for future research and policy-making are discussed.

Reducing Burnout in Primary Care: A Step Toward Solutions.

Physician burnout has reached epidemic proportions in the United States, and COVID-19 has only exacerbated the strain on the physician workforce. To gather data on organisation-level support for physician burnout prevention initiatives, the American Hospital Association, AdventHealth, and the Coalition for Physician Well-Being collected responses from more than 500 top-level executives from healthcare systems across the United States, documenting the current state of organisation-level interventions to support physician well-being. This paper discusses the findings, which revealed that organisational initiatives to curb physician burnout vary in scope and degree, but the need for organisation-level interventions appears to be widely recognised.

Never before has physician suffering received as much attention in the peer-reviewed medical literature and popular media as now. The purpose of this paper is to propose that the manner in which these concerns are being addressed is further complicating physician and medical family well-being due to the perpetuation of work ambivalence. A search of the English literature was conducted using PubMed to identify papers addressing physician burnout and other forms of psychosocial suffering. In addition, a review of case records from the past 40 years of clinical experiences as counselors and life coaches to physicians and their life mates was conducted. Reported levels of physician burnout and psychosocial morbidity have escalated over the past 10 years, as have clinically observed levels of work/life conflict expressed both by physicians and their spouses. We contend that the contemporary rhetoric addressing physicians' psychosocial experience is yielding the iatrogenic effect of promoting work ambivalence, which is a key building block in fostering physician burnout and its sequelae. We propose that curbing physician burnout requires a combination of empathy about the plight of physicians today, compassion that fuels workplace redesigns and family support, and self-compassion on the part of individual physicians. Both clinical experience and research suggest that physician well-being can be enhanced by coaching physicians to protect positive engagement in their work while practicing resilience-enhancing tactics and strategies.