More must be done to protect doctors from burnout, US researchers say

Health service leaders must do more to keep doctors “happy, energised, and healthy” and help them perform well and avoid burnout, say US researchers.

The researchers, led by Michael Privitera at the University of Rochester Medical Center, have issued a “call to action” on the issue. They warned that rising levels of stress among doctors were endangering patients and staff and damaging performance, work relationships, and career choices. Uncoordinated health reforms and conflicting mandates from regulators, insurers, and state and federal agencies were also adding to pressure on providers and individuals, the researchers said.

Their study, reported in the Journal of Hospital Administration,1 found high levels of physician burnout and occupational stress. “Physician burnout is real, multifactorial in cause, currently underdiagnosed, and underappreciated in impact on the healthcare workforce and systems,” they wrote.

The study cited evidence showing that 46% of US physicians surveyed reported burnout. At a time of shortages of doctors, many were leaving medicine early, and some were committing suicide because of job related stress.

Healthcare reforms have added new levels of complexity to healthcare delivery, subjecting providers to disparate, confusing mandates and “coercive” financial incentives, they said. Systemic factors could affect healthcare staff on a personal, physical, emotional and cognitive level, “which in turn adversely affects care relationships and quality of patient care,” they added. “Many factors . . . indicate that the healthcare workforce and the public are now at physical, emotional, and financial risk by the uncoordinated cumulative over-expectation of cognitive workload imposed on providers and staff.”

The team drew a distinction between “temporary” situations of high stress that are “expected” as part of physicians’ work and “chronic, cumulative, and incremental stress.” They considered factors affecting stress and burnout, such as individuals’ personalities, attitudes, expectations, and life experiences, and “external” factors, such as medical training, debt, workplace, and domestic pressures.

The researchers said that the overall economy and healthcare reorganisation had been cited as the top two external factors contributing to doctors’ stress, while the top two work related factors were overlong hours of work and administrative demands. “Adding more mandates, regulations, laws, or complex policies to an overworked workforce is not a harmless endeavour, especially if there is no clear scientific evidence that quality of care will be improved,” they said. “Having a daily sense that your work life is under siege from innumerable outside sources creates more demoralization and stress than is currently appreciated.”

They argued that healthcare decision makers must assess potential unintended consequences before mandating new healthcare initiatives, and medical training could help to predispose some doctors to burnout and mean that they don’t seek help. “Pushing oneself beyond usual human abilities is the cultural norm,” they said.

The researchers said that doctors and other healthcare staff should be offered more support as they were a “precious resource and should be assisted to work at the top of their license and training.” Providers, legislators, regulators, and other agencies must, at the very least, not add to problems and should apply the Hippocratic oath, to “first do no harm,” they argued.

“Leadership commitment to action is key. Gaining back the trust of physicians and staff and sending a message that their welfare is cared about takes consistency, transparency, and action,” the researchers said. “We as a system of healthcare need to keep them happy, energized, and healthy so they can do what they want to do in the first place: practice good medicine.”