A discussion paper released yesterday by the National Academy of Medicine (NAM)—formerly known as the Institute of Medicine—recommends researching the organizational, practice, financial, regulatory and legal factors that contribute to burnout among physicians and other health care professionals (HCPs).
The research should identify how such factors place HCPs at a higher risk for burnout and also look at how to improve the work lives and well-being of HCPs by addressing and evaluating interventions to reduce distress. Further interventions are needed to target the unique needs of each type of HCP, says the paper, released as part of the NAM Action Collaborative on Clinician Well-Being and Resilience.
The collaborative, which works to “identify priorities and collective efforts to advance evidence-based solutions and promote multidisciplinary approaches to reverse clinician stress and ultimately improve patient care and outcomes,” was launched in January. The AMA is an inaugural sponsor of the effort.
There is a need for more rigorous research to inform more robust interventions, says the discussion paper, co-written by a panel of experts that includes Christine A. Sinsky, MD, vice president of professional satisfaction at the AMA.
“Intervention studies have used convenience sampling, lacked appropriate comparison groups, were short in duration, involved only a single discipline or organization, and focused primarily on individual interventions, such as mindfulness-based stress reduction, despite problems within the health care system being a much greater contributing factor to burnout and dissatisfaction,” says the report.
A burnout epidemic among HCPs in the U.S. is marked by high rates of suicide and depression, with as many as 400 physicians committing suicide each year, according to the NAM paper. More than half of U.S. physicians are experiencing substantial symptoms of burnout, evident in specialties such as emergency medicine, family medicine, general internal medicine and neurology, the NAM paper says.
High prevalence of burnout and depression has also been reported among medical students and residents—higher than those of similarly aged individuals pursuing other careers. While physicians have twice the risk of burnout compared with other professions, this problem isn’t unique to them. Nurses and other clinicians report high rates of dissatisfaction and stress too.
According to the NAM discussion paper, in a 1999 study of more than 10,000 registered inpatient nurses, 43 percent experienced a high level of emotional exhaustion. And another study of 1,171 registered inpatient nurses showed that 18 percent experienced depression compared to the national prevalence of 9 percent. While there is little known about burnout in other members of the health care team, a similar prevalence among nurse practitioners and physician assistants has been suggested.
More research is also needed to explore the potential implications that HCP distress and well-being has for health care outcomes, the discussion paper says.
Wide-ranging collaboration
Representatives from more than 30 professional organizations attended July 2016 closed meeting hosted by the NAM. The meeting’s goals were to “improve understanding of the nature of the challenges to clinician well-being; consider activities currently under way to address the issues; explore opportunities for collaborative engagement; and consider the potential role of the NAM in leading an initiative to address this issue.”
More than 50 organizations joined the NAM again in January to share information and determine framework for a course of action targeting burnout.
The NAM will meet again July 14 in Washington, with the aim of establishing clinician well-being as a national priority. Among the more than 20 professional and educational organizations joining the initiative will be the AMA, which has placed a high priority on understanding and addressing the sources of physicians’ professional dissatisfaction.
“The very people who have devoted their lives to keeping others healthy are at great risk of suffering from work-induced burnout,” James L. Madara, MD, executive vice president and CEO of the AMA, said in a previous statement. “Physician well-being must be a top priority in national discussions on patient care.”
Organizations attending the next meeting will work with the NAM to “explore promising approaches to promoting clinician well-being by highlighting innovations in medical education, individual interventions, and organizational models.” Learn more about the NAM’s efforts and register for the upcoming meeting.
The AMA’s STEPS Forward™ collection of practice-improvement strategies helps physicians make transformative changes to their practices. It offers modules on preventing physician burnout in practice, preventing resident and fellow burnout and improving physician resiliency. These modules may be completed for continuing medical education credit. The AMA’s STEPS Forward collection features 49 practice-improvement modules. Several come thanks to a grant from, and in collaboration with, the Transforming Clinical Practices Initiative.
The Physician Wellness section of AMA Wire® features ongoing coverage of issues related to burnout, including advice from experts in achieving work-life balance.
- Physician burnout: Detailing the impact, exploring solutions
- Tragedy sparks program to create work-life balance for medical residents
- Report reveals severity of burnout by specialty
