Willie Underwood III, MD, MSc, MPH, became a doctor to make a difference. He loved medicine. He dreamed about it.
But burnout changes things.
"Burnout is real," Dr. Underwood said. "People like myself … are now waking up at 3 in the morning wondering: Did we make the right choice? Why are we doing this? That's unacceptable, for them, their families, and for our patients."
Dr. Underwood, chair of the AMA Board of Trustees, discussed his concerns about physician burnout and offered best practices to reduce physician burnout rates in a recent episode of “AMA Update.”
Identify issues at the system level
In 2021, 64% of physicians reported experiencing at least one symptom of burnout. Meanwhile, half of all practicing physicians still reported burnout in 2023.
And nearly 40% of practicing physicians have plans to leave their current role.
“At this point, burnout becomes more than just a well-being issue, it becomes a patient-access issue," Dr. Underwood said. "Burnout is now an epidemic in medicine, and treating it has to be a top priority for all of us."
That treatment begins at the system level, he said.
Of particular concern is that nearly 80% of physician dissatisfaction is related to system-level issues, says an estimate from the American College of Physicians. AMA data shows that EHRs play a major role in that dissatisfaction. Dr. Underwood shared that for every eight hours physicians spend with patients, they spend at least five hours working on the EHR.
Most of that time is spent outside regular work hours, he added.
“These systematic issues are bigger than any one physician could address on their own. They require the attention and commitment of organizations to truly solve these,” Dr. Underwood said. “When organizations do address these issues, that is when we see real change."
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.
The AMA has achieved recent wins in five critical areas (PDF) for physicians.
Follow four best practices
The AMA launched the Joy in Medicine™ Health System Recognition Program to help health systems reduce burnout and improve physician well-being. Dr. Underwood provided four best practices any organization can follow to begin that improvement process.
Start by offering well-being assessment to understand the scope of the problem. Ideally this assessment would be distributed annually, but at a minimum, it should be performed every three years, Dr. Underwood said. This assessment will help organizations identify underlying drivers of burnout, understand what is needed to support professional well-being, and provide those offerings.
The second step is clear organizational commitment.
"No sense measuring it if you don't address it," Dr. Underwood said. "One best practice that we recommend is an organization establish a formalized well-being committee and an office of well-being. Why? Because you need someone to take responsibility for solving the problem."
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Once organizational commitment is in place, the focus needs to shift toward operational efficiency. Workflow and inefficiencies with technology—particularly the EHR—are key components driving physician burnout. To help mitigate that, Dr. Underwood recommended systems begin measuring the amount of time physicians spend with the EHR.
Dr. Underwood also recommended that systems assess the level of teamwork that exists within their organization, since effective teamwork plays a key role in physician satisfaction and well-being.
"Teamwork makes the dream work," Dr. Underwood said. "If we can't work together, you've got a hostile, toxic environment."
Learn about other best practices with the AMA Joy in Medicine road map (PDF).
Have important conversations
Dr. Underwood also believes the International Conference on Physician Health™ and the American Conference on Physician Health play a pivotal role in shaping the conversation around burnout and how it can be addressed at the system level.
If that conversation does not happen, Dr. Underwood fears physicians will continue to suffer burnout and leave the field. He doesn't want colleagues waking up in the middle of the night questioning their career decisions.
He believes a different future can exist for physicians—one not plagued by burnout.
"I hope our physicians can recapture the joy that they had when they got accepted to medical school, when they got accepted to their residencies, when they got their first job and even their second job and third job, instead of wishing that they never did it in the first place," Dr. Underwood said. "We work too hard for that. This is not just a physician issue. This affects everyone."
“AMA Update” is your source for physician-focused news. Hear from physicians and other experts on trending public health concerns, practice issues and more—because who’s doing the talking matters. Catch every episode by subscribing to the AMA’s YouTube channel or listen to all AMA podcasts at ama-assn.org/podcasts.
