How bad is the physician burnout epidemic in American medicine?
Sometimes a gut reaction is the best indicator.
For Alpa Shah, MD, a psychiatrist who specializes in women’s mental health at Marshfield Clinic Health System, the gut check came after her two young adult daughters both relayed plans to enter the field of medicine.
Traditional expectations, according to Dr. Shah, would be that she and her husband, who are both physicians and from India, would be delighted to hear the news.
“Culturally, we should be overjoyed that our two daughters are talking about going in their parents' footsteps,” she said. But ... “I'm working in the space of physician health and well-being, and my heart sank, and I thought: Do you really want to do this? And so that was a moment of pause and reflection for me.”
Dr. Shah, who is also member at-large for the AMA Integrated Physician Practice Section, said considering those who will soon enter the field of medicine helps bring home the urgency of improving physician well-being.
“We talk about burnout as a contagion,” Dr. Shah said. “But I also think that by changing the culture, by embracing vulnerability, humility and compassion, we can also bring about a positive contagion.”
The Marshfield Clinic Health System, founded in 1916, has seen most of its growth in roughly the last 10–12 years and now encompasses 11 hospitals. Marshfield Clinic is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
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™.
Assessing the issue
For its part, Marshfield Clinic has undertaken a full slate of efforts to help support physicians’ well-being, efforts that continued with their first AMA Organizational Biopsy® this year. The survey yielded a wealth of information that the health system is continuing to process, Dr. Shah said.
“Not a single domain of well-being, culture, practice support, the connections, the individual piece or the drivers of well-being and burnout have been untouched,” Dr. Shah said. “Needless to say, the stress level's been high in the organization and the biopsy results have been somewhat confusing, surprising and concerning. What we found is the stress at work is high, the burnout is high, and the patient-seeing hours are higher.”
Administrative tasks for physicians, though, are less than what’s seen on the national level, and Marshfield Clinic physicians are better at using four weeks of vacation time compared to what national statistics show. Also, time spent by “physicians on nonphysician tasks is less than what we see nationally,” she said. But recent changes to their EHR system have created some challenges for physicians.
“This is something we're going to have to take time to digest,” Dr. Shah said.
Physicians helping physicians
Dr. Shah said Marshfield Clinic has thrown its weight behind a particularly robust peer group called the Physician and Allied Professionals Health Committee, which provides resources for physicians and also advocates system-level changes that promote physician health.
“Ultimately, the goal is really creating a joyful workplace, understanding that professional experience and fulfillment are fundamental to our patients receiving the best care possible,” Dr. Shah said.
Particular care in the committee is taken with physicians who have seen adverse medical outcomes in their patients, she said.
“It's hard for any one of us to go through our career in medicine not having experienced an adverse outcome. And the shame, the guilt, the isolation that follows with it, and the higher risk of burnout, suicide and depression associated with it is well-known,” Dr. Shah said. “When somebody experiences an adverse outcome, there's an outreach to our committee member and we reach out to them and offer confidential support.”
But in addition to helping physicians who are experiencing trauma, the committee also is finding ways to improve doctors’ social bonds with one another.
“We've also worked to establish some social connections,” she said, naming a virtual Bollywood dance and online classes in mixology, painting and baking as some of the events organized for physicians.
"Recognizing that physicians are a high-risk profession for depression, substance use disorders and suicide, our committee assists physicians in getting confidential treatment and helps support their reintegration into practice,” Dr. Shah said.
Tackling a multifaceted problem
Sometimes, it’s crucial to approach an issue from more than one direction. Dr. Shah mentioned one case in which three primary care physicians were struggling with a documentation backlog. The referrals came amid the recent rollout of an augmented intelligence (AI)—also known as artificial intelligence—transcription feature.
“I thought maybe these individuals are not using that,” Dr. Shah said. “Turns out, each individual was … however, the turnaround time was such that there was no way they could finish the documentation the same day.” With this real-world feedback, they were able to advocate with the chief medical information officer to address the issue.
In addition, the physicians involved got extra coaching to help them take the most advantage of the AI transcription and update their approach to documentation to complete it in a timely fashion.
In the end, though, Dr. Shah said there is clearly much that can and is being done to address the systemic drivers of physician burnout.
“With the right focus, motivation and energy,” she said, “there's certainly hope for all of us for a better future in medicine.”
