Reshaping our health care system to reduce physician burnout
Burnout is a significant problem in health care, threatening the well-being of physicians along with the quality of care they provide to their patients.
The Maslach Burnout Inventory Manual defines burnout as “a psychological syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment.” According to the CMA National Physician Health Survey, 30% of physicians and residents report high levels of burnout — with medical residents, women and early-career physicians at the greatest risk.
Addressing burnout requires meaningful system-wide change. Deliberate and concerted efforts are needed on a national scale to promote the conditions that will optimize physician health and wellness.
This guide can serve as a starting point for that change, exploring the signs of burnout and its human and economic costs, and presenting several strategies for managing and preventing it.
Warning signs and symptoms of burnout
An article in the online health publication VeryWellMind lists the following indications that a physician may be suffering from burnout:
- Feelings of alienation from work-related activities, including viewing their job as increasingly stressful and frustrating, feeling cynical about their work, or emotionally distancing themselves from their work
- Headaches, stomach aches or intestinal issues
- Emotional exhaustion, including feeling drained, unable to cope or unmotivated to get work done
- Under-performance, including having difficulty doing everyday tasks at work or at home, being unable to concentrate, or experiencing a lack of creativity.
Systemic causes of burnout
Eating healthy foods and getting adequate sleep and exercise promote positive mental health. However, the Canadian Medical Protective Association's (CMPA) guide to healthier physicians says system-level factors can make maintaining these behaviours unrealistic for many physicians — possibly contributing to burnout.
These factors include:
- Inefficient work processes (e.g., increased administrative tasks, physician-entered documentation)
- Excessive workloads, long hours and high patient volumes
- Less time spent on meaningful work
- Lack of control and autonomy
- Inadequate support for “second victim” effects
- Negative leadership behaviours and lack of social support
- Limited opportunities for collaboration
- Changes to work context and care delivery models due to new technology
The human and economic costs of burnout
In addition to taking a personal toll on physicians, burnout has been linked to increased health care system costs, adverse patient outcomes and medical-legal events, according to an article published in the Journal of Internal Medicine.
The CMPA found that medical-legal issues and complaints made to colleges and hospitals by patients have risen by more than 20% over the past five years. Burned-out physicians play a role in that as they are more likely to take shortcuts, answer patient questions and discuss treatment options inadequately, and make treatment or medication errors that cannot be attributed to a lack of knowledge. Their patients also tend to be less compliant with treatment plans and take longer to recover.
Burnout is also associated with decreased productivity, which can be measured in terms of work ability, sick days taken, and physicians’ intent to either continue practising or change jobs.
The CMPA says burnout is a sign that something is wrong in a physician’s environment. It shows that the structure and processes of medicine need to evolve to create a health care system that cares for caregivers.
To make improvements and track progress, it’s important to assess rates of burnout among physicians and medical learners. The following scales are often used to measure burnout among health care providers:
The Maslach Burnout Inventory: Human Services Survey*, which measures:
- Emotional exhaustion
- Sense of personal accomplishment
*Note: there is a fee to access this resource.
The Oldenburg Burnout Inventory*, which measures:
- Physical, cognitive and affective exhaustion
- Disengagement from work
*Note: To access the full-text resource, you can request a copy directly from the authors.
The Copenhagen Burnout Inventory which measures physical and psychological fatigue related to:
- Personal factors
- Work-related factors (e.g., clients, patients, students)
Management and prevention of burnout
Burnout is reversible when changes are made to the work environment. For those changes to be meaningful and sustainable, health care stakeholders must recognize burnout as a problem and invest in solutions.
Actions organizations, systems and institutions can take include:
- Implementing strategies to reduce the stigma associated with mental illness. This can reduce the professional obstacles faced by physicians seeking mental health care.
- Supporting proactive mental health programs for physicians and learners, and encouraging physicians to seek appropriate and confidential mental health care if needed.
- Acknowledging physicians’ concerns about seeking care and identifying avenues for accessing confidential care, particularly for residents and trainees.
Physicians can practise self-care by implementing personal strategies to deal with fatigue, stress and uncertainty. Meeting basic needs is a good place to start. Physicians should strive to eat, drink and sleep regularly, and avoid negative coping strategies such as excessive intake of caffeine, sugar, alcohol or drugs.
Taking greater control of the pace of life with mindful transitions can also help fight burnout. For example:
- Transitions within the workday offer opportunities to ask questions such as:
- Am I distracted or anxious?
- Do I need a mental break?
- Transitions from work to home can provide time to process the day. Physicians should talk to their families about how best to support this transition mentally and emotionally. Some may want to vent about their day when they arrive home, while others may prefer to be left alone.
- Transitions from home to work can help physicians get ahead of anxious thoughts. Questions that may be useful include:
- What do I want to feel today?
- What do I need to bring that would be helpful to my team?
- What am I scared of?
- Can I do something with those feelings right now?
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