Canadian Medical Association

Physician wellness is a growing concern in the medical profession

Physicians are at risk of experiencing poor mental health and burnout because they are exposed to workplace factors that exert ongoing high stress, such as long work hours and work overload (both of which they have little control over) as well as the emotional strain inherent to the profession. 

Burnout has three main symptoms: 

  • Emotional exhaustion. “I'm not sure how much longer I can keep going like this.”
  • Detachment or depersonalization. This can manifest as cynicism, sarcasm, or the need to vent about patients or the profession. 
  • Diminished sense of personal accomplishment. “What's the use? My work doesn't really serve a purpose anyway.”

Burnout erodes physicians’ professionalism and can have profound effects on their health. An article by Shanafelt and colleagues (2017) shows a link between burnout and alcohol use, depression and suicide

In addition to high rates of burnout, the CMA National Physician Health Survey revealed that 34% of Canadian physicians and residents screened positive for depression and 8% had thought of taking their own life within the last year. 

This article provides rationale for investing in physician wellness, based on successful U.S. models and non-healthcare Canadian workplaces. (More research is needed to identify specific challenges for the Canadian health care system.) Note: there is a fee to access this article (buy or rent a read-only copy here

Employers have a responsibility to support the health of their staff

Health care employers have the same ethical responsibility to address physician wellness as other employers have to their workers. That means they must take action to address any occupational and personal barriers to positive physician health.

Yet many health systems do not have adequate programs in place to address physician health and wellness. This is due to a combination of factors, including a lack of knowledge around best practices as well as a perceived lack of evidence that investing in wellness programs can have a positive impact on the bottom line. However, research shows that this investment yields valuable returns to physicians, patients and organizations.

Investing in wellness makes economic sense

In addition to the ethical argument, there is a strong economic case for investing in physician wellness. Evidence in Canada and the U.S. suggests burnout represents real costs to the health system. Here’s how: 

Increased turnover
Burnout is a major driver of physician turnover, which is costly. In addition to the costs associated with recruitment and onboarding, each new hire brings a dip in productivity because it takes time for a physician to work effectively in a new organization. High turnover also has an impact on the quality of patient care, as new physicians are less familiar with patient histories and need time to build trust with each patient. Turnover can also affect employee morale and an organization’s reputation.

Decreased productivity
Physicians experiencing burnout will often work reduced hours, take more sick leave and be able to devote less effort to work. Studies have shown that because of the high fixed costs in health care, even a small change in productivity can have a large impact on an organization’s bottom line.

Lower quality of care
Research has also revealed a link between physician burnout and patient care quality indicators, including longer patient recovery times, suboptimal prescribing and test ordering habits, and lower patient adherence to treatment recommendations. In addition to the obvious impact this has on each patient, lower quality of care also affects the organization as a whole — for example, by hurting its reputation or causing it to use resources inefficiently.

Increased risk of medical errors 
Physician burnout has been shown to predict medical errors more strongly than fatigue. A large meta-analysis revealed that around 1 in 20 patients are exposed to preventable harm in medical care. The associated legal implications can significantly impact an organization’s finances and reputation.

Fortunately, burnout is reversible — and even preventable if addressed appropriately. According to one study, burnout is primarily driven by excess job demands and insufficient resources and support, making it a system-level problem rather than an individual problem resulting from personal limitations. That means if the issue is largely system-driven, the solution must be as well. 

The ROI of workplace wellness programs 

Canadian research shows just how costly burnout can be, but also the potential savings of implementing strategies to address it.

An article published in BMC Health Services Research used national survey data to examine two recognized consequences of physician burnout: early retirement and reduced clinical load. The authors used economic modelling to estimate the predicted financial loss in health care services and found:

  • Early retirements would result in a service loss of an estimated $185 million
  • Reduced clinic hours would result in an additional $28 million in losses
  • Total estimated cost of burnout over a career cycle is $213 million

Other industries also offer insights into building a business case for investment in physician wellness. According to a report by Deloitte, Bell Canada’s 2018 return on investment (ROI) for every dollar invested in workplace mental health programs was $4.10. Between 2012 and 2019, Bell recorded a positive ROI on its investment in workplace mental health every year.

A study out of the Mayo Clinic showed the impact of a comprehensive, system-level strategy to promote physician wellness and engagement. After the strategy was implemented:

  • The absolute burnout rate at the Mayo Clinic decreased by 7%, despite a national 11% increase
  • Rates of burnout in non-physician colleagues also decreased

As burnout is linked to negative system-level metrics (e.g., lower quality of care, higher turnover rate, decreased patient satisfaction), positive impacts on organizational productivity and long-term viability are likely when there is investment in physician wellness and engagement.

Where to start?

Although addressing burnout is complex, it is possible — and the ROI is measurable.

You may be unsure where to begin or you may not believe you have enough resources to make a meaningful difference. However, evidence suggests that even modest investments can have an impact. For instance, issues like flexibility, sense of community and meaning in work can often be addressed with limited investment.

Experts recommend avoiding “generic” wellness programs. They should be tailored to the team or department in question based on an assessment of its current state of wellness. Start by identifying workplace factors that drive burnout and engagement. Then you can make incremental improvements over time. Often, existing programs can be refined to meet the most pressing issues. 

View a common stepwise approach to addressing physician wellbeing

Looking to the future

Strengthening the health and wellness of the physician workforce is a shared responsibility. Individual physicians must take steps to maintain their personal health and wellness, but health care employers must also implement system-level initiatives. Together, let’s commit to taking the first step to make meaningful change.

Topics

Organizational wellness Burnout Policies, standards and best practices

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