Medical System Issues Contributing to Burnout (AMA)
The medical system itself contributes stresses that can lead to burnout in staff and the effects may be felt by medical trainees. The AMA recently listed 12 such factors that drive up physician burnout (Berg, 2020):
- Attempts to improve the healthcare system, such as standardization, productivity targets, and cost controls can pressure physicians to act contrary to their values and decrease their sense of autonomy and control.
- Laws, regulations, and standards are sometimes created without considering the administrative burden which drains time from patient care.
- Healthcare reform and multiple payment systems’ complex rules, processes, metrics, and incentives are a source of administrative burden and financial pressures.
- Medical record documentation and coding requirements by multiple sources, sometimes inconsistent with each other, add another time-consuming burden.
- Quality measurement and reporting, in addition to the many benefits, add a duplicative performance measure that is not clinically relevant.
- Prescription drug monitoring programs, which help avoid polypharmacy and identify drug-seeking behavior, have state-run databases that vary and can be burdensome to use.
- Maintaining privacy and security of health information and protecting electronic health information adds steps to the administrative burden.
- Prior authorization process for medications, diagnostic procedures, and referrals varies with payers and often involves requests for additional information. This task is sometimes passed on to medical students. Aside from the administrative burden, this can interfere with timely patient care and autonomy in medical practice.
- Professional licensure at the state level often involves answering questions about physical and mental health status, which can result in physicians not seeking treatment for treatable illness out of concern for how it may impact their career. (See additional AMA resource on the effect of getting mental health treatment.)
- Maintenance of certification requirements for specialty practice is time-consuming and handled on one’s own time. This process is being evaluated for possible change.
- Professional liability insurance requires disclosure of mental health concerns, which is a barrier to seeking appropriate treatment. Malpractice lawsuits also contribute to burnout. Using emerging technology adds uncertainty and anxiety about liability risks.
- The patient-physician relationship has changed to a more patient-centered collaborative one, but a downside is less trust in physicians and the healthcare system.
What Is Worth Trying to Change?
Develop discernment about which issues are important enough to take on and bring to the attention of the administration. You may have more impact if you act with student organizations or other groups available for taking collective action. Learn about and consider what consequences there may be.
- Find out how it is handled when students meet with Deans or clerkship directors with problems. Is a person being reported notified of who reported them?
- Make informed decisions about how best to spend your energy. Is the issue one that is worth taking on? If not, keep your focus on your most important goals and let the rest go.
Sometimes, it may be difficult to identify exactly what changes clinic leadership could make to meet the healthcare workforce’s needs. A review of research on developing resilience to combat burnout, written before the pandemic, identified factors that leadership can foster to help develop resilience in nursing staff: (Quick Safety, 2019)
Factors that leadership can foster to help develop resilience in staff
- Safe and positive work environment
- Enhance meaningfulness of work
- Invite participation in decision making
- Express confidence that employee can fulfill expectations and recognize accomplishments
- Facilitate goal attainment. Improve employee skills and knowledge and provide resources for effective performance
- Provide autonomy, minimize constraints of rules and restrictions, allow efficiency and creativity
Leadership strategies, such as debriefing and validation
What the Healthcare Workforce Needs from Leaders
(IHI Multimedia, 2020)
The Institute for Healthcare Improvement recently published a list of what leaders in healthcare could provide to promote well-being in the workforce:
- Meet the needs of the workforce, including the basic needs of food, PPE, and childcare.
- Use effective and open communication, with inclusive listening sessions in which leaders show curiosity and empathy.
- Leaders acknowledge their personal vulnerability and humility.
- Lead the way in overcoming negative bias by asking “What is going or working well?”
- Normalize help-seeking
- Acknowledge losses by honoring them, while at the same time, present a path of hope for going forward.
- Discuss changes that may not have been possible in the midst of crisis, but that should be implemented to prepare for any future crisis.
Berg S. The 12 factors that drive up physician burnout. American Medical Assoc. 2020.
IHI Multimedia Team. How Leaders Can Promote Health Care Workforce Well-Being. 2020, December 10).
Quick Safety. (2019). Developing resilience to combat nurse burnout. The Joint Commission.