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National report sounds alarm on clinician burnout

Jan. 25, 2018, 9:15 AM

According to a new report, burnout is on the rise among clinicians and constitutes a growing threat to the nation’s healthcare system. (iStock image)

It’s an epidemic that can’t be controlled with vaccines, hand-washing, facemasks or quarantine. Burnout — a syndrome of exhaustion, emotional detachment from one’s work and reduced sense of accomplishment — is on the rise among physicians, nurses and other healthcare professionals and threatening the entire healthcare system.

A new report issued by the Blue Ridge Academic Health Group calls clinician burnout a “hidden epidemic” and suggests that addressing it should be one of the highest priorities across the healthcare industry.

“At stake is nothing less than the ‘joy of work,’ those elements that the most productive and empathetic clinicians bring to their patients; the sense of professionalism that every doctor, nurse, and other health professional has a right to expect from their career; and the satisfaction, quality and safety that is rightfully demanded by patients,” said Jeff Balser, MD, PhD, President and CEO of Vanderbilt University Medical Center (VUMC) and Dean of Vanderbilt University School of Medicine.

Balser is a current co-chair of the Blue Ridge Academic Health Group (BRAHG) with Jonathan Lewin, MD, President and CEO of Emory Healthcare. The group, which consists of leaders of academic health centers and experts in health policy, studies and reports on issues of importance to improving the healthcare system, with a focus on the role of academic health centers.

Academic health centers have a special role in addressing burnout because they educate and train each new generation of professionals

“Academic health centers have a special role in addressing this issue because we educate and train each new generation of professionals. Our clinicians model the values and professional lifestyles that our students and trainees will emulate in their own careers,” Balser said.

Large-scale studies of U.S. physicians have found that burnout is more prevalent among physicians than in the workforce at large. A 2014 study reported that more than half of U.S. physicians are experiencing burnout. Burnout also affects other health professionals including nurses, nurse practitioners, physician assistants and medical assistants.

The BRAHG report explores the problem, drivers and the impact of burnout. It is the first report that attempts to quantify the economic impact of physician burnout, a staggering figure of $150 billion per year, or 4.7 percent of the nation’s annual healthcare expenditures.

That figure reflects increased physician turnover, productivity loss associated with early retirements, and the projected cost of medical errors linked to burnout. It does not take into account many other effects of physician burnout — including the high toll of depression and suicide that might have roots in burnout — or the costs of burnout to the full range of other health professionals.

“It’s clear that physicians and health-care professionals are strained,” said Mary Yarbrough, MD, MPH, associate professor of Clinical Medicine and executive director of Faculty and Staff Health and Wellness at Vanderbilt.

“We have more pressures, more technology, more documentation, different ways that people are communicating with us, electronic medical records to navigate, quality metrics to meet, patients grading us. The list goes on and on, and there’s a toll for each of these things,” Yarbrough said.

Yarbrough and Reid Thompson, MD, William F. Meacham Professor and Chair of Neurological Surgery, are co-chairs of the VUMC Task Force for Empowerment and Well-being, which was established last year to address the issue of physician burnout.

The task force conducted a survey of all Vanderbilt physicians, which revealed that about half had some symptoms of burnout, consistent with national trends.

“We are not immune from this problem at Vanderbilt,” Thompson said.

The VUMC survey revealed broad themes that physicians identified in naming needs for their best work and personal well-being. The most mentioned needs included self-care, staffing support, leadership support and autonomy. The task force has made initial recommendations and is continuing to address the issue.

“We’re starting a conversation and calling attention to these needs,” Yarbrough said. “I think we’re in the middle of a paradigm shift in medicine where we’ve got to step back and think about how we structure our practices to be more efficient.”

The task force recognizes the need to support not only physicians, but all staff, Yarbrough said. The initial focus on physicians will translate into strategies and organizational changes that establish a culture of well-being, accountability for well-being, and support of self-care at all levels.

These efforts are in line with the BRAHG report, which draws from the national healthcare quality movement and suggests applying similar concepts, such as de-stigmatizing clinicians who ask for help, encouraging transparency, empowering all members of the care team and focusing on system improvement.

The report supports creating chief wellness officers in healthcare organizations, analogous to chief quality officers, with direct links to CEOs.

“I would argue that the institutions that will be successful going forward will be the ones that have addressed this problem head-on and have developed strategies to mitigate clinician burnout,” Thompson said. “I think the work of our task force may be the most important of my career.”

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