Turning Down the Heat: What to Do About Physician Burnout

By Jaidev Dasgupta, M.S., Ph.D.
Project Leader, Managing Workplace Complexity, PHS

“The effects of burnout and depression on medical trainees are growing,” writes Dr. Miguel Paniagua in 100 Days of Rain: A Reflection on the Limits of Physician Resilience. “[M]any health care practitioners silently bear the burden of not only struggling to care for their patients, but also for themselves” (NAM Perspectives, 2017). This is the current state of affairs of the health care system. More than half of practicing physicians are experiencing burnout, a state of emotional exhaustion that leads to compassion fatigue and the loss of professional effectiveness, according to a recent study in the Lancet. This, in turn, affects patients’ experience, eroding satisfaction and potentially the quality of care.

Awareness of the burnout phenomenon has grown in the past decade, and despite efforts to rein it in, the burnout rates continue to rise. Currently, there are two approaches to addressing burnout. One, the individual approach, is to enable doctors to take care of their own mental and physical health in order to cope with mounting challenges in the workplace. This focuses on building resilience, the use of mindfulness techniques, reducing stress, tapping into peer support, and so on. The second perspective sees burnout as arising from faulty organizational structures and burdensome technologies, such as EHRs. The focus here is on redesigning workplace processes and tools. While both these approaches have yielded some positive results, their long-term efficacy and scalability have not been established.

Other aspects of the burnout problem deserve attention. One of these is community. Doctors must be viewed as part of the community they serve. A primary care physician serving in an underfunded, understaffed community health care center may be at higher risk of burnout and depression — a risk that is unlikely to be mitigated unless the conditions of the workplace change. It also matters that health care delivery has become an industry — which, like any other industry, operates with the mantra “more with less.” When maximizing profit is the motive, physician burnout is a likely side effect.

The burnout epidemic is not simply a result of individual or organizational issues. Ailing physicians are a sign of a system that needs help at multiple levels. The health care system operates in the context of related entities that can affect its performance: community, industry, regulations, and the overall socio-cultural environment. That’s why at Physician Health Services we are developing a burnout intervention program that takes a broader perspective, exploring solutions that go beyond the individual, team, or organization. Addressing physicians’ work-related illness may need a paradigm shift toward an ecological approach that recognizes those levels of influence and their effects on physicians’ well-being.

Dr. Dasgupta is an Encore Fellow at PHS (Encore Fellowships match seasoned professionals with social purpose organizations; ESCNE.org). He is the author of In Search of Immortality (Manohar, 2015). In the recent past he was a scientist, technologist, and entrepreneur.

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