Adapted from How to Succeed as a Healthcare Leader by Rachel Miller, MD.

Burnout has reached crisis levels among healthcare workers. Earlier this year, U.S. Surgeon General Vivek Murphy issued an advisory highlighting the urgent need to alleviate the burnout crisis and promote the mental health and well-being of health workers.

Addressing the problem begins with identifying what’s fueling it. In this post, we explore five common causes of burnout unique to healthcare professionals, and actions that might be needed to alleviate them.

WHO: Burnout is an occupational phenomenon

Though burnout has been a challenge for decades, our understanding of it has evolved. In 2019, the World Health Organization (WHO) began the process of changing the definition of burnout from a “state of vital exhaustion” to a “syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” In doing so, the organization defines burnout as an occupational hazard rather than a medical issue.

Just months after the WHO initiated this change, COVID-19 hit, magnifying pressures on frontline workers — particularly in healthcare. As Murphy puts it, the pandemic has been a uniquely traumatic experience that’s pushed healthcare workers and their families past their breaking point. The longer we delay action, the more we risk the health of our communities.

Common drivers of burnout

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In examining factors hampering the mental health of clinicians, we come to five common drivers of burnout.

1. Poor EHR implementation and workflow

 When electronic health records (EHRs) were introduced, no integration standards followed to ensure they’d work seamlessly across varied healthcare organizations. The result has been an operational nightmare. Doctors spend nearly six hours a day entering data or otherwise interacting with EHRs — nearly twice as much time spent on direct patient care.

In efforts to correct the problem, many health systems now hire medical scribes to handle data entry — a costly workaround that doesn’t eliminate the need for time-consuming, manual tasks. Research is underway for ways to make EHR systems easier, though we’re not there yet.

Looking ahead, physicians have an important role to play in defining what EHR processes look like in the future, and how the technology can fit most effectively into the workflow of patient care.

2. Constant introduction of new technology

From pacemakers to MRIs, PillCams and more, we’ve witnessed a slew of new technologies designed to improve diagnosis and care in the past decade. Artificial intelligence, once limited to sci-fi movie plots, is also poised to accelerate the transformation of healthcare in a not-so-distant future.

Along with the promise and benefits each innovation brings comes a significant learning curve: Clinicians must learn how to use and maintain new technology tools, plus understand how to evaluate and apply output data.

Here, too, physicians play a vital role in deciding how new technology can best be employed to improve patient care.

3. Long hours

Doctors have always worked long hours. And yet, there’s significant difference between time spent on patient care and time spent on administrative tasks like EHRs or regulatory compliance reporting. Physicians and other healthcare staff need as much sleep as everyone else, but the reality of medicine is that illnesses do not follow a nine-to-five schedule.

Only someone who understands medical science can decide when it is appropriate for a clinician to stay on-site in the course of treatment, and when a patient’s care can be safely transferred to the hands of another shift.

Sleep deprivation and poor work-life balance are common offshoots of working excessively long hours. Both put patients, clinicians and health organizations at risk.

4. Financial stress

Student debt remains a major source of financial stress for healthcare professionals. Though student debt is not exclusive to physicians, most medical students graduate with an average debt exceeding $190,000. 

In addition, because we are a litigious society, doctors must also deal with liability issues. The high cost of malpractice insurance — plus the emotional stress of a potential lawsuit and damaged reputation — add to the weight on the shoulders of medical professionals.

5. Bureaucracy and loss of control

The role of physicians today differs sharply from what it was just a few years ago. Once viewed as heroes and trusted authorities when it came to patient care decisions, physicians now must navigate a host of stakeholders including technical specialists, insurance companies, government regulation, and the resulting bureaucracy that goes into those decisions.

Take health insurance providers, for instance. While health insurance increases patient access to care, insurance company rules also present barriers to the practice of medicine. One example is the step therapy rule for cancer treatment. The rule requires doctors to start chemotherapy treatments with drugs chosen by the insurance company rather than the physician. Insurance companies almost always choose the least expensive option, even when that drug is more toxic than the doctor thinks is needed, or even when it was already tried, without success, at a time when the patient was covered by a different insurance plan. These bureaucratic, not medical, decisions can be costly — even deadly — for a patient.

Other insurance company rules affecting care include:

  • requiring prior authorization (i.e., an approval form that the physician must file with the insurer) before a patient can get a particular medication or treatment;
  • excluding medications based on the cost or lack of financial incentive from the pharmaceutical company to the insurer;
  • switching the medication prescribed by the doctor to a similar — but not necessarily as effective — medication chosen by the insurance company; and
  • extremely low reimbursement for mental health services (Ginsberg 2017).

These limitations are especially stressful when physicians know that decisions are being made based on factors not directly related to a patient’s condition.

Rising best practices

These are, undoubtedly, complex problems in increasingly complex environments. Solutions aren’t simple, and answers aren’t always obvious.

On a positive note, the following practices have produced positive outcomes in supporting healthcare workers. (You may glean detailed guidance for each of these items from the U.S. Department of Health and Human Services.)

  1. Give staff a voice: Involve workers in identifying problems and solutions.
  2. Engage multiple and supportive communications strategies.
  3. Practice walk-around, direct communication and modeling.
  4. Provide space for staff physical fitness and wellness.
  5. Explore employee support strategies.
  6. Offer or facilitate financial support for staff.
  7. Offer free water and food for all healthcare workers.
  8. Encourage recognition of grief and loss.
  9. Promote existing support programs.
  10. Offer resources and referrals as appropriate.

In the absence of magic wands and one-size-fits-all formulas, one thing is clear: Healthcare organizations that manage to thrive, remain relevant and financially healthy in the years ahead are those who invest in their people — particularly in developing transformational leaders who, in turn, can cultivate teams who are well equipped and engaged to sustain quality healthcare delivery.

Adapted from How to Succeed as a Healthcare Leader by MEDI Leadership Coach Rachel Miller, MD.

Rachel Miller
About the author

A certified executive coach and physician leader, Dr. Rachel Miller is passionate about bridging the gap between clinical and executive leaders.
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