Hospital Physician Burnout: Causes and Solutions
Written by Joshua Kleinstreuer
IN A NUTSHELL:
- Hospital medicine among the fastest-growing health care specialties
- Approximately 55 percent of hospitalists experiencing burnout
- Can have an impact on patient outcomes, physician well-being
Hospital medicine is among the fastest-growing health care specialties in the country, and with that comes a rapid rise in the rate of physician burnout.
A national survey found that hospitalists were most satisfied with the quality of care they provided as well as their relationships with other staff members. The study found that the hospitalists were least satisfied with organizational climate, autonomy, compensation, and availability of personal time (Hinami et. al).
All of these negative factors can contribute to physician burnout, which is characterized by emotional exhaustion and a reduced sense of accomplishment.
When a physician experiences emotional exhaustion, they often feel overextended and depleted of their own emotional and physical resources. Reduced personal accomplishment is characterized by negative self-appraisal, inefficiency in work responsibilities, and feelings of incompetence (Maslach et. al).
Those who work exclusively in a hospital face specific challenges, stress factors, and are responsible for around the clock patient care. The atypical work schedule hospital workers endure disrupts personal and family time. Similar to physicians overall, a large percentage of hospitalists are married or living with a partner. A majority described their marriages as good or very good, according to the survey. More hospitalists are single than in the general physician population. However, that could be due to the large proportion of a younger demographic working as hospitalists, according to the report (Hinami et. al).
In regards to mental health, 11 percent of study participants said they had had thoughts of suicide, but had not attempted it; 4% said they had attempted it; 81% said they had not had thoughts of suicide, and 4% preferred not to answer. Most hospitalists do not seek help for burnout or depression, according to the study. Only 12% of hospitalists said that they would seek help or are currently seeking help. Two-thirds of respondents said they would not be likely to seek professional help for burnout or depression and had not done so previously (Hinami et. al).
An article published in The American Journal of Managed Care online blog (Rosenberg 2018) said that studies have indicated there is a correlation between physician burnout and an increased risk of patient safety incidents, reduced patient satisfaction, and a reduction in care quality.
The longitudinal Internal Medicine Resident Well-Being (IMWELL) Study found that higher levels of burnout were associated with increased odds of reporting a major medical error within the first three months. Increased physician depersonalization levels were shown to be linked with longer recovery times for patients after they were released from the hospital (West et. al 2018).
Burnout can cost the healthcare industry between $2.6 billion and $6.3 billion each year, according to a new study published in the Annals of Internal Medicine. The researchers calculated a baseline of nearly $5 billion in costs from turnover, reduced productivity and other burnout-related factors.
The study also revealed that each employed physician leads to about $7,600 in burnout costs each year for their facilities, but the costs can range between $3,700 to $11,000 per physician, depending on how the analysis is conducted (Hans 2019).
The (American Medical Association) AMA developed a module in partnership with the American College of Physicians and the Society of Hospital Medicine, on how leaders can promote positivity in hospital medicine:
1. Understand burnout:
Aside from unusual work schedules, physicians in a hospital setting face unique burnout drivers:
- Limited academic opportunities
- Pressured to care for patients outside their scope of practice,
- Work in a relatively new field
- Face competing priorities from different stakeholders
Facility leaders are encouraged to conduct an anonymous needs assessment survey about burnout, individual goals, group goals. Following the survey with personal, small group discussions can be helpful to develop a deeper understanding.
2. Maximize engagement:
According to research, burnout increases when a physician feels a lack of autonomy or purpose. Engagement aims to boost those feelings and can be achieved by building a sense of community, providing professional development opportunities, encouraging academic excitement, and minimizing exhaustion.
3. Promote self-care:
There are several factors of self-care that are unique to hospitalists. Night shifts can lead to insomnia and sleep disturbances, which makes it important to focus on promoting sleep hygiene and regular exercise.
Additionally, working in a hospital setting opens the door to more serious medical events, thus self-care should also focus on dealing with death. This can be achieved through reflective writing, peer support groups, and mindfulness exercises.
4. Increase communication across specialties:
Frequent communication with various specialties and support staff can help collaboration and create a teamwork environment.
5. Provide recognition:
Developing a reward and recognition program is an inexpensive way to promote teamwork and show the value of staff members.
Overall, to increase workplace satisfaction and reduce hospitalist burnout, programs should focus on climate and fairness within the health care organization, increased personal time, and increased compensation (Hinami et. al).
Han S, Shanafelt TD, Sinsky CA, et al. Estimating the Attributable Cost of Physician Burnout in the United States. Ann
Intern Med. 2019;170:784–790. [Epub ahead of print 28 May 2019]. doi: https://doi.org/10.7326/M18-1422
Hinami, K., Whelan, C. T., Wolosin, R. J., Miller, J. A., & Wetterneck, T. B. (2012). Worklife and satisfaction of
hospitalists: toward flourishing careers. Journal of general internal medicine, 27(1), 28–36.
Hospitalist burnout: 5 ways for leaders to tackle growing problem. (2020, February 27). Retrieved from
Maslach, C., Jackson, S. E., Leiter, M. P., Schaufeli, W. B., & Schwab, R. L. (1986). Maslach burnout
inventory (Vol. 21, pp. 3463-3464). Palo Alto, CA: Consulting psychologists press.
Rosenbuerg, J. (2018, October 4). Physician Burnout Associated With Poorer Patient Outcomes. Retrieved March 6,
2020, from https://www.ajmc.com/focus-of-the-week/physician-burnout-associated-with-poorer-patient-
West, C. P., Dyrbye, L. N., & Shanafelt, T. D. (2018). Physician burnout: contributors, consequences and
solutions. Journal of Internal Medicine, 283(6), 516–529. doi: 10.1111/joim.12752
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