Does Physician Burnout Injure Patients? Isn’t the Time for Action Now?

Physician and healthcare worker burnout is dangerous

It is estimated that 350 doctors in the United States commit suicide every year – roughly a doctor a day.

Serious medical errors are significantly increased, causing injury to patients.

Health care costs and insurance premiums increase.

Why? The answer is physician burnout.

Physician burnout affects over 50 percent of doctors in the country, and between 2011 and 2014, the latest year for which statistics are available, physician burnout increased by nine percent.

“Physicians working in the specialties at the front lines of care (e.g., emergency medicine, family medicine, general internal medicine, neurology) are among the highest risk of burnout,” according to a National Academy of Medicine discussion paper titled “Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care.” “Burnout is nearly twice as prevalent among physicians as US workers in other fields after controlling for work hours and other factors. Several studies have also found a high prevalence of burnout and depression among medical students and residents, with rates higher than those of age-similar individuals pursuing other careers.”

The tragedy is taking a terrible toll on doctors dying by their own hands. The morbid irony is that doctors have less of a chance of succumbing to cancer, heart attack or stroke, primarily because of their knowledge of the importance of early diagnosis, but more of a chance of succumbing to a highly treatable disease. The tragedy also is taking a terrible toll on patients becoming victims of major medical errors. A new study by the Mayo Clinic shows that the emotional, mental and physical fatigue that comes with being a doctor leads to costly and critical mistakes. In that study, the authors concluded that:

“This study suggests that burnout, poor wellbeing, and low work unit safety grades are independently associated with increased odds of recent perceived major medical errors among US physicians. A multifaceted approach is needed to reduce medical errors, including interventions to improve unit-level patient safety infrastructure as well as system-level interventions combatting physician burnout and promoting well-being.”

Burnout is recognized as common hazards among health care professionals,” according to the study, titled “Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors.”  The incidence of physician burnout is estimated to be more “…than 50%, excessive fatigue is reported by 45%, and the suicide rate is 3- to 5-fold higher than in the general population”. This condition has led to or contributed to patient safety events and medical errors. Most studies evaluating health care professional burnout and quality of care have found an inverse relationship, although this finding has not been universal. In the Mayo Clinic study, they found in a three-month period, 691 medical errors linked to physician “burnout”. Of those, over 20% resulted in traumatic patient injury or death.

Poor physician well-being in other domains (eg, fatigue, depression, poor quality of life) has been linked to reduced patient safety in many, but not all, studies. Most reports have been cross-sectional observational studies, and a nuanced understanding of the potentially bidirectional connection between physician well-being and patient safety remains in its infancy.”

While much more research remains, the time for action is now. Patients should not be harmed, or worse, by major medical errors that can be prevented.

“This study suggests that burnout, poor well-being, and low work unit safety grades are independently associated with increased odds of recent perceived major medical errors among US physicians,” the Mayo Clinic writes. “A multifaceted approach is needed to reduce medical errors, including interventions to improve unit-level patient safety infrastructure as well as system-level interventions combatting physician burnout and promoting well-being.”

The Rochester, Minn.,-based facility is one of the pioneers in such safety efforts, establishing the Program on Physician Well-Being in 2007. The program is dedicated to daily health and wellness, and every employee must go through the classes and engage in it.

“Defining the prevalence, causes, and consequences of physician burnout across the career span, and developing evidence-based interventions that improve the work-lives of physicians and the care they provide to patients,” is how the Web site describes it.

Stanford Medicine launched a health-and-wellness program for employees in 2017 and hired a chief wellness officer to run it. Dr. Tait Shanafelt, a hematologist, oncologist and associate dean of Stanford University’s medical school, is charged with addressing the issues doctors inherently face – endless paperwork, records-keeping and patient overload – that all lead to excruciating hours.

“There needs to be a greater culture around vulnerability and supporting each other in the demands of the work,” Shanafelt told Kaiser Health News in an article titled “Stanford’s Chief Wellness Officer Aims To Prevent Physician Burnout.” “We also need to understand the unique challenges and demands of each specialty. A surgeon and a radiologist have different jobs. Emergency physicians, for example, have high rates of burnout but also high rates of work-life satisfaction. But unless we as a profession have a dialogue about burnout more broadly, all the things we do in training will have a limited impact. The minute new doctors go into practice, they look at behavior of their more senior colleagues and they’re instantly going to adopt that behavior.”