Aug 16, 2019
Dr. Richard Balon gives a lecture on physician burnout and
mandated wellness and Nick Andrews talks to Damian McNamara about
the final days of Hahnemann University Hospital in
MD: professor of psychiatry and training director at Wayne
State University, Detroit.
In March, Dr. Balon spoke at the American
Academy of Clinical Psychiatrists 2019 annual meeting in
Chicago, sponsored by Global Academy for Medical Education. Global
Academy and this news organization are owned by the same
By Jacqueline Posada, MD, who is a consultation-liaison
psychiatry fellow with the Inova Fairfax Hospital/George Washington
University program in Falls Church, Va.
Physician burnout and effective
- The scales (for example, the Maslach
Burnout Inventory) do not necessarily represent the full extent
- If physicians work 12 hours but find fulfillment in work, they
will be tired but not necessarily burned out. However, if
physicians work 12 hours a day feeling frustrated by the systemic
problems, then burnout can ensue.
- Common contributors to provider burnout:
- Excessive workload: Pressures of working
with an electronic medical record, extensive time spent on
documentation; lack of work satisfaction and job control; lack of
respect for the work; and student loan burden.
- “Moral injury”: The emotional burden that
occurs when physicians cannot deliver ideal care/treatment to
patients, especially when limited by resources (such as insurance
or poverty), or other systemic health care issues.
- Work environment and organizational
culture: These factors also contribute to physician
Burnout is a problem for health care organizations as a
- Two main ways to address burnout: physician-directed
interventions (focused on individuals) and organization-directed
- Organization-directed burnout prevention strategies include:
- Reducing workload; reducing time spent on documentation, such
as decreasing time spent in front of EMRs; cultivating effective
teamwork; fostering a sense of job control.
- Organizations prefer individual-focused interventions over
- Examples include mindfulness teaching, yoga,
cognitive-behavioral therapy techniques, education about burnout,
- Individual-focused interventions are great, but they are not
realistic for changing the culture that contributes to
Interventions for burnout
In a systematic review and meta-analysis in
JAMA Internal Medicine, Maria
Panagioti, PhD, and colleagues found that:
- Burnout interventions focused on individual physicians have
small, significant effect on physician burnout.
- Organizational-directed approaches result in greater treatment
effects, especially when interventions focus on promoting healthy
- The impact of individual interventions can be improved when
supported by organizational interventions.
- Interventions targeted at more experienced physicians within
primary care settings show greater treatment effect than
interventions targeted at less experienced physicians within
secondary treatment settings.
Approaches identified by staff can lead to meaningful change, as
outlined by in a
New England Journal of Medicine article by
Melinda Ashton, MD.
- A Hawaiian health care system queried individuals (physicians
and mid-level and nursing staff) to identify which parts of EMR
documentation were poorly designed, unnecessary, and could lead to
unintended burdens contributing to burnout.
- This type of survey improves the efficiency of a system and
illustrates that the health care organization cares about
preventing clinician burnout.
Panagioti M et al. Controlled interventions to reduce burnout in
physicians: A systematic review and meta-analysis. JAMA
Intern Med. 2017 Feb 1;777(2):195-205.
Ashton M. Getting rid of stupid stuff. N
Engl J Med. 2018 Nov. 8;379(10):1789-91.