HOW CAN ORGANIZED MEDICINE help to prevent and treat physician burnout? According to Eileen Barrett, MD, MPH, actions should include reducing documentation requirements and performance measures as well as advocating to remove questions about mental health from the medical licensure process.
For years, Dr. Barrett has sounded the alarm about the need to prevent burnout among clinicians. In a well-known Annals of Internal Medicine opinion piece published during the pandemic, Dr. Barrett and her co-authors wrote that they were “gravely concerned” about exhaustion and disillusionment among physicians and hospitalists. Health care employers and organized medicine, they stated, needed to swiftly “take tangible steps to preserve” a rapidly deteriorating clinical workforce and to turn physician burnout around.
In the opinion piece, Dr. Barrett said physicians need not only resilience training, but systemic change: extended childcare and flexible scheduling for parents, fewer administrative harms, free and confidential mental health resources, no more stigmatizing questions about mental health in credentialing and licensing, suicide prevention strategies, and an end to institutional inertia.
“Burnout is an occupational phenomenon, and we can’t fix burnout unless we fix our workplaces.”
Eileen Barrett, MD, MPH
Workit Health
Dr. Barrett’s lens into physician burnout comes after many years of patient care. An academic hospitalist who practiced at the University of New Mexico in Albuquerque, she also spent more than a decade treating patients in different community settings.
She stopped providing direct patient care last year to focus on quality improvement work for people seeking treatment for substance use disorder—another of her clinical and advocacy passions. All the while, Dr. Barrett has filled regional and national leadership roles in professional societies, as chair emerita of ACP’s Board of Regents, for instance, and currently as president-elect of the American Medical Women’s Association (AMWA).
Now several years after that editorial appeared, how much progress on physician burnout does Dr. Barrett believe has been made? She spoke to Today’s Hospitalist.
Your opinion piece called on medicine to help reduce physician burnout, and over the last several years, you’ve taken on top leadership roles in several medical organizations. What have those organizations been able to achieve?
Our medical organizations and professional societies have had many accomplishments, and yet there is also much work to be done—certainly by organized medicine, but more so by the places where we work. Our professional societies provide community, advise and amplify best practices for reducing burnout and fostering professional fulfillment, and undertake advocacy to reduce administrative and other burdens—all work that is particularly necessary as we see the degradation of community in our workplaces. I don’t know how physicians learn about and do this work without professional medical societies!
Even more important than advocacy and education is organizations helping prepare practicing clinicians to be change agents within their own places of work. Burnout is an occupational phenomenon, and we can’t fix burnout unless we fix our workplaces.
Several recent and high-profile successes that resulted from medical professional society advocacy include reduced documentation requirements, reducing the number of performance measures required by CMS and revising state license applications not to ask about mental health. We know these questions deter clinicians from seeking mental health care.
Putting an end to such questions was one of the critical changes your editorial called for to mitigate physician burnout. Are you encouraged by the number of health care systems and states that have adopted such changes?
It absolutely has been a success story. It took people to recognize that they can change those application questions, and that doing so should be aligned with existing best practices.
Having said that, those changes in themselves aren’t enough. We can encourage people to use mental health resources as often as we want, but that doesn’t help if they don’t have the time or if, in seeking that care, they’re stigmatized.
You left direct clinical care, and many physicians have likewise cut back or cut out direct patient care to become physician advisors or physician coaches or entrepreneurs. Was burnout behind your latest career move?
No, I loved my work as a hospitalist, and I miss direct patient care dearly.
There are many factors behind why so many clinicians are taking different positions than in the past. Physician burnout is surely one of those, and studies during the pandemic looked at how many doctors and nurses were considering leaving clinical care. Also, health care is so complex that experienced physicians who know how to navigate it are needed to improve it. So many now are called to non-patient care work.
Also, since we don’t have a network of easily accessible childcare in this country and most hospitals don’t have a meaningful back-up system, full time clinical work isn’t often sustainable for young parents.
Additionally, something else that’s under-discussed in hospital medicine is that in community settings, shifts start at 7 a.m. and end at 7 p.m. That is harder physically as people age and it’s harder logistically when trying to navigate with family needs.
Another factor that contributes to physician burnout: Medical culture has long been a perfectionist one. Are clinicians at least getting better in terms of talking to each other about stressors and burnout?
I see a generational difference in that a lot of early-career colleagues have a much more realistic, clear-eyed perspective on how we all are human. They understand that hospitalists should seek and receive mental health and physical health care. However, there is still a lot of work to be done to foster a healthier medical culture.
Since the end of the pandemic, I’ve heard several people in health care say that it’s back to “business as usual.” They point to trends like doctors, particularly early-career ones, being back to pulling extra shifts, for instance, because they want to retire their educational debt. Post-pandemic, do you think it’s back to business as usual?
The pandemic was a humanitarian catastrophe that hospitalists observed and lived. Just as in natural disasters, people don’t just move on without acknowledging loss and disruption, and seeking and undergoing healing and recovery. I haven’t heard anyone who works in a hospital say that things are “business as usual”; instead, I am seeing colleagues working in hospitals at greater than 100% capacity, with fewer support staff and with patients who are more medically complex and vulnerable than ever.
You mentioned educational loans: I’ll be very interested to see what the impact of the vastly expanded loan forgiveness is on hospitalist retention. More specifically, if people suddenly no longer owe $300,000 because they may receive loan forgiveness after five years of (very hard) service, that may change their relationship to how many hours they want to work in an environment where they’re not treated well.
Perhaps this will create an imperative for hospitalist workplaces to treat staff better. Ideally this would happen because it is the right thing to do, but it may be because people move on when they have options.
Physician wellbeing resources
• The “Humans before Heroes” initiative and others from the American Medical Women’s Association.
• The Physician Support Line (1-888-409-0141) is free, confidential and anonymous, and it connects clinicians with psychiatrists willing to help physicians and medical students in the U.S. No appointment needed.
• The Dr. Lorna Breen Heroes’ Foundation advises the health care industry on how to implement wellbeing initiatives. It also helps build awareness of the need for mental health resources for clinicians and funds research into and programs for mitigating burnout among health care professionals.
Phyllis Maguire has been Executive Editor of Today’s Hospitalist since 2006. Based in Bucks County, Pa., her health care interests are hospital medicine and long-term care options. She also likes zydeco, hiking, and reading memoirs and romances.
Elephant in the room: Hospitalists and hospital staff being abused by patients and their families! AND that often is encouraged by administrators who want to make patients happy. If I had a nickel for every time I was called by a nursing manager to come back and smooth the feathers of an irate patient or family when I’d already conferenced with them multiple times and it was obvious they were being manipulative … then I’d be rich or at least maybe I’d still be working at a hospital where I really enjoyed my coworkers and my interesting job. I recently… Read more »