The Doctor’s Advocate | First Quarter 2022
An Ounce of Prevention

Clinician Burnout: From a Crisis to a Movement

Christine K. Cassel, MD, MACP, Professor of Medicine and Senior Advisor for Strategy and Policy, University of California, San Francisco, School of Medicine

Workplace surveys and reports from the U.S. Bureau of Labor Statistics continue to signal a burnout-fueled professional exodus from healthcare.¹

Burnout is not a new problem—we knew what it was before we had a name for it. Even before the pandemic, burnout began getting more attention for three reasons: (1) Metrics measuring it have been publicized; (2) studies have shown burnout’s effects on patient safety, quality of care, and patient experience; and (3) the focus on systems has highlighted that clinicians’ experiences working in healthcare systems have been a driver of burnout.

I had the honor of chairing a major report for the National Academy of Medicine (NAM) on clinician burnout, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.² When we delivered our report in late 2019, the demands we documented included excessive workload, unmanageable work schedules, inadequate staffing, administrative burden, interruptions and distractions, inadequate technology support, time pressures, and moral distress. And that was before the pandemic.

The occupational health definition of burnout is what occurs when job demands exceed resources. To find solutions, we need to remember that these systems are made up of people, and that is where human factors science comes in. I invited a systems engineer from the National Academy of Engineering to co-chair the report, because solving burnout isn’t just about clinicians learning to meditate. It is about changing the systems in which we work.

What Contributes Most to Burnout?

A 2021 Medscape survey asked physicians questions such as, “What contributes most to your burnout?”³ Unsurprisingly, we saw clinicians reporting that they were overloaded with “inbox” management and bureaucratic tasks requiring “pajama time” to catch up on computer work. But one complaint took me by surprise: Lack of respect from administrators, employers, colleagues, or staff. So, some of this is about our peer relationships.

It also speaks to a systems issue. As more and more clinicians become employed, rather than practicing independently, many have the feeling that those in leadership do not understand or care how to make the workflow better at the frontline. We must attend to this aspect of burnout because it leaves people feeling like pawns with little or no control, autonomy, or ability to contribute to systems improvement—which is itself a major contributor to burnout. One positive finding from a Stanford study shows that even within the same institution, physicians can report dramatically different rates of burnout, with lower burnout strongly correlated to the perception of shared values with supervisors.⁴

What Are Policymakers Hearing About Burnout?

Right now, we have the ear of leaders who can help us make real advances at the national policy level. Vivek Murthy, MD, U.S. Surgeon General, has paid attention to burnout since before the pandemic and is now Co-Chair of the NAM-hosted Clinician Well-Being Action Collaborative. He directs the attention of policymakers to the following areas:

Reduce the documentation burden. This issue deserves examination from both technical and regulatory perspectives. We are working with the Office of the National Coordinator for Health Information Technology and CMS to examine documentation requirements, clarify what is really necessary, and find ways to decrease clinician burden.

Bring together technology innovators. Technology innovations are needed to leapfrog over some problems presented by EHRs and to provide better, more user-friendly technology solutions to help clinicians get the information they need more quickly and efficiently.

Convene CEOs, system leaders, and compliance chiefs to develop toolkits. We are encouraging leaders to listen, identify the forces in their systems that are causing burnout, take steps to mitigate those forces, and share leadership resources.

Convince state licensing boards to remove the stigma of seeking mental health treatment. Some state boards are taking the lead, but we need them all to follow suit. Clinician burnout is compounded when healthcare professionals feel they cannot seek mental health services without licensing board scrutiny.

What Can We Do in Our Own Systems?

Sometimes individuals see the complexity of systems theory and they think, “There’s nothing I can do.” But the answer is exactly the opposite: This problem, which needs people working on it from every angle, offers many opportunities to intervene. Every work environment is its own system, and our own environment is the place to start. Here are some questions to ask that can lead to areas for system change:

How do we get people to come to work with the best of themselves? Some of this is obvious, like allowing a work/life balance and support for childcare, but some of it is how we treat each other and how we think about the flexibility of roles within the workforce.

Where can I actually make a difference? Look for areas that you have control over or can influence. Focus your efforts on these areas.

Who are the innovators in my system? Encourage and support innovators who suggest different perspectives or strategies. This can lead to additional improvement ideas at the microsystem level and also battle burnout by making people feel more valued and empowered.

How can we adjust our staffing models? Staffing needs to be more efficient while still allowing clinicians to maintain the human interactions with their patients that are sometimes the most rewarding part of the job.

My message is that we should take advantage of the attention focused on burnout and find ways to address some of the daily obstacles. Step by step, we can create an industrywide movement to address burnout and sustain clinician well-being at the system level.

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