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Top Challenges 2021: #3 Physician burnout and autonomy

Medical Economics JournalMedical Economics January 2021
Volume 98
Issue 01

In late 2020, Medical Economics® asked our physician audience what they thought would be the most challenging issues they will face this year. This is what they told us.

The perennial issue of physician burnout has only been intensified by the equipment shortages and shutdowns of the COVID-19 pandemic. Despite increased awareness in the health care system the same problem persists.

The 2020 Medical Economics®Physician Burnout Survey found that burnout is pervasive among physicians, with 91% of doctors saying they have felt burned out from practicing medicine at some point in their career. A further 71% of physicians reported feeling burned out at the time of the survey.

When asked what caused their burnout, 31% of physicians said too much paperwork and government/payer regulations, 15% cited poor work-life balance/work too many hours and 12% said the COVID-19 pandemic.

While little can be done on the ground with regard to increased stressors from pandemic, there are ways health care leaders can reduce the underlying issues.


Howard Baumgarten, LPC, has extensive experience working with physicians who feel burned out. He says there are three categories of burnout physicians should be on the lookout for: physiological, which can take the form of physical symptoms like headaches and high blood pressure; mental/emotional, which can take the form of anxiety and/or depression; and behavioral, which can take the form of increased alcohol use or smoking, overspending and not sleeping.

He says that once a physician starts feeling the symptoms of burnout, they should take steps to fight it. He gave some helpful tips for physicians to prevent feeling the heat of the health care system.

The first strategy is to aim for seven to eight hours of sleep, starting at the same time every night, and to avoid both drinking alcohol and screen time before bed. The next is to get 30 minutes of aerobic exercise four or five times a week with some muscle-building exercises mixed in. Physicians should also avoid sugary and fried foods and do something that makes them feel good, such as a hobby.

The National Academy of Medicine released a report early in 2020 saying personal stress management strategies are insufficient to tackle the burnout problem facing health care. While some of the suggestions the academy gave relate to structural issues, some can be adopted for independent practice leaders.

They are:

  • Create positive work environments.
  • Address burnout in training and at the early career stage.
  • Reduce tasks that do not improve patient care.
  • Improve usability and relevance of health IT.
  • Reduce stigma and improve burnout recovery services.
  • Autonomy

According to the 2020 Medical Economics® Physician Burnout Survey, 11% of physicians experience burnout due to a lack of autonomy or career control.

Wendy Dean, M.D., a psychiatrist and president and co-founder of Moral Injury of Healthcare, says that following the long period of rigorous training, focusing on independent, critical thinking with strict adherence to algorithms based on reimbursement policies
can be grating.

Beyond the big systemic hurdles that must be crossed to bring this issue under control, Dean recommends that physicians learn how the incentives are aligned at their health care institution.

“Understand how reimbursement happens, what the incentives are at their entity,” she says, “and whether they can negotiate to build bridges with the administration, build bridges with other licensees, so that everyone can work together to start fixing things at the local level.”

Dean says that by talking to their fellow physicians they can see what the patterns are and where the stumbling blocks may be.

“As you start to look into that more and more, you can quickly become an expert and can have the tools available to you to change what that problem is,” Dean says.


Susan T. Hingle, M.D., professor of medicine at Southern Illinois University School of Medicine, says there are burnout resources available on the websites of most major physician organizations, such as the American College of Physicians for internists.

She says many hospital systems also offer support phone lines to help deal with the increased stress from the COVID-19 pandemic.

“I want people to know that those are available and to know that there’s no shame in asking for help,” Hingle says. “That’s how we’re all going to get through this: by helping each other and getting through it together.

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