Why do doctors experience burnout?

June 30, 2020

Jeffrey Bendix, Logan Lutton

How common is physician burnout and why does it happen?

The AMA defines burnout as “a stress reaction marked by depersonalization, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients.”

According to recent authoritative studies, burnout is widespread among doctors- and growing.

In The Physician’s Foundation’s “2018 Survey of America’s Physicians” 77.8 percent of respondents reported having feelings of burnout sometimes, often or always, up from 74 percent in 2016.

In a 2015 study of burnout’s prevalence published in the Mayo Clinic Proceedings, 54.4 percent of those surveyed reported at least one feeling of burnout in 2014, up from 45.5 percent in 2011.

Many factors contribute to burnout, but most of them stem from a dysfunctional healthcare system that prevents doctors from providing quality care to patients.

“We feel caught between doing the work our patients need and the work we feel is mandatory in our environment.” -Christine Sinsky, MD, vice president of professional satisfaction, AMA

EHRs are a leading cause of burnout, due to lack of interoperability, poor user interfaces and interference with face-to-face patient care.

In addition, their use often surfaces organizational dysfunction in hospitals and healthcare systems, where non-physicians often are deciding which EHR system to purchase and how it will be configured, with little input from doctors.

“If you’re a physician telling management that this technology you use every day is inadequate, and you’re being told the EHR isn’t for you but is for billing and complying with Medicare, that response is a surefire path to burnout.”-Mark Friedberg, MD, senior physician policy researcher, RAND Corporation

Loss of physician autonomy is another frequently-cited cause of burnout, as more physicians leave independent practice to become employees of hospital systems.

Even doctors practicing independently no longer enjoy the degree of autonomy they once did due to the need to meet payer requirements such as prior authorizations and quality metrics.

“When someone else is paying the bill, to some extent they’re going to insert themselves in the [care] process by determining how much they’re going to pay for treatment” -Robert McLean, MD, president, American College of Physicians

An additional cause of burnout is an erosion in the belief that everyone in the healthcare system is acting in the best interest of patients, rather than their own bottom line.

As evidence, doctors cite the quantity of documentation required for E&M codes, along with the increasing use of step therapy and prior authorizations for medications.

“All these strategies may have some validity to them, but they’ve resulted in stealing time from physicians that they’d rather spend focusing on the clinical aspects of patient care”-Clif Knight, MD, board member, Action Coalition on Physician Well-Being and Resilience

Some experts think the term doesn’t accurately describe the exhaustion, frustration and cynicism many doctors feel, preferring instead the term “moral injury.”

“With every patient encounter you’re in a bind and not able to do what you were trained to do. You can tolerate it as an occasional event, but when it happens every day it becomes a crushing burden.”-Wendy Dean, MD, senior medical officer, Henry M, Jackson Foundation for the Advancement of Military Medicine.

“It’s not that docs aren’t working hard, it’s that they’re having to make decisions that go against core beliefs. It’s that alteration of the moral compass that makes docs feel like they’re betraying their patients.”-Adam Schwarz, MD, physician well-being champion, American College of Physicians