Burnout has been a longstanding challenge in healthcare, gaining heightened attention during and after the COVID-19 pandemic. In addition to its emotional toll, provider burnout can lead to consequences like increased medical errors, reduced productivity, clinician turnover, and decreased patient satisfaction, to name just a few.
Managing these risks is essential to protect patients and providers. This includes addressing underlying issues and supporting those who are affected.
WHAT IS PROVIDER BURNOUT?
Burnout can affect any clinician or caregiver. It happens when stress related to work reaches unhealthy levels, leading to consequences such as:
- Emotional exhaustion: Feeling physically and emotionally drained.
- Depersonalization: Feeling callous, sarcastic, resentful, or numb.
- Low sense of personal achievement: Feeling incompetent or sensing a lack of achievement in one’s work.
CAUSES OF BURNOUT
Causes of burnout can range from working in a chaotic environment (often inherent to healthcare) to dealing with stressors like patient morbidity, medical errors, or malpractice risks. Staffing shortages and changing demands (such as mounting administrative and EMR tasks) can add further major burdens and contribute to a loss of meaning and connectedness.
HOW TO IDENTIFY BURNOUT
Unaddressed burnout can sometimes have far-reaching impacts for providers and clinicians, including broken relationships, alcohol and substance abuse, and health problems like coronary artery disease and depression (which has been linked to suicidal ideation).
While people can react differently under stress, knowing the “APGAR” signs of burnout can help identify possible warnings:
A—Appearance: a decline in self-care, an increase in fatigue, or changes in weight.
P—Performance: a decrease in performance (e.g., missing work) or an increase in “workaholism” (e.g., working excessively but less efficiently).
G—Growth tension: apathy, irritability, or feeling overwhelmed.
A—Affect control: moodiness and difficulty managing emotions.
R—Relationships: relationship struggles or social isolation.
WAYS TO SUPPORT CLINICIAN WELL-BEING
One way to support someone who seems burned out is to check in with them and continue to follow up, e.g., with phrases like, “You seem a little stressed. Anything I can help you with?”
Self-care activities may also help, though the pervasiveness of burnout suggests that it is more of a system challenge than a personal one. Drivers of clinician well-being include:
- Meaning in work
- Social support and community at work
- Organizational culture and values
- Efficiency and resources
- Control and flexibility
- Workload and job demands
- Work-life integration
WHAT CAN ORGANIZATIONS DO?
While organizations play an important role, their approach will likely depend on their size and complexity. Examples of proactive measures may include:
- Conducting a workforce assessment of clinician well-being
- Fostering interdisciplinary teamwork and dialogue
- Providing mental health access
- Offering mentorship (formally or informally)
- Planning for PTO with inbox and patient coverage
- Setting priorities and boundaries (e.g., to avoid work overload)
- Establishing a well-being program (with components including, e.g., conflict resolution resources, community building, and a 24-hour hotline—even if the “hotline” in a smaller organization entails calling a colleague directly)
CAUTION: DISCOVERY CONSIDERATIONS
Deciding how to structure organizational well-being initiatives and who should take the lead can depend on an organization’s size and resources. One important factor to consider is discovery, i.e., what information or evidence could be requested in the event of a legal trial.
While peer review protections allow for non-discoverable exchanges, discovery concerns can still arise around scenarios like:
- Peer breaches of confidentiality (which are discoverable)
- HR actions (which can be subject to discovery)
- The use of apps such as WhatsApp, iMessage, or Teams
Solo practitioners and others who have questions about this should speak with an employment attorney for guidance.
PEER COACHING AND PHPs
Other programs that can help address and combat burnout include:
- Peer Coaching Programs—These programs can provide meaningful support to providers by listening, engaging, empathizing (not sympathizing), reflecting, and following up.
- Physician Health Programs (PHPs)—These programs exist in nearly every state (including Washington and Oregon) to provide confidential support and resources to physicians and other healthcare professionals.
KEEP PROGRESS GOING
Some research suggests that the battle against provider burnout is moving in the right direction. Still, burnout remains a serious concern, and it often goes unreported or unaddressed until it reaches a crisis point.
The reality is that if providers are experiencing burnout, patients are impacted, too. Leadership that takes this seriously and implements meaningful measures can help protect patients, providers, and the profession.