Physician burnout can be described as the feeling of having “your batteries spent.” Only, when a toy’s battery runs out, it stops working. Physicians don’t have this luxury. They’re required to continue performing to meet the varying and complex needs of their staff, patients, and organizations.
The symptoms of burnout are varied and complicated, but often include a state of emotional exhaustion, an increase in detachment, and a decrease in productivity. Research shows burnout has negative effects on healthcare systems and ultimately the quality of patient care. Moreover, it impacts the health of clinicians and contributes to the decline in the number of practicing physicians.
So, where did this all start? How did we get here? Below is a brief history on clinician burnout.
1974: The first published mention of burnout
Clinical psychologist Herbert Freudenberger used the word burnout to describe, “excessive demands on energy, strength, or resources” accompanied by symptoms including “malaise, fatigue, frustration, cynicism, and inefficacy” during his work as a volunteer at a free clinic.
1981: An official measurement of burnout published
The Maslach Burnout Inventory to assess burnout, named after its creator Christina Maslach, was introduced. The scale measures emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment. The model is still used by researchers to assess burnout today.
Mid-1980s/early 1990s: The growth of HMOs
Some physicians believe the rise of HMOs in the mid-1980s and into the early 1990s resulted in a pressure for physicians to spend less time than they wanted with patients.
2009: “Meaningful use” of electronic health records (EHRs) put into legislation
The American Reinvestment and Recovery Act included incentives for hospitals who adopted EHR technologies. Many researchers and healthcare professionals point to EHR requirements as a contributor to burnout.
2013: Report reveals severity of burnout by specialty
Medscape surveyed physicians from 27 specialties and found the highest percentage of burnout was for physicians in emergency medicine or critical care. Almost 40% of all respondents indicated experiencing at least one symptom of burnout.
2014: Expanding from the triple aim to a quadruple aim
The healthcare community widely uses the triple aim—enhancing patient experience, improving population health, and reducing costs—to guide health system performance. Researchers recommend expanding to a quadruple aim, adding the goal of improving the work life of healthcare professionals.
2015: Over half of U.S. physicians report symptoms of burnout
The Mayo Clinic published research that investigated work-life balance among physicians between 2011 and 2014. More than 54% reported at least one symptom of burnout in 2014, up from 46% at the start of the study in 2011. The study also found depression rates at 40%, and suicidal ideation at 6%.
2016: Major health system CEOs call burnout a public health crisis
10 CEOs declared that “the issue of burnout is a matter of absolute urgency” in HealthAffairs, citing the above research from the Mayo Clinic.
2017: IHI publishes Framework for Improving Joy in Work
In response to increasing levels of burnout, the Institute for Healthcare Improvement published a whitepaper intended to help healthcare leaders better understand the barriers to joy in work and how to create strategies to foster an engaged workforce.
2017: The National Academy of Medicine launches a burnout network
In response to increasing levels of clinician burnout, more than 60 organizations joined the Action Collaborative on Clinician Well-Being and Resilience to use evidence-based strategies to improve clinician well-being.
2017: Work hour restrictions are established
The Accreditation Council for Graduate Medical Education (ACGME) established the Maximum Hours of Clinical and Educational Work per Week requirement, stating clinical and educational work hours must be limited to no more than 80 hours per week to foster “the best outcomes for our patients, and the well-being of our residents, fellows, and faculty members.”
2018: Burnout increases for all specialties
Medscape published updated research on burnout by specialty. The number of respondents who indicated experiencing at least one symptom of burnout increased from 40% to 42%. Critical care remained the specialty with the highest rates of burnout at 48%, tied with neurology (48%), followed by family medicine (47%), OB/GYN (46%), internal medicine (46%), and emergency medicine (45%).
2018: Conversations around moral injury start to appear
STAT published an article about physicians suffering from moral injury. There is an ever-widening gap between the care clinicians want to provide and the care they find that they can provide. Navigating these competing demands can lead to moral injury, where clinicians feel symptoms of burnout from the inherent structures of the system. Therefore, the authors assert the symptoms of burnout can’t be combated by simply working harder or smarter.
March 2019: Major medical organizations call burnout a public health crisis
The Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and Massachusetts Health and Hospital Association called burnout a public health crisis.
April 2019: Spok survey
Spok conducted a survey to learn more about the prevalence of clinician burnout. Major findings included 92 percent of clinicians called burnout “a public health crisis,” and 90 percent believe increased and ineffective technology contributes to risk of clinician burnout.
May 2019: Burnout becomes a medical condition
The World Health Organization added burnout to its handbook as a recognized medical condition.
June 2019: Research estimates the cost of physician burnout at $4.6 billion
The Annals of Internal Medicine released research that estimated “approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States.”
Major medical journals, healthcare news, thought leaders, and healthcare organizations alike have agreed that physician and clinician burnout is a public health crisis. The rates of burnout among physicians in the U.S. exceed those of every other profession, and there is a growing body of research on strategies to help combat the symptoms. I hope this brief history of physician burnout will help us better understand how we got here, and drive conversations and ideas for how to move forward.