More than one-third of physicians at a large academic medical center met criteria for physician burnout in a recent study, and burnout was found to take a toll on care delivery. So report Cleveland Clinic investigators in a research letter published in JAMA Internal Medicine.
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“These findings have important implications for physician retention and healthcare delivery,” says lead author Amy Windover, PhD, a clinical psychologist in Cleveland Clinic’s Center for Behavioral Health and Office of Patient Experience. “They suggest that routine assessment for physician burnout by healthcare organizations is warranted to determine needs for individual and organizational support.”
Dr. Windover and colleagues reviewed data from a survey of 1,528 Cleveland Clinic physicians conducted in 2013 and 2014. Physicians completed the Maslach Burnout Inventory, which assesses burnout in three domains — emotional exhaustion, depersonalization and personal accomplishment — as well as burnout overall. Survey findings were analyzed in conjunction with data on physician employment status, patient satisfaction and ombudsman complaints.
Results and implications
Of the 1,528 physicians surveyed, 1,145 responded (75 percent). Among responding physicians, 399 (35 percent) met criteria for overall burnout.
Multivariate analysis showed that burnout on the emotional exhaustion subscale was significantly associated with greater likelihood of leaving the organization and higher patient satisfaction with primary care physician communication, whereas overall burnout and depersonalization were not.
“Physicians who spend more time providing patient care end up emotionally depleted,” Dr. Windover observes. “This likely stems from limited time for completing the significant administrative tasks associated with patient care.” She adds that this finding suggests that physicians who need burnout interventions aren’t likely to be identified by low patient satisfaction scores.
Burnout on the depersonalization subscale was significantly associated with greater likelihood of an ombudsman complaint, but overall burnout and emotional exhaustion were not. “This suggests that patients may be more impacted by the depersonalizing effects of physician burnout than by emotional exhaustion among physicians,” Dr. Windover says.
No association was observed between burnout and productivity or patient satisfaction with inpatient or specialty care.
Keeping burnout at bay
In response to these findings and biennial engagement surveys, Cleveland Clinic leaders heightened their recognition of physician burnout as a pressing issue. They acted by organizing departmental “town hall” meetings to pinpoint specific needs and by establishing a Staff Experience team, including six physicians, to adopt programming around outreach, clinical enhancements, professionalism, well-being and professional growth. These efforts include coaching, peer mentorship and professional fulfillment training.
“This ongoing programming is designed to comprehensively support physicians, explore and share practice efficiencies, and build community in ways that reflect Cleveland Clinic’s group practice culture,” Dr. Windover explains.
That culture may actually give Cleveland Clinic physicians a leg up on their colleagues in other settings in terms of keeping burnout at bay. “Physicians here can pursue research or other projects that add diversity to their workday in lieu of nonstop patient care and, notably, the paperwork burden that accompanies it,” says Dr. Windover.
In fact, the 35 percent prevalence of physician burnout in the current study is lower than that in other recent studies.
“Although our study is limited by its single-center design and retrospective nature, the similarities between Cleveland Clinic and other major health systems suggest that many academic medical centers can learn from our findings and benefit from routine assessment of burnout to develop and evolve support systems in response,” Dr. Windover concludes.