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Solutions to physician burnout — US National Academy of Medicine report

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In response to concerning rates of burnout among US clinicians and trainees, the National Academy of Medicine has published a report that aims to find solutionsby shifting focus away from the individual and by proposing systemic changes in health-care organisations, academic institutions, and at all levels of government.

Medical training and clinical practice are continuously associated with stress – often welcomed and considered a positive motivating factor. However, notes an editorial in The Lancet, the recently recognised triad of emotional exhaustion, depersonalisation, and reduced professional efficacy, defined as burnout, questions the role of stress in clinical practice.

Burnout has the propensity to put patient care at risk and has a detrimental effect on medical workforce retainment. A health-care system under pressure undoubtably contributes to professional burnout: long working hours, outdated and not fit-for-purpose technologies, and mounting documentation requirements shift the focus away from patient care, causing work–life imbalance, insufficient job resources, ineffective multidisciplinary teams, and a dismissive organisational culture.

Physician burnout is now recognised as a global health-care predicament. In the US, burnout affects more than half of practising physicians and, more worryingly, is on the rise among medical students and trainees. Similar trends are also reported in other high-income countries such as the UK as well as in low-income and middle-income countries like China.

In response to concerning rates of burnout among US clinicians and trainees, the National Academy of Medicine published a report on 23 October. The report aims to find solutions to burnout by shifting focus away from the individual and by proposing systemic changes in health-care organisations, academic institutions, and at all levels of government. The report focuses on prevention and mitigation of physician burnout by promoting professional wellbeing. The idea behind these recommendations is not to create additional burdens on health-care systems but to encourage prioritisation of tasks that most benefit patients in need of care and the physicians who treat them.

The report proposes to create a positive work environment that fosters professional wellbeing, enhances patient care, and reduces risk of burnout. Health-care organisations should adopt system models that adequately balance job demands and resources with regular assessment of physician burnout. They should also aim to eliminate eroding professional wellbeing factors, such as outdated technology or unnecessary paperwork.

Academic institutions should create engaging learning environments by focusing on real-life hospital scenarios and applying situational clinical judgment that could lower the risk of future trainee burnout associated with the stress of clinical uncertainty. Additionally, medical students should be encouraged to access confidentially relevant support programmes. The report calls for a human-centred approach to lower the unnecessary administrative burdens. Technology solutions could be improved by clinician–vendor collaboration in their design and deployment. Furthermore, regulatory policies should ensure the optimal flow of clinically useful data within the health information system.

Clinicians’ personal health information should be confidential and not admissible in malpractice litigation proceedings. A final recommendation calls for further investment in a co-ordinated research agenda that aims to identify the best measures for addressing clinician burnout.

The report, albeit tailored for a US audience, has global implications. It recognises how personal stress management strategies might be insufficient to address clinician burnout. Instead, there is a need to acknowledge system-wide issues originating from workplace culture, health-care policy, and public expectations. However, system-specific characteristics are highly variable among countries, with different effects on physician burnout. For example, the scarcity of high-quality primary health-care provision in China puts additional pressures on secondary care systems, making the country’s hospital doctors particularly vulnerable to burnout.

Many theories of physician burnout suggest that it stems from doctors no longer feeling connected with the health-care system and from a self-perceived loss of autonomy in the provision of care. The landscape of global health-care systems has shifted focus towards enhanced cost-effective performance that might have triggered its progressive dehumanisation. In a pressurised health system burdened with administration, changing financial incentives, outdated technology, altered professional expectations, and regulatory policies insufficiently aligned with professional values, the art of medicine itself might be corroded.

By contrast, patient-centred health systems that reinstate physicians’ sense of purpose and promote a higher degree of physician interconnectedness have the potential to rehumanise health care.

The Lancet comment

The National Academies of Science Engineering Medicine report (registration required)

See also

Registrar burnout at Wits far exceeds international norms

We all have a role in tackling the burnout endemic

SA’s silence over high stress and burnout among medical professionals

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