Most occupations probably cannot boast that 93 percent of their members find their work rewarding and that 91 percent think it makes the world a better place, as discovered in a recent survey of U.S. physicians. Yet that research also suggests those numbers can drop precipitously when physician burnout increases.
The purpose of the study, published in Mayo Clinic Proceedings, was to evaluate the association between professional burnout and physicians’ sense of calling. Researchers found physicians who experience burnout are, indeed, less likely to view medicine as a calling, as measured by true-false responses to six survey items, including “I find my work rewarding,” “My work is one of the most important things in my life,” and “If I were financially secure, I would continue with my current line of work even if I were no longer paid.”
Almost 30 percent of the more than 2,200 respondents reported experiencing some level of burnout. Physician views on calling that varied the least between those who were not burned out and those who were completely burned out were for the item, “My work makes the world a better place.” More than 83 percent of physicians who were completely burned out responded affirmatively to this item, which was only 14 percent lower than those who reported no burnout.
The calling item with the greatest response difference was “I would choose my current work life again if I had the opportunity,” to which completely burned-out physicians responded affirmatively less than 32 percent of the time, a difference of 61 percent from those unaffected by burnout. On the “I find my work rewarding” item, nearly all physician respondents unaffected by burnout—98 percent—agreed with the statement. In contrast, just 65 percent of completely burned-out physicians said they find their work rewarding.
“Given the personal and collective-level consequences of medicine as a calling, concerns have been raised that the changing physician workplace may be eroding such a professional identity,” the study’s authors wrote. “Over the past decade, the rapid adoption of electronic health records and the proliferation of pay-for-performance metrics have markedly altered how physicians experience their everyday work lives.”
Quadruple aim hinges on solutions
“Although detrimental to the well-being of physicians, professional burnout is also associated with lower patient satisfaction, increased medical errors, poorer health outcomes and higher health care costs,” wrote the authors, Andrew J. Jager, Michael A. Tutty, PhD, and Audiey Kao, MD, PhD. Jager and Dr. Kao work in the AMA’s Ethics Standards Group, of whom the latter is vice president. Tutty is group vice president of Professional Satisfaction and Practice Sustainability at the AMA.
“Given the significance of outcomes linked to burnout, promoting physician wellbeing is seen as an essential element of successful health system transformation, leading some to refer to a quadruple aim that explicitly recognizes the need for physician and care team well-being,” they added.
With passage of the Medicare Access and CHIP Reauthorization Act of 2015, the authors noted, the health care system is poised for transformation, so the time is right to implement system-wide changes that advance the goals of the quadruple aim. At the 2016 AMA Annual Meeting, the House of Delegates adopted policy on the quadruple aim, adding “the goal of improving the work-life balance of physicians and other health care providers” to the existing triple aim of improving population health and patients’ care experiences while cutting per capital health care costs.
Support at the policy, practice, personal levels
The AMA also has policy encouraging further studies and disseminating the results of studies on physician and medical student burnout to the medical education and physician community. AMA policy supports programs to assist physicians in early identification and management of stress, focusing on the physical, emotional and psychological aspects of responding to stress in physicians' professional and personal lives, as well as when to seek professional assistance for stress-related difficulties.
In addition, the AMA last year adopted policy supporting strategies to destigmatize mental illness and enable timely and affordable access to mental health services for undergraduate and graduate students. It also supports collaborations among university mental health specialists and local public or private practices to provide a larger pool of resources, “such that any student is able to access care in a timely and affordable manner.”
The AMA’s STEPS Forward™ collection of practice improvement strategies helps physicians make transformative changes to their practices. It offers modules on preventing physician burnout in practice, preventing resident and fellow burnout and improving physician resiliency.