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Physician Burnout and Occupational Stress: An inconvenient truth with unintended consequences
Healthcare providers and staff are the proximal source of quality of care provided to patients. Today’s world of health care reform and other value-based initiatives have added new levels of significant complexity to health care delivery. This cumulative chronic high-level stress is imposed by multiple regulatory, insurance, federal, and state forces that do not coordinate well with one another resulting in disparate, conflictual, or confusing mandates. Each have authoritative capital. Together they have potential to affect healthcare workers on a personal, physical, emotional and cognitive level which in turn adversely affects care relationships and quality of patient care. We need to be concerned about the effect that this enormous occupational stress has on them as individuals and how it impacts the care provided. Physician shortages exist and are projected to get worse. There is a high burnout rate in current physicians. Some are retiring early, leaving medicine, or worse dying of suicide from job related stress. Mechanisms of this negative effect of stress and Burnout on providers, institutions and healthcare quality are discussed. The aim of this paper is to provide an overview of current state of knowledge merging information from various fields on this issue. Areas that require action are identified and possible solutions are offered. Healthcare providers and staff are the proximal reason for the quality of care provided to patients. What effect does increasing high-level and chronic occupational stress on providers and staff imposed from multiple uncoordinated sources have on them personally and ultimately the patients they serve? Has physician burnout been multiplied and yet underappreciated in impact? We currently have a time-challenged, overburdened, and burned-out healthcare workforce. There exists no single group to oversee the reasonableness of the total human burden on staff and providers placed by regulatory, certification, national, state, and industry sources. There is no agency or mandate that ensures coordination and collaboration of these independent forces to be cognizant of total logistical impact. 46% of surveyed physicians reported burnout, with even higher rates in front line doctors (Family Medicine, General Internal Medicine, and Emergency Medicine).[1] Suicide rate for physicians is higher than the average suicide rate in the US.[2] MD early retirement or leaving medicine from economic, healthcare reform regulatory pressures and burnout.[3] Physician shortages anticipated in 2014: Without Affordable Care (ACA)/with ACA, 30,200/58,000[4] Request is in Congress to increase med ical student slots with hope to increase residency slots as well.[5] Many factors that will be discussed indicate that the healthcare workforce and the public are now at physical, emotional, and financial risk by the uncoordinated cumulative over-expectation of cognitive workload imposed on providers and staff[6, 7] Cognitive workload is known to be a risk factor to workers and the people they serve in such professions as airline pilots, air traffic controllers, and nuclear power workers. Yet, there is little attention in the area of healthcare delivery. Additionally, healthcare providers deal with illness and death and must suppress emotional responses and other emotional work. This places them at more risk than the above professions to become overwhelmed and impaired from excessive cognitive load. Providers and staff are at their core an altruistic profession, tend to be high achievers, and are mentored in self-effacement.
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