National report focuses renewed attention on clinician ‘burnout’

Last month, the National Academy of Medicine (NAM) released a 300-page report that applies the same systems thinking that has become a mainstay of patient safety work to the challenge of clinician burnout.

The report, Taking Action Against Clinician Burnout: A Systems Approach to Professional Well Being, organizes NAM’s recommendations under six goals:

  1. Create positive work environments.
  2. Create positive learning environments.
  3. Reduce administrative burden.
  4. Enable technology solutions.
  5. Provide support to clinicians and learners.
  6. Invest in research.

Beginning with professional education, through practice on the frontlines of care delivery, business and regulatory concerns, and new research agendas, the framework amounts to a transformative blueprint for a health care system of the future.

Burnout — emotional exhaustion, cynicism, and a diminished sense of professional accomplishment — is now recognized as a problem affecting workers throughout health care, with harmful ramifications for their personal well-being, as well as their patients and organizations. Among health care professions that have been surveyed — primarily nurses, physicians, residents and medical students — the number of individuals who report symptoms of burnout range from 35% to 60%. The incidence of burnout among other groups, such as pharmacists and dentists, has not been adequately measured, but is assumed to be significant.

Pascale Carayon, Ph.D., who co-chaired the interdisciplinary committee with Christine Cassel, M.D., acknowledged in an interview with JAMA’s Editor, Howard Bauchner, M.D., that there is no easy fix for the problem:

We cannot say, “You should do 1, 2, 3.” So we defined guidelines for well-being systems primarily targeted on healthcare organizations, to give a roadmap for where they can start engaging.

According to the report, wellness training and support for clinicians are helpful and should be part of organizational strategies but do not alone sufficiently address the root causes of burnout.

We’re planting seeds on a dozen fronts, and they’re all sprouting. Although it may still be awhile before the effects are felt on the frontline, I’ve really been heartened. People understand why this is important, and they’re doing something about it.

Steven Defossez, M.D.

Massachusetts organizations have begun to make changes

In Massachusetts, academic institutions, professional societies and health systems have been working on these issues and are optimistic that the effect of early improvement efforts will grow as they gain traction and scale. Steven Defossez, M.D., practicing radiologist and Vice President of Clinical Integration at the Massachusetts Health & Hospital Association, says, "We’re planting seeds on a dozen fronts, and they’re all sprouting. Although it may still be awhile before the effects are felt on the frontline, I’ve really been heartened. People understand why this is important, and they’re doing something about it."

Dr. Defossez co-chairs the Joint Task Force of MHA and the Massachusetts Medical Society that, together with the Harvard T.H. Chan School of Public Health and the Harvard Global Health Institute, published A Crisis in Health Care: A Call to Action on Physician Burnout in January 2019. Like the NAM report, it issues ambitious recommendations, including expansion of health services for clinicians, improved usability of electronic health records, and appointment of executive-level leadership for clinician wellness at all provider organizations. In addition, MHA’s Promoting Employee Well-being Committee, which has been meeting since March 2018, has posted numerous resources on PatientCareLink, MHA’s publicly available quality and safety website.

The Massachusetts Board of Registration in Medicine (BORIM) is also supportive. Working with the Joint Task Force, BORIM committed to all applicable recommendations made by the Workgroup on Physician Wellness and Burnout of the Federation of State Medical Boards, which includes removing barriers to physicians’ access to behavioral health services. BOROIM has also agreed to allow 7 of the 10 risk management credits physicians need for continuing education to be about wellness and burnout.

Maryanne Bombaugh, M.D., M.Sc., MBA, President of MMS, also appreciates BORIM’s leadership on this issue. She emphasizes the importance of leadership to address burnout at all levels, from the regulatory and health care corporate boards through health systems, physician practices and all clinical environments. Dr. Bombaugh believes, “Unless leaders embrace this as fundamentally important, it may it may not get action. The leaders of every practice — large or small — set the tone for a positive, learning work environment that supports its physicians and employees. Patients are incredibly important and so are those who care for them.”

See also: Reducing burnout tops the to-do list of health care orgs


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