Physician Burnout: A ‘Big Problem’ That Warrants Broad Solutions, Analysis Suggests

Programs aimed at preventing physician burnout are more effective when they target “big picture” problems rather than coach individual doctors on self-care, a meta-analysis has found.

“Physicians should not handle burnout alone,” the study’s lead author, Maria Panagioti, PhD (Manchester Academic Health Science Centre, England), told TCTMD. “Burnout is a serious and complex problem which is driven by workload, imbalance between job demands, and prolonged stress. This means that if we want to prevent it, we need a combination of interventions.”

Julie Damp, MD (Vanderbilt University, Nashville, TN), who serves as chair of the American College of Cardiology (ACC) Cardiovascular Training Council, agreed that burnout merits this level of attention. “It’s really important for physicians to acknowledge that this is a big problem,” she said to TCTMD, commenting on the new paper. “It’s something that we all hear about but don’t necessarily actively talk a lot about.”

The message of the meta-analysis might come as a relief to physicians, Damp noted, “because if you have experienced some of these symptoms of burnout, I think it would make you feel less alone.” Rather than being evidence of a “personal failure,” burnout instead “is something that happens really frequently in the systems in which we work. And the most effective ways to prevent it are system-wide changes,” she stressed.

Emotional Exhaustion

For their analysis, published online December 5, 2016, in JAMA Internal Medicine, Panagioti and colleagues combined data from 19 studies on anti-burnout interventions involving 1,550 physicians.

Overall, the programs were associated with a “small” yet statistically significant reduction in burnout, equaling a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory compared with controls.

Subgroup analyses suggested that interventions directed at organizations (ie, those that “introduced changes in the resources, the working environment, and/or work tasks to decrease stress”) were more effective at reducing burnout than where those directed at physicians (“eg, cognitive behavioral therapies, mindfulness-based stress reduction techniques, educational programs for improving communication skills”).

While the researchers caution that the quality of the evidence is too low to “allow firm practical recommendations,” they say it does offer insights.

“Organization-directed interventions were more likely to lead to reductions in burnout, but there were large variations in terms of actual approaches, intervention ingredients, and intensity,” Panagioti et al write, noting that the most effective were those “that combined several elements such as structural changes, fostering communication between members of the healthcare team, and cultivating a sense of teamwork and job control.” Most of the programs were quite simple, however, and involved only “simple reductions in workload or schedule changes,” perhaps due to concerns over costs or barriers to implementation, they point out.

Describing the effect of physician-directed programs as “very small,” the researchers report that they found no differences based on the content or intensity of various approaches.

‘Quality of Patient Care Could Be at Risk’

To TCTMD, Panagioti said that clinicians who want to advocate for change can point out that the rewards of burnout prevention extend beyond their own mental health. “We should emphasize that if we want to retain professionally competent physicians and ensure high-quality care for patients, the well-being of physicians has to be prioritized and supported. We need to create an appropriate and enabling working environment for physicians,” she explained.

Without this support, “the quality of patient care could be at risk,” Panagioti added, reporting that she and her colleagues are conducting research to better understand the relationship between physician burnout and patient outcomes.

“[We] need to feel empowered to advocate for ourselves to address [feelings of burnout],” Damp stressed, “because we know that the burnout is associated with outcomes that are not ideal, both from a personal and professional level and also from a patient quality level.”

Physicians also should urge national organizations like the ACC and other professional societies “for more open and progressive discussion about these things, and potentially development of some broader reaching programs to address it,” she said. Key components to a successful system-wide intervention, Damp suggested, are “things that can address appropriate workload balance, making sure that people are practicing at the upper end of their skillsets, [and] making sure that they feel some degree of control of their job situation.”