Of Course Physician Burnout is a Public Health Crisis

Of course Physician Burnout is a Public Health Crisis !!

And it is WAY beyond time for our Manhattan Project.

A recent video post on Medscape by Art Caplan PhD from the Division of Medical Ethics at New York University Langone Medical Center calls out Physician Burnout as a public health crisis. The 426 comments on the post attest to the chord this struck with physicians across the country. 

I totally agree ...

• If HIV is a public health issue
• If lead poisoning is a public health issue
• If infant car seats are a public health issue

Then physician burnout should be recognized as a public health issue - a true public health crisis - in any setting where physicians take care of patients.

Here's why ...

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1) The prevalence of physician burnout among American physicians

Just looking at the latest comparative study of the general US physician population from Mayo, notice the trend:

This fascinating study was originally performed in 2011 and repeated in 2014. Here are the results.

• The percentage of physicians suffering from at least one symptom of burnout:
  2011 = 45.5% -- 2014 = 54.4%
• In addition, the 2014 survey showed 39% of responding doctors screened positive for depression
• And 7.2% of the doctors in the 2014 study admitted to contemplating suicide the previous year - an 80% increase over the 2011 figure of 4.0%

The prevalence of physician burnout in American doctors is mind boggling.

The connection between physician burnout, depression and suicidal ideation should be causing healthcare leaders across the country to lose sleep at night even if all they are thinking about is the health and wellbeing of the physicians themselves.

And we both know the effects of physician burnout ripple into care of patients in a way that casts a much larger shadow.

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2) The known effects of physician burnout on the doctor's practice and larger life

• Lower patient satisfaction
• Lower quality of care
• Higher error rates 
• Higher malpractice risk
• Higher levels of both physician and staff turnover
• Higher rates of physician alcohol and drug use, divorce and physician suicide 

Let's just look at medical errors for a moment:

The issue of medical errors as a source of morbidity and mortality in the general population is a public health issue in its own right.

Current estimates show medical errors cause somewhere between 200,000 and 400,000 deaths a year and an economic impact of nearly $1 trillion on the US economy.

Studies also show physician burnout significantly increases self reported medical errors in both practicing physicians and residents. 

Not all medical errors are caused by physicians, but the connection between burnout and medical errors is solid -- and the connection between medical errors and adverse outcomes is undeniable.

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3) The definition of Public Health from the World Health Organization:(underlining is mine)

"Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. Thus, public health is concerned with the total system and not only the eradication of a particular disease. The three main public health functions are:

• • • • The assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities.
      • The formulation of public policies designed to solve identified local and national health problems and priorities.
      • To assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services.

Public health professionals monitor and diagnose the health concerns of entire communities and promote healthy practices and behaviours to ensure that populations stay healthy."

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The equation here is third grade math simple;

Prevalence + Impact
= Public Health Crisis 

There were 916,264 licensed physicians in the US in 2014. Hundreds of studies on the prevalence of burnout have been performed over the last 40 years, showing burnout rates hovering at one in three physicians on any given practice day.

The official response has typically been hand wringing - even the surgeon general is getting into the act - and endless prevalence studies. Yet, notice that no public health resources have been devoted to the early detection and treatment of physician burnout to date.

Imagine the public outcry and government/industry response if we were talking about a similar workplace issue in other professionals with huge levels of responsibility;

• Airline Pilots
• Air Traffic Controllers

Physician control much of the decision making in an industry that makes up 17% of our Gross Domestic Product for heaven's sake ... and over 50% are significantly compromised on the job site on any given day.

OF COURSE this is a public health issue. 

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It's time for Physician Burnout's Manhattan Project

We raced Hitler to the bomb - and won - with a national effort to do what was thought to be impossible at the time. We won because of resolve and a focused deployment of resources to address a threat to the nation.

I would argue that physician burnout is perhaps equally important here in here in 2016. The difference is that much of the effects of physician burnout still percolate beneath the surface of public awareness.

Our outcome goal is to implement the Quadruple Aim across the healthcare industry in the USA as quickly as possible.

It is time for a national, top level, industry-wide campaign to ...

• • Develop a simple physiologic measure to detect burnout.
    We already know the physician is the last one to recognize their burnout. Even if they are aware, they will almost never slow down to get help. My question is this: Is there a physiologic measurement of burnout that can make diagnosis objective? If so, what is that test? My initial thoughts lean towards serum cortisol or some other stress hormone measurement.
    
    
  • Catalog effective physician burnout prevention and treatment methods.
    Remember physician burnout is not a problem. There is no single solution. This list will be extensive - like our MATRIX report with over 117 prevention methods. It is time to make the master list.
    
    
  • Convene a worldwide conference on physician wellbeing and burnout prevention to begin isolating best practice strategies to prevent burnout.
    An effective strategy will only have 3 - 5 components. The stockpile of techniques to choose from will be extensive - see above.
    
    
  • Build a nationwide network of pilot projects on tools to prevent and treat burnout with reporting to a central database.
    When a technique proves effective in a pilot site, it is packaged for dissemination to the entire healthcare industry. The emphasis should be on simple implementation steps and metrics to track effectiveness.
    
    
  • Hold organizations accountable for detecting and treating burnout in their employee physicians.
    In this brave new world where the majority of physicians are employees, it is up to the employer to prove that physician burnout is not degrading the performance of their providers on any given office or hospital day.
    
    This involves more than just their clinical skills and experience. Burnout destroys the abilities of even the most high performing physicians. We must begin to measure and address this pervasive negative influence on the doctor's quality of life and the quality of the care they provide.

Last but not least ...

Remember that physicians are just the indicator species here ... like the spotted owl in the old growth forest.

We are just a marker for burnout throughout the delivery system.

Any advances we make in our burnout prevention efforts must be rolled out to our front line patient care colleagues ... Nurse Practitioners, Physician's Assistants, nurses, MA's, reception and so many more ... as soon as they are identified.

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PLEASE LEAVE A COMMENT:

Do you think physician burnout is a public health issue? Explain ...