TABLE OF CONTENTS

Clinician Burnout Report

This report breaks down the clinician burnout crisis, looking at causes and solutions for addressing burnout on a systemic and individual level.

Burnout by the Numbers

30-50%

of advanced practice providers, like nurse practitioners and physician assistants, report burnout.1

70%

7 of 10 physicians wouldn’t recommend the profession to their children or family members.2

42%

Nearly half of all physicians report experiencing burnout.3

$7.75 Million

Stanford Medicine estimates that burnout costs the organization at least $7.75 million per year.4

2x

Burned out physicians are twice as likely to be involved in patient safety accidents.5

What is burnout?

The World Health Organization (WHO) defines burnout as an occupational phenomenon and syndrome resulting from chronic workplace stress that impacts professionals across industries.7

In 2019, WHO changed its definition of burnout from a “state of vital exhaustion” to officially classify it as a syndrome.8

This important change further legitimized burnout as a serious problem.

No profession is more vulnerable to burnout than medicine.

A 2012 study revealed that 45.8% of physicians—far more than professionals in any other industry—reported at least one symptom of burnout on the Maslach Burnout Inventory.9 Other healthcare professionals have also reported “rampant levels” of burnout.10

While levels can vary by specialty, burnout is a prominent issue across all fields of medicine.

One study found that physicians at the front line of care access— family, internal, and emergency medicine—experienced the highest rates of burnout.9 In 2020, Medscape reported that physicians in the fields of urology, neurology, and nephrology were the most burned out.3

The bottom line is, while burnout trends by specialty may shift over time, providers across medical specialties have consistently reported alarming rates of burnout.

Burnout is best identified by the following symptoms (which include and build on components from the Maslach Burnout Inventory) in relation to work:11

  • Feelings of emotional, physical, and/or mental exhaustion
  • Reduced ability to perform efficiently
  • Depersonalization or impersonal response toward a service, care treatment, or instruction
  • Lack of personal accomplishment
  • A lack of energy
  • Increased mental distance
  • Feeling negative or cynical

What’s causing burnout?

Medical professionals have the unique privilege and responsibility of delivering life-saving care. While medicine can be rewarding, it is often an extremely high-stress environment full of stressors that contribute to burnout.

Administrative Burdens

With the implementation of the Affordable Care Act (ACA) in 2010, payment reforms shifted from volume-driven to value-driven, creating new documentation requirements.

  • The average physician in the US spends 2.6 hours per week complying with external quality measures, which takes time away from patient care.
  • 34.6% of nurses’ time each day is spent managing communication.13
  • For each hour of clinical face time, physicians spend two hours on administrative work.10

Increasing the time clinicians must spend on administrative tasks decreases their satisfaction at work and depersonalizes the practice of medicine, all leading to higher rates of burnout.

Managing Electronic Health Records (EHRs)

EHRs have taken on a prominent role in clinical workflows, yet many EHRs do not deliver an easy user experience (UX) for clinicians. In the past, medical records provided a brief patient history to ensure continuity of care. But now, EHRs document against potential medical malpractice, ensure adherence to quality initiatives, and support billing processes.

Relying heavily on a tool with a cumbersome UX increases screen time for clinicians, pulls their time and focus away from direct patient care, and increases their likelihood of burnout.

  • It’s reported that anywhere from 13-40% of physician burnout is related to EHRs.14
  • Some physicians spend more than half of a typical 12-hour shift on documentation.10

Unrealistic, Inequitable Scheduling

Adding to documentation woes is a lack of work-life balance for providers. With an aging population, a growing provider shortage, increasing documentation rules, and ballooning patient demand, clinicians are working more than ever.

  • The average physician in the US works 51 hours per week.
  • 25% of US physicians work more than 60 hours per week.10
  • Residents are expected to work 80 hours a week.15

In addition to grueling hours, clinicians are largely unsatisfied with the makeup of their schedules, which tend to lack flexibility, don’t allow for sufficient vacation, and include too many weekend and night shifts.

These concerns are growing across medical specialties, particularly with younger physicians.

Providers who work long hours to ensure continuity of care should have access to equitable scheduling, at a minimum. Issues like unequal distribution of nights and weekend shifts are easily avoidable with advanced scheduling software, such as PerfectServe’s Provider Scheduling powered by Lightning Bolt.

Give Valuable Time Back to Nurses

Nurses play a central role in providing patient-centered, cost-effective care. They are responsible for care coordination and communication with each patient’s family members, as well as a growing care team of physicians and specialists, ancillary staff, and care coordinators. In addition to nurses’ growing list of daily non-clinical tasks, inefficient care coordination workflows prevent them from providing better patient care.

A 2018 time and motion study13 revealed that in four hours, nurses spent around 32 minutes communicating with patients and family and 51 minutes communicating and coordinating care with members of the care team3— fully 34.6% of nurses’ time each day. Technology aimed at improving nurse workflows has often contributed to their frustration by adding siloed, task- specific “solutions” to their workload. On top of this, nurse turnover rates increased from 13.5% to 16.7% during 2019.2 From 2020-2021, nurses felt burnt out and overworked due to increased patient demand, poor communication, and hospital staffing shortages.

How can healthcare organizations combat burnout?

To date, much of the burden to combat burnout has been left to clinicians. While things like meditation, yoga, and other mindfulness strategies can help curb stress and burnout, systemic change is needed to truly address the crisis.

“No one tasked with saving lives and promoting the health of others should be expected to meet benchmarks set decades ago that leech from a physician’s own well-being and are designed for people with a full-time stay at-home partner.”

Suvas Vajrachara, Ph.D.
Lightning Bolt Founder

1

Create an environment that values patient care over productivity.

Medicine has a long way to go to improve its work culture. With a history of avoiding regulations on shift hours and encouraging burnout-inducing work levels, the healthcare industry has been known to prioritize productivity in a way that can negatively impact patient care.

A key part of changing this culture will be understanding that valuing and caring for clinicians leads to better patient care.

2

Better working hours and more equitable schedules.

Unrealistic shift schedules lead to sleep-deprived and emotionally exhausted clinicians, which is harmful to them and dangerous for patients.

Think about this: There are regulations in place that limit shift length and require rest for truck drivers and airline pilots, but not for clinicians.

Unfortunately, medicine has a long history of dangerous scheduling practices, which are completely unnecessary. With the right solutions, organizations can leverage prescriptive analytics to provide equitable provider scheduling without sacrificing patient access, care quality, or productivity.

Learn more about how organizations can improve efficiency and create balanced schedules.

3

Improve EHR usability and decrease documentation time.

EHRs have grown to encompass excessive documentation tasks, and compared to the average smartphone interface, many EHRs don’t feel user friendly to clinicians. It’s unfair that the burden of managing documentation tasks to prevent negative outcomes lies on the shoulders of already overworked clinicians.

Multiple parties, including EHR vendors, hospitals, health systems, and legislators, should share the responsibility of simplifying clinical documentation processes. Until that happens, clinicians should be strong advocates for improvements in their workplace and beyond.

4

Integrate essential technologies and resources to free up time for clinicians.

While improvements to EHRs and the documentation process continue, there are strategies organizations can use right now to ease clinicians’ administrative burden. There are many opportunities to streamline workflows by integrating solutions to reduce logins and vendors needed per workflow.

Consolidating vendors can have a huge impact on speeding up tasks, simplifying the user experience (UX), and reducing frustration for clinicians, with fewer steps, clicks, logins, and lookups to manage.

Side benefits include a smaller vendor footprint for the organization.

Here are a just few examples of how the right integrations can simplify clinical workflows:

  • Speech recognition software and natural language processing can reduce time spent taking notes.
  • Automated smart routing, like PerfectServe’s Dynamic Intelligent Routing®, can streamline communication by seamlessly connecting the right care team members at the right time.
  • Provider Scheduling powered by Lightning Bolt can free up time spent creating complete shift schedules and allow providers to request time off from their smartphones without back-and- forth calls and emails.

The best solutions are adaptive and will evolve to meet organizational and industry needs over time, integrating with essential systems and offering a smooth UX so clinicians can focus on patient care.

5

Offer wellness resources.

To combat burnout, organizations need to ensure that physicians have stress management resources at their disposal every step of the way. It can be simple and cost effective for organizations to offer weekly meditation, access to mental health services, professional coaches, and other wellness management resources.

Fortunately, it is increasingly common for medical schools, residency programs, and other clinical settings to offer wellness support.

6

Reduce the stigma surrounding mental health care and burnout.

Denial is not healthy or productive. Organizations should foster a culture in which clinicians can acknowledge the difficulties they face in order to alleviate strain and maintain a sense of well-being. To combat the burnout crisis, organizations must encourage their clinicians to seek help.

“Instead of continuing to indulge a culture in medicine that rewards silence, real change will happen when we encourage physicians to talk about the truly unhealthy conditions they’re facing that are affecting their well-being and the well-being of their patients.”

Dr. Dianne Ansari-Winn
Anesthesiologist, Founder of the Physician Vitality Institute, and Lightning Bolt Physician Advisory Board Member
Sources
  1. Advanced Practice Providers Well-Being Index, 2021: mywellbeingindex.org/versions/app-well-being-index
  2. Survey: EHRs, Value-Based Care Causing Docs to Sour on Profession, Healthcare Innovation, Rajiv Leventhal, Oct. 1, 2018: hcinnovationgroup.com/policy-value-based-care/news/13030759/survey-ehrs-valuebased-care- causing-docs-to-sour-on-profession
  3. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide, Leslie Kane, MA, Jan. 15, 2020: medscape.com/slideshow/2020-lifestyle-burnout-6012460#2
  4. At Stanford, physician burnout costs at least $7.75 million a year, AMA, Sara Berg, Nov. 17, 2017: ama-assn. org/practice-management/physician-health/stanford-physician-burnout-costs-least-775-million-year
  5. Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction, JAMA Network, Maria Panagioti, PhD et al., Sep. 4, 2018: jamanetwork.com/journals/jamainternalmedicine/ fullarticle/2698144
  6. Counting the costs: U.S. hospitals feeling the pain of physician burnout, Reuters, Julie Steenhuysen, Nov. 21, 2017: reuters.com/article/us-usa-healthcare-burnout/counting-the-costs-u-s-hospitals-feeling-the-pain-of- physician-burnout-idUSKBN1DL0EX
  7. Burn-out an “occupational phenomenon”: International Classification of Diseases, WHO, May 28, 2019: who. int/mental_health/evidence/burn-out/en/
  8. WHO Redefines Burnout As A ‘Syndrome’ Linked To Chronic Stress At Work, NPR, May 28, 2019: npr.org/ sections/health-shots/2019/05/28/727637944/who-redefines-burnout-as-a-syndrome-linked-to-chronic- stress-at-work
  9. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population, JAMA Network, Tait D. Shanafelt, MD et al., Oct. 8, 2012: jamanetwork.com/journals/ jamainternalmedicine/fullarticle/1351351
  10. Burnout in United States Healthcare Professionals: A Narrative Review, PMC, Thomas P. Reith, Dec. 4, 2018: ncbi.nlm.nih.gov/pmc/articles/PMC6367114/#REF20
  11. The Maslach Burnout Inventory Manual, Evaluating Stress: A Book of Resources, ResearchGate, Christina Maslach et al., Jan. 1997: researchgate.net/publication/277816643_The_Maslach_Burnout_Inventory_Manual
  12. A cross-sectional study exploring the relationship between burnout, absenteeism, and job performance among American nurses, BMC Nursing, Liselotte N. Dyrbye et al., Nov. 21, 2019: bmcnurs.biomedcentral. com/articles/10.1186/s12912-019-0382-7
  13. Nurses’ Time Allocation and Multitasking of Nursing Activities: A Time Motion Study, AMIA Annual Symposium Proceedings, 2018: 1137-1146, Yen, P. et al., 2018: ncbi.nlm.nih.gov/pmc/articles/ PMC6371290/#r34-2975707
  14. Study Shows Physician Burnout Directly Related to EHRs, EHRIntelligence, Christopher Jason, Sep. 27, 2019: ehrintelligence.com/news/study-shows-physician-burnout-directly-related-to-ehrs
  15. Physician Hours: Should Physicians Work Less? Locum Jobs Online, Aug. 8, 2018: locumjobsonline.com/ blog/physician-hours-should-physicians-work-less
  16. Can medicine really become family friendly? Yes, but not without systemic change, Mobile Health Times, Suvas Vajracharya, Ph.D., Dec. 18, 2019: mobilehealthtimes.com/can-medicine-really-become-family-friendly- yes-but-not-without-systemic-change
  17. Asking physicians this one simple question may hold the answer to burnout, KevinMD, Dianne Ansari-Winn, MD, MPH, Nov. 20, 2019: kevinmd.com/blog/2019/11/asking-physicians-this-one-simple-question-may-hold- the-answer-to-burnout.html

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