Physician Burnout: What It Is and How Pediatricians Can Avoid It

Professional burnout is one of the biggest challenges for practicing physicians. Research has shown that physician burnout increased by 20 percent between 2011 and 2014, and the factors which cause this condition continue to expand. Interestingly, this study found that burnout is not necessarily the result of physicians being depressed or less content at home, but rather they are not happy at work.

Authors of the research, Andrew Alexander, MD, and Kenneth Ballou, MD, listed three symptoms of physician burnout:

  • a feeling of a lack of accomplishment

  • feelings of cynicism

  • a loss of zeal, zest , and enthusiasm for work

When discussing the first symptom, they said, “the physician-patient relationship, which has provided happiness to physicians over the years, is now threatened by an insurer–employer–provider relationship.”

Seven Ways to Know if Burnout is Affecting a Physician

According to research from Dr. Mark Linzer, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, and published in an article for the American Medical Association on physician health, “there are at least seven ways to know if a practice might be getting the best of a physician and that it is time to take action.”

1. The physician has a high tolerance to persistent stress. Stress consistently ranks as the primary predictor for burnout among physicians. This is because, according to Linzer’s research, physicians who consistently operate under high stress are at least 15 times more likely to burn out.

2. The medical practice is exceptionally chaotic. A quick glance around a practice will let the physician know if he or she may cave to stress.

“People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.”

3. The doctor does not agree with his supervisor’s values or leadership. Whether physicians are at large hospitals or in private practice, it's important for them to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane. This is a very important factor for physician satisfaction.

4. The physician is an emotional buffer. Working with patients requires more than just medical expertise. “Often, the doctor acts as an emotional buffer,” Dr. Linzer said. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”

5. The job constantly interferes with family events. Spending quality time with loved ones helps physicians perform better.

“When they can’t do those things, it’s all they think about during the day and the patient suffers,” said Dr. Linzer. He cites work-life interference as one of the most common predictors for burnout among physicians in his studies.

6. The physician lacks control over his or her work schedule and free time. When work demands increase, but control over one’s schedule does not, stress can kick in and spark burnout.

7. The doctor does not practice enough self-care. If physicians continually neglect themselves, they might neglect patients too. “As physicians, we want to be altruistic, but one of the keys to altruism is self-care,” said Dr. Linzer.

An Intervention for Burnout

In a 2015 study, an intervention was completed in 34 primary care clinics to see if improving work conditions could decrease burnout and improve quality of care. Burnout was documented in 37 percent of clinic physicians at baseline.

Improvements could broadly be defined into 3 categories:

  • improved communication

  • changes in workflow

  • targeted quality improvement projects

After 12 to 18 months, burnout was reassessed. Some of the interventions included:

  • monthly provider meetings that focused on work/life or practice management issues

  • offloading nonessential tasks such as Medical Assistants (MAs) scribing

  • removing bottlenecks to increase physician/patient contact time

  • pairing MA’s with particular physicians

  • increasing appointment times by five minutes

  • instituting a prescription refill line

  • nurse coordinators leading support for patient issues and sharing calls

The report concluded that, “Intervention clinicians showed more improvements in burnout (21.8 percent vs 7.1 percent less burned out); were more satisfied (23.1 percent vs 10.0 percent more satisfied); and were less likely to report an intention to leave the practice. It appears that a systemic intervention to apply workflow redesign and improve communication between clinic and physician staff might decrease burnout and potentially improve retention.”

Pediatricians and Burnout

Despite the fact that burnout is greater in the physician workforce, compared with the general population, pediatricians experience less burnout than most other specialties, according to recent research. This translates to about 35 percent of pediatricians experiencing this condition, compared to approximately 50 percent among all physicians. Also, about 60 percent of pediatricians feel that their practices leave them with enough time for personal and family matters, compared to about 50 percent of all other specialties.

This report correctly notes that, “Although burnout may impact pediatrics less than other specialties, the numbers still indicate a significant problem.”

How an EHR Can Help Decrease Pediatrician Burnout

“Pediatricians are fundamentally motivated by a desire to care for children and their families,” said Chip Hart, Director of PCC’s Pediatric Solutions consulting group and author of the popular blog “Confessions of a Pediatric Practice Consultant.”

“The current research supports the fact that the physician-patient relationship is a source of happiness, not stress, for pediatricians. Most of the burnout-causing problems of modern pediatrics are external to the practice and largely revolve around third parties interfering with that physician-patient relationship.

In my experience, technology is often a dividing point for many pediatricians - the right tools will ameliorate many of these stressful demands and improve a pediatrician’s work-life balance. The wrong tools, especially technology designed for non-pediatricians, will make them even more unhappy.

“Many of our clients have found that a pediatric-focused electronic health records (EHR) platform allows a busy pediatrician to have time for patient-centered diagnostic and treatment activities, while spending less time on meeting the demands of record-keeping, billing, collections, outreach, and other administration tasks.

“For example, the PCC platform has embedded Bright Futures and American Academy of Pediatrics decision support. Both are extremely valuable and time-saving for a busy pediatrician.

“We have also designed our platform to enable a pediatrician, practice manager, and their staff to keep up with the latest ‘best practices’ among practitioners from around the country with our Dashboard tool. This results in the doctor, manager, and clinical/administrative team having more peace of mind by knowing they are offering quality treatment to patients and identifying where they need to improve.

“Our annual PCC Users’ Conference is a free source of timely information that clinicians and administrative team members can use to stay current on all changes related to the specialty of pediatrics.  

There are many clinical features that pediatricians crave in their EHR but don't usually get - family/sibling based charting, weight-based dosing, a pediatric-oriented portal - those are the features that set PCC's EHR apart.

“Finally, PCC EHR is a tool for helping a busy pediatric practice run their business more efficiently and profitably. Nothing is more depressing and stressful for a pediatrician than to work the long hours that are necessary to build a successful practice and then have little or no profit at the end of the year. Our EHR helps prevent this from happening.

“All of these features have been developed for and in conjunction with pediatricians around the country. Our development team is constantly updating the PCC platform and these modifications to the software are shared with our clients on a regular basis.

“The PCC platform leverages technology to enable a busy pediatrician to have time for the important parts of his or her life - treating patients and spending time with family. Over time, this can result in less stress and fewer burnouts.”

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Tags: pediatric mental health, pediatric ehr, practice management