Magazine article The Nation's Health

Concerns Grow about Burnout, Stress in Health Care Workers: New Demands Adding to Burden

Magazine article The Nation's Health

Concerns Grow about Burnout, Stress in Health Care Workers: New Demands Adding to Burden

Article excerpt

Faced with rising pressures to produce better outcomes at lower costs, the U.S. health care system is making big changes in how it delivers care. The shift is good for patients, but behind the scenes, health workers are burning out at alarming rates.

"This is a significant public health problem, because it affects the functioning of all of our health systems," Bryan Bohman, MD, senior advisor to the WellMD Center at Stanford Medicine, told The Nation's Health. "Imagine a problem that affects quality of care, results in high turnover, reduces productivity, destroys people's personal lives and increases the risk of suicide. That's what burnout is, except it tends to work undercover."

While health care is an inherently high-stress field --after all, life and death are frequently on the line --its workers are reporting worsening rates of burnout, which is often characterized by emotional exhaustion, a low sense of personal fulfillment from work and depersonalization, which makes it harder to connect with patients in meaningful ways.

In 2012, a landmark study in the Archives of Internal Medicine surveyed more than 7,200 U.S. physicians, finding that nearly half reported at least one symptom of burnout, putting doctors at higher risk than other U.S. workers. In 2015, a study published in Mayo Clinic Proceedings found that burnout prevalence went up by 9 percent among U.S. physicians between 2011 and 2014, while remaining stable among other worker groups. In a 2018 report from Medscape that surveyed more than 15,000 physicians across 29 specialties, 42 percent reported burnout.

Beyond burnout, 39 percent of physicians report depression and about 400 physicians die by suicide each year, which is twice the rate of the general population. The suicide rate among women doctors is about 130 percent higher than the general population, while men doctors experience a 40 percent higher rate. Nurses also report high rates of burnout and depression, as well as high rates of post-traumatic stress disorder symptoms.

The high rates impact patient health, with research showing links between burnout and the risk of medical errors and health care-associated infections, as well as patient access, with burnout tied to higher turnover and higher odds of leaving medicine altogether. That is especially concerning, as projections show the country faces a potential shortage of up to 35,000 primary care physicians.

Advocates and researchers say the data point to systemic problems that demand health systems and policymakers more carefully consider how a rapidly changing work environment is driving providers out of the field and into mental distress.

In fact, a number of researchers have called for expanding the field's guiding "triple aim" framework --which calls for enhancing patient experiences, improving population health and reducing costs --to a quadruple aim, with the additional goal of improving the working lives of health care providers. Some advocates are also calling for stronger policies, such as legislation introduced into the U.S. Senate last year that would set rules around nurse-patient ratios and is modeled after a 2004 California law that resulted in lower nurse burnout rates and greater nurse retention.

"This is no longer just a few people working behind the scenes to address this problem," said Bohman, a clinical professor of anesthesiology, perioperative and pain medicine at Stanford. "We have America's attention now and there's a lot of good work happening to try to identify the problem, prevent it and treat it. But we don't have a complete playbook just yet."

Health systems taking action on burnout

Across the country, health systems are taking new steps to better support provider well-being, but research on what works to reduce clinician burnout is still fairly limited. Complicating matters more is that providers often cite work factors, such as excessive work hours and increasing clerical demands, as top contributors to burnout. …

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