May 1, 2019
By Jacqueline Posada, MD, 4th-year resident in the department of
psychiatry & behavioral sciences at George Washington
MD: professor of psychiatry and training director at Wayne
State University, Detroit.
In March, Dr. Balon spoke at the
American Academy of Clinical Psychiatrists 2019 annual meeting
in Chicago, sponsored by Global Academy for Medical Education
(GAME). GAME and the MDedge Psychcast are owned by the same
Physician burnout and effective
- The scales (for example, the
Maslach Burnout Inventory) do not necessarily represent the
full extent of burnout:
- If physicians work 12 hours but find fulfillment in work, they
will be tired but not necessarily burned out. However, if
physicians work 12 hours a day feeling frustrated by the systemic
problems, then burnout can ensue.
- Common contributors to provider burnout:
- Excessive workload: Pressures of working with
an electronic medical record, extensive time spent on
documentation; lack of work satisfaction and job control; lack of
respect for the work; student loan burden.
- “Moral injury”: The emotional burden, which
occurs when physicians cannot deliver ideal care/treatment to
patients, especially when limited by resources (such as insurance
or poverty), or other systemic health care issues.
- Work environment and organizational culture:
These factors also contribute to physician burnout.
Burnout is a problem for health care organizations as a
- Two main ways to address burnout: Physician-directed
interventions (focused on individuals) and organization-directed
- Organization-directed burnout prevention strategies include:
- Reducing workload; reducing time spent on documentation, such
as decreasing time spent in front of EMRs; cultivating effective
teamwork; fostering a sense of job control.
- Organizations prefer individual-focused interventions over
- Examples include mindfulness teaching, yoga,
cognitive-behavioral therapy techniques, education about burnout,
- Individual-focused interventions are great, but they are not
realistic for changing the culture that contributes to
Interventions for burnout
In a systematic review and meta-analysis in JAMA Internal
Maria Panagioti, PhD, and colleagues found that:
- Burnout interventions focused on individual physicians have
small, significant effect on physician burnout.
- Organizational-directed approaches result in greater treatment
effects, especially when interventions focus on promoting healthy
- The impact of individual interventions can be improved when
supported by organizational interventions.
- Interventions targeted at more experienced physicians within
primary care settings show greater treatment effect than
interventions targeted at less experienced physicians within
secondary treatment settings.
- Approaches identified by staff, as outlined in a New England
Journal of Medicine article, can lead to meaningful change.
- A Hawaiian health care system queried individuals (physicians,
mid-levels, and nursing staff) to identify parts of EMR
documentation that are poorly designed and unnecessary, and lead to
unintended burdens contributing to burnout.
- This type of survey improves efficiency of a system and shows
that the health care organization cares about preventing clinician
Panagioti M et al. “Controlled interventions to reduce burnout
in physicians: A systematic review and meta-analysis.”
JAMA Intern Med. 2017 Feb 1;777(2):195-205.
Ashton M. “Getting rid of stupid stuff.”
N Engl J Med. 2018 Nov. 8;379(10):1789-91.