Burnout: From the reason to the remedy

January 1, 2017

Discussions about burnout and increasing rates of physician suicide are everywhere. If you’re feeling symptoms, you’re not alone – and the College is stepping up to help allergists experiencing burnout.

It’s ok to admit it – this isn’t what you signed up for. You went through residency to help patients, to get one-on-one face time with them, and have them walk away feeling better. But lately you’ve been bogged down with clerical work – entering data and notes in the EHR, even when you’re at home in your pajamas. You might be feeling a bit of what everyone is talking about – burnout. “Between 50% and 60% of physicians are now experiencing clinical symptoms of burnout,” said Mark O’Hollaren, MD, FACAAI, during the keynote session at the Annual Scientific Meeting. "And approximately 400 physicians per year commit suicide in the U.S.”

So, what is burnout, anyway? According to Dr. O’Hollaren’s presentation, it’s the progressive loss of idealism, energy and purpose. It leads to emotional exhaustion – the loss of passion. It brings cynicism and depersonalization. It comes with fatigue, ineffectiveness – the loss of desire to accomplish great goals and make the world a better place. In short, it makes the quality of your life a whole lot worse.

You’ve probably heard a lot about it at this point – it’s a hot topic in medicine. It seems like every health blog from KevinMD to STAT are writing think pieces about this issue. The National Academy of Medicine is launching a new action group to address the high rates of depression and suicide among health care workers in the U.S. And it’s all for good reason. But why is it happening so much in the last few years? Dr. O’Hollaren agreed completely with another presenter at our keynote session, Abraham Verghese, MD, MACP, well-known author and voice in medicine. A lot has to do with electronic health records (EHR).

While intended to improve patient care and efficiency, these cumbersome systems have only lead to increased work and less time with patients. “The medical record as it now exists is a mistake of epic proportions. There is just no two ways about it,” said Dr. Vergehese, to a round of raucous applause. “We are the highest paid clerical workers in the country – we really are.” His presentation offered shocking statistics – for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on the EHR. Outside office hours, physicians spend another one to two hours of personal time each night doing other clerical work. With that in mind, it doesn’t sound surprising that allergists are feeling exhausted.

There are other factors, as well. During his presentation, Dr. O’Hollaren brought up a couple of other reasons – like the changing health care environment and shift from volume  to quality. Additionally, high deductible health plans are not making things any easier. Patients often are not compliant with medications or tests due to out-of-pocket costs, but this affects your outcomes and how you are looked at as a provider. All of these issues pile up and lead to that horrible feeling of malaise that affects more than just physicians. “Burnout is bad for patients, it’s bad for providers,” said Dr. O’Hollaren. “It’s bad for our marriages, families and friends, it’s bad for our health care system, it’s bad for the country overall, it’s just bad all the way around.”

The good news is that the College is here to help you if you are starting to feel inklings of burnout in your life.

“Prior to our Annual Meeting last November, we knew that physician burnout was an important problem among physicians in general,” said Stephen Tilles, MD, FACAAI, president of the College. “But judging from the overwhelming and sometimes emotional responses to the keynote session, it appears that burnout among allergy/immunology specialists is also a significant problem. The College understands that burnout is a threat to our members, and therefore addressing this issue has become a high priority.”

The College has put together a task force on physician wellness, chaired by Gailen Marshall Jr., MD, PhD, FACAAI. “The Task Force for Promoting Allergy and Immunology Physician Well-Being is aimed at identifying allergy/ immunology physician-specific factors that can
adversely impact the risk for physician burnout,” said Dr. Marshall. “We plan to gain insight into the scope of this problem for our members through web-based questionnaires, focus groups and by establishing a listserv to allow online discussion between College members and the task force about this critical issue. Once these allergy/immunology-specific risk factors are firmly defined, the College will use this data to effect changes to reduce (and someday eliminate) these risks for physician burnout.” The task force is still in its infancy, but the more that College members participate in the questionnaires, focus groups, etc., the more complete the assessment and recommendations to reduce the risk of burnout will be. 

Dr. Marshall emphasized the importance of membership participation in the coming year. “Given the size of our small specialty and the relatively meager number of new providers coming into the workforce annually, it is critical that we identify specific risk factors (similar and distinct from other specialties) that affect our providers. We can then develop strategies that will address these risk factors and advocate for their implementation into our future health care system,” he said. “Otherwise, we face the risk of extinction of our specialty based upon the wear and tear of our physician workforce.” 

Reading so much about burnout might make you start to feel, well, burned out. Take a deep breath and try to stay optimistic. With all the attention being paid to this important issue, remember that change is always on the horizon. “I have a sense that the pendulum is finally gathering steam,” said Dr. Verghese during his presentation. “No health care system can afford the kind of attrition where 50% of your staff are depressed and going part time. People are waking up that we need a change.”