The CEOs of the nation's most prominent health systems authored an article in Health Affairs examining the widespread issue of physician burnout, its main contributors, leaders' role in responding to burnout and an 11-item call to action.
The authors of the article include:
- John Noseworthy, MD, president and CEO of Rochester, Minn.-based Mayo Clinic
- Delos "Toby" Cosgrove, MD, president and CEO of Cleveland Clinic
- Mitchell Edgeworth, CEO of Nashville, Tenn.-based Vanderbilt University Hospitals and Clinics
- Ed Eillison, MD, executive medical director and chairman of the board for the Southern California Permanente Medical Group in Pasadena, Calif.
- Sarah Krevans, president and CEO of Sacramento-based Sutter Health
- Paul Rothman, MD, CEO of Johns Hopkins Medicine in Baltimore
- Kevin Sowers, RN, president of Duke University Hospital in Durham, N.C.
- Steven Strongwater, MD, president and CEO of Atrius Health in Newton, Mass.
- David Torchiana, MD, president and CEO of Boston-based Partners HealthCare
- Dean Harrison, president and CEO of Chicago, Ill.-based Northwestern Memorial HealthCare
Burnout is the experience of three interrelated components: exhaustion, cynicism and inefficacy. More than half of U.S. physicians reported experiencing at least one symptom of burnout, according to a Mayo Clinic study cited by the authors. To mitigate the effects of burnout and help prevent it in the future, health system leaders must address the root causes of what many have deemed a health crisis of epidemic proportions.
Studies have shown that physician burnout is directly attributable to lack of control over one's work, greater regulatory burdens imposed by increased performance measurements (on quality, cost and the patient experience), the rising complexity of medical care, EHRs and process inefficiencies that detract from time spent with patients, according to the authors.
They contend that addressing burnout should be a major priority for all healthcare leaders, as it has the potential to threaten patient safety, quality of care and ultimately increase healthcare costs.
"Executive attention to the issue of burnout in physicians and other health professionals is paramount to make the changes necessary to improve the health care environment," the authors wrote. To further this goal, the CEOs held a summit at the American Medical Association in Chicago in September 2016, during which they reviewed data on the extent of physician burnout, the consequences for health systems and patients and steps leaders can take to address the issue.
"There was clear consensus among all present at the AMA summit that addressing the issue of burnout is a matter of absolute urgency," they wrote. "We candidly acknowledge that we don't have all the answers, or know for certain what the most impactful interventions are, but we are beginning to learn and progress is being made in some areas."
The CEOs committed to the following 11 practices and interventions to address physician burnout at their organizations, and encourage other healthcare CEOs to do the same.
1. Consistently measure physician well-being using a standardized, benchmarked instrument.
2. Where possible, incorporate measures of physician well-being into organizational performance dashboards alongside financial and other performance metrics.
3. Measure and monitor the institutional costs of physician turnover, early retirement and reductions in clinical effort.
4. Emphasize the value of leadership development for physicians and managers who lead physicians.
5. Understand and address the clerical burden and misallocation of work to physicians that contributes to the exhaustion component of burnout.
6. Encourage collaborative, team-based care models that maximize physician expertise and delegate tasks to other care team members appropriately.
7. Encourage policymakers to address the mounting regulatory burden that contributes to inefficiency, redundancy and waste in healthcare.
8. Support the AMA and other national organizations to work with regulators and technology companies to align both policy and technology to the advanced models of team-based care and to reduce the burden EHRs impose on all users.
9. Encourage and support the AMA and other national organizations that are developing initiatives to make progress in this area by compiling and sharing best practices from institutions that are addressing burnout effectively.
10. Continue to educate CEOs and other stakeholders in the healthcare arena about the importance of mitigating burnout and improving the well-being of physicians and other healthcare providers.
11. Use organizational research to determine the most effective policies and interventions that improve healthcare providers' well-being.