Exhaustion and Cynicism Drive Physician Burnout Increase at Mass General

Strategies adopted to address burnout include sponsoring social events to enhance connections between physicians.

From 2014 to 2017, physician burnout increased five percentage points at Massachusetts General Hospital Physicians Organization in Boston, according to research published today.

Other research indicates that nearly half of physicians nationwide are experiencing burnout symptoms, and a study published in October found burnout increases the odds of physician involvement in patient safety incidents, unprofessionalism, and lower patient satisfaction. Burnout has also been linked to negative financial effects at physician practices and other healthcare organizations.

The research published today in Journal of the American Medical Association found exhaustion and cynicism were the primary drivers of increased burnout at Mass General's physician organization. The research was based on survey data collected from more than 1,700 physicians.

The survey data showed exhaustion increased from 52.9% in 2014 to 57.7% in 2017, and cynicism increased from 44.8% in 2014 to 51.1% in 2017.

The exhaustion finding was particularly troubling, the JAMA researchers wrote. "We found physicians were more vulnerable to emotional exhaustion than any of the other subscales of burnout. Physicians reporting high levels of exhaustion were more likely to reduce their clinical schedules, reduce the number of patients in their practice, leave the practice, or retire."

The researchers noted that physician turnover has several costs including patient and clinician distress as well as the expense of replacing physicians, which can be as high as three times a doctor's annual salary.

Primary care physicians reported higher levels of exhaustion compared to medical specialists. "These findings may be associated with the amount of time primary care physicians spend documenting on the EHR and serving as the clinicians responsible for the management of patients' multiple complex medical and social problems," the researchers wrote.

Burnout data points
 

The JAMA article has several other key data points.

• Early-career physicians who had less than a decade of practice experience since their training were more susceptible to burnout than veteran physicians.
   
• The higher burnout rate in 2017 may be linked to implementation of a new electronic health record system because average time devoted to administrative tasks increased from 23.7% in 2014 to 27.9% in 2017, and increased time spent on administrative tasks was linked to higher burnout.
   
• Several favorable working conditions were associated with lower odds of burnout: workflow satisfaction, positive relationships with colleagues, time and resources for continuing medical education, opportunities to impact decision making, and having a trusted adviser.

Addressing physician burnout
 

The lead author of the research, Mass General physician organization CMO Marcela del Carmen, MD, MPH, told HealthLeaders that the physician group has implemented several efforts to reduce burnout.

"We have allocated funding to each of our 16 clinical departments to develop and institute initiatives to mitigate burnout in their departments. We have central efforts including sponsoring social events to enhance connectivity amongst the faculty, efforts to improve our use of the electronic health record through personal- and practice-level training, and funding to support peer-to-peer coaching programs, yoga, and meditation sessions."

Del Carmen's research team also suggested that burnout prevention efforts could be tailored for early-career physicians, who reported relatively high dissatisfaction with department leadership, relationships with colleagues, quality of care delivery, control over work environment, and career fit.

"These findings point to potential opportunities in this vulnerable group to mitigate burnout, such as initiatives that promote community building and networking and harnessing effective leadership," the researchers wrote.