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We Already Know How To Save Physicians From Burnout

Discussion in 'Hospital' started by The Good Doctor, Jun 9, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    The foundation of modern medicine has been built on a well-established, iterative process of empirical research and the pragmatic implementation of new discoveries. A relevant example of this paradigm can be seen in the development of Pfizer’s and Moderna’s COVID-19 vaccines.

    Researchers developed a hypothesis to use an mRNA vaccine, demonstrated its promise in animal research and substantiated its safety and effectiveness in human subjects through clinical trials, leading to the vaccines now becoming an integral part of our efforts to prevent the spread of the coronavirus.

    Because of these principles, we have advanced science and medicine in the last hundred years arguably beyond what any of our forefathers would have expected. We have given all of this care in order to help patients and help provide better treatment options for their conditions. Yet, when it comes to taking care of our physicians and preventing burnout, we have failed to put these same scientific principles into practice; it’s time for a change.

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    We can begin to look at physician burnout with the same scientific principles as we would in any other study.

    First, we must answer the following question: do physicians experience higher rates of burnout than individuals in other professions? The answer is a resounding yes; the burnout rate for physicians is 49%, while the burnout rate for the general public is 28%. The next step in the process would be to figure out the mechanism of disease — why do physicians experience such high rates of burnout? The literature provides some clues.

    Some of the most prominent factors behind physician burnout include 1) increased time spent charting/using the EHR, 2) increased time spent performing administrative tasks, 3) too many hours spent working, and 4) a lack of respect from patients.

    Stated otherwise, we have acknowledged that the disease exists and understand its mechanism of propagation. Naturally, as with any other disease process, we would then try to cure that disease by developing and testing medications in clinical trials. Treatments to resolve physician burnout have already been discovered and have been shown to be effective by numerous studies. These include (1) increasing use of medical scribes in practice, (2) decreasing hours during residency training, and (3) increasing face-to-face communication between physicians and patients. These solutions should be implemented in practice in the following ways.

    Increase the use of medical scribes in hospitals and offices

    The most common opposition to the use of scribes is that scribes will cost hospitals or practices more money than they can afford. The economic conditions resulting from the pandemic have further exacerbated this kind of financial concern. However, a study published in JAMA Dermatology suggests that this viewpoint is not necessarily correct. In their study, Namburdi et al. found that 79% of physicians were willing to take on an increased patient load if they had access to medical scribes, and if a physician were to take on one extra patient per session, then the scribe would essentially pay for themselves. Moreover, the study showed that having more scribes in practice actually increased overall revenue by 7.7%. Another study conducted by the American Medical Association demonstrated that scribes increase physician satisfaction, decrease burnout, and increase patient satisfaction.

    Decrease the hours required during residency training

    The grueling hours during residency training are among the most arduous part of the path to becoming an attending physician. Nearly 38% of physicians between the ages of 25 and 39 experience burnout stemming from long working hours. Fatigued residents are significantly more likely to commit medical errors.

    Naturally, the question arises: are the 80- to 100-hour workweeks necessary to train a physician? A study published in the BMJ showed that doctors who worked 90-100 hours a week did not produce better patient outcomes than physicians who had trained in the hospital for significantly less time. It could be argued that we are already improving in this area since the advent of the 80-hour workweek regulation. However, studies have shown that many residents still continue to exceed the 80-hour workweek due to external pressures. A national survey found that 60% of residents reported working more than 80 hours on an average week, and 70% of residents reported working longer than they should have without reporting it.

    Implement bedside rounds

    Medicine today has transitioned from “treating the patient” to “treating the data.” Stanford physician Abraham Varghese coined the term “I-patient” to describe this phenomenon. His argument is that, fifty years ago, medicine consisted of physicians talking about cases directly in front of the patient during bedside rounds. Today, it consists of physicians discussing cases in front of a computer in a conference room. As a result, patients may no longer see the full extent of time and effort that goes into their care. When the physician walks into a room and sees a patient for less than 15 minutes, the patient may think that is all the time the doctor spends on him or her and may consequently be unaware of the care transpiring behind the scenes. Perhaps we should go back in time and do what the doctors did 50 years ago — implement bedside rounds in hospitals. Allowing the patient to see the full range of care efforts may go a long way towards promoting mutual understanding with their health care providers.

    So, the question arises, why have we not put these theories into practice?

    After all, if we continue with the analogy of the coronavirus vaccine, the next step of implementation post-clinical trial is widespread distribution. Yet, we have failed in this regard with treating physician burnout. The short answer is, the implementation of any new programs, especially on a national scale, is difficult.

    We can again see that to be the case in the example of distributing coronavirus vaccines. However, in addition to sound scientific principles, medicine has been built on resilience. We have found a way to cure what we once thought was incurable, we have found a way to distribute medications to millions of people around the globe, and now it’s time to find a way to implement these proven solutions to save our physicians.

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