A Path Forward: Addressing Clinician Burnout Through Systems-Level Change

While the COVID-19 pandemic has shone a spotlight on burnout in the healthcare community, it is a “preexisting condition.” Burnout is defined as a work-related stress reaction that leads to emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. Long years of training, even longer hours per shift, combined with excessive administrative duties, emotionally charged encounters with illness and death, and inadequate work-life balance have taken its toll on clinicians. The last two years have amplified this imbalance with physicians, nurses and other clinical healthcare professionals, adding additional personal safety concerns, misinformation regarding the pandemic and moral dilemmas related to rationing care to their list of stressors.

 

Recent information indicates that burnout is endemic in healthcare, with surveys citing more than 50% of both physicians and nurses admitting to key signs of burnout such as overwhelm, emotional exhaustion and irritability. The increased visibility of physician burnout—and its impact on clinicians, their communities and patients—has led to calls to action that incorporate systemic and policy level mandates, as well as individual-centered approaches to promote clinician well-being. Such multipronged approaches provide individual resources that bolster fatigued clinicians while ensuring the organization’s culture and daily processes actively support clinicians return to the joy of medicine.

Traditionally, well-being initiatives have focused primarily at the self- and people-level, with an emphasis on individual and group-based resources. However, effective strategies must include safe spaces for physicians and nurses to offer candid feedback without fear of career retaliation. Also vital are increased access to free mental healthcare—with blocked time for clinicians to attend these services—and improved access to child and elderly care. As a result of the turmoil of COVID-19, additional resources may include legal guidance for physicians asked to expand their scope of practice and financial safeguards for reduced hours or decreased pay. 

 

Healthcare organizations can further bolster clinician well-being by engaging in clinician-led quality improvement initiatives that directly impact their practice of medicine. These QI initiatives may include standing order sets and templates to improve EHR efficiency, addressing excess patient caseload and utilizing other resources to improve clinicians' daily experience in healthcare.

 

At an organizational level, a culture of well-being in which senior leadership truly prioritizes clinicians can set the tone for physician and nurse well-being. Leaders can promote work-life balance by offering flexible schedules for clinicians. There are tools currently available to encourage a clinician-friendly culture such as the AMA’s evidence-based module on burnout prevention. 

 

A commitment to diversity and inclusion via hiring processes, equitable pay and swift responses to clinicians' concerns regarding these topics reinforces the notion that the healthcare organization values clinician well-being. 

 

At a systemic level, it is healthcare legislation, such as those that address Medicaid, Medicare and Telehealth reimbursement rates, which directly affect clinicians’ livelihood, documentation requirements and administrative duties, and invasive license renewal queries that ask about clinicians' utilization of mental health resources. A health system that uses its local and national standing to lobby for clinicians’ interests will send a strong message that it truly values the well-being of clinicians within the organization. 

 

A singular approach to burnout cannot address its multifaceted causes. Rather, reducing clinician burnout requires a comprehensive approach that addresses its roots from the individual level all the way to the healthcare system and policy level. Within this framework, a guiding principle that puts clinicians first and prioritizes open communication and honest feedback will allow healthcare organizations to take the first steps in promoting well-being and much-needed healing.