AHRQ Views: Blog posts from AHRQ leaders
Caring for the Healers
A family doctor in solo private practice was feeling exhausted. He felt as if he had a full-time job caring for patients, which is why he became a physician, but also a second full-time job filing paperwork to comply with administrative and reporting requirements.
The doctor’s exhaustion was not simply physical, although he was not getting enough sleep after logging on to his electronic health system for several hours every night after his family had gone to bed. He felt emotionally drained and dreaded going to his office. He realized he was becoming numb to the needs of the people he served and no longer had a sense of accomplishment in his work. His only solution, he feared, was closing his practice. But he was worried about leaving his small town without a doc. He was burned out.
This physician, a dedicated clinician who practices in the Northwest, is not alone. In the United States, professional burnout is thought to be twice as high among doctors and nurses as among other workers. And it’s a problem that should concern all Americans: Studies have shown that health care settings in which doctors and nurses are experiencing symptoms of burnout have higher rates of medical errors, poorer patient outcomes, and worse patient experience.
Moreover, health care professionals experiencing burnout are more likely to leave their jobs, leave the practice of medicine altogether, and experience anxiety and depression. At AHRQ, we believe addressing clinician burnout is not only important to improving the quality, safety, and value of health care, but also is part of our commitment to caring for America’s healers.
AHRQ is proud to be a member of the National Academy of Medicine’s (NAM) Action Collaborative on Clinician Well-Being and Resilience. The Collaborative brings together researchers, clinician organizations, health care systems, policymakers, and patient organizations to raise awareness about the problem of burnout in the health professions and explore potential solutions.
As a leader in research and measurement, AHRQ has contributed to a NAM discussion paper on establishing a research agenda related to clinician burnout. The Agency also helped to develop several resources on how health care systems can effectively measure burnout among clinical staff, including a paper published this week that provides practical suggestions for health care systems in choosing appropriate tools for measuring clinician burnout.
Through its EvidenceNOW initiative, AHRQ is using its expertise in practice improvement research to explore how to support primary care practices in building clinician well-being. A thought-provoking new paper in the Journal of General Internal Medicine from EvidenceNOW’s national evaluation team (ESCALATES) describes the findings from a survey of more than 10,000 primary care team members in over 1,350 primary care practices across the Nation. Burnout was reported by over 20 percent of respondents overall, with physicians reporting slightly higher rates of burnout than non-clinical staff.
These are bittersweet findings; while these rates are lower than the rates of burnout often reported for physicians in primary care, they still represent a substantial amount of suffering. The researchers also found that staff who work in hospital- or health system-owned practices and community health centers reported higher rates of burnout than people working in small independent practices. The authors suggest that these findings may indicate that clinicians who have more autonomy and decisionmaking power, as well as closer working relationships and a shared sense of responsibility for the practice’s success, are less likely to experience emotional burnout. These findings are consistent with a previously published paper from the New York City EvidenceNOW Cooperative that examined burnout in physicians in the city’s small independent primary care practices
The physician I described at the beginning of this blog received help from EvidenceNOW and a practice facilitator. Focusing first on his greatest stress, his coach helped him streamline his data reporting. As the physician’s paperwork and reporting burdens lessened, the facilitator was able to engage him in thinking about quality improvement activities. He became energized by how data allowed him to see his practice in new ways and helped him target improvements in the care he was providing. As a result of his participation in EvidenceNOW and the personalized support he received, he reclaimed the joy of caring for patients and decided to remain in practice.
We all have a role to play in achieving the quadruple aim of health care—ensuring that American health care is higher quality, more affordable, and more patient-centered, while restoring the joy of clinical practice for those who have dedicated their lives to caring for us.
Dr. Meyers is Chief Medical Officer of AHRQ.