Forum Message From the Dean
Provider Burnout Affects Us All
My commentary for this edition of Medicine at Michigan focuses on an extremely important issue — “provider burnout” — which has over the past several years been recognized as a growing problem. I won’t lament how we got here but rather will call on all of us to recognize that provider burnout is not a problem impacting only a handful of health care professionals or those who have less resiliency.
Burnout is not a “diagnosis” but a response to chronic stress in the workplace that manifests as exhaustion, detachment, cynicism, or feeling a lack of accomplishment; in short, the opposite of engagement. These stressors include pressures of student debt, difficulty with work-life balance, strenuous hours, and administrative burdens that add hours to each work day. Aside from generating feelings of disengagement and dissatisfaction, burnout puts residents, nurses, physicians, and others at greater risk for stress and exhaustion, depression, and, tragically, even suicide. Ironically, it is not just providers who suffer, but ultimately the people we are trying to help, our patients, whom we disservice.
It is well documented that over 50 percent of physicians suffer from burnout, regardless of their practice environment — academic or private practice, primary care, or specialties. Burnout rates are increasing rapidly and fueling concerns that valued faculty and physicians will choose to leave medicine altogether to protect their health and well-being. In an era when we face growing trends of physician shortages, national health care is potentially at risk. Recent studies indicate that nurses and other health care professionals are experiencing the same challenges and distress.
We absolutely need to understand burnout, but, more importantly, we need to determine how we can develop better ways to manage the daily workflows and stressors that we share as health care providers. Raising this issue as a significant priority for any health care setting is key. Unless it is discussed at the highest levels of leadership and decision making, whether in a private practice or an academic setting, even small but meaningful changes will not occur. One way to approach this conversation is an emphasis on the fourth aim — provider well-being — in addition to the Centers for Medicare and Medicaid Services’ triple-aim mantra of quality, cost, and outcomes.
Much research has been conducted in this arena, and a focus on teamwork and clearly defined roles and responsibilities seems to improve the care environment. Redefining workflow assignments and allowing each member of the care team to practice at the “top of their license” also contribute to a more balanced workload. Other changes, like more flexible scheduling and the use of scribes to handle documentation, can further improve work-life balance.
Now more than ever, we need to be committed to practice and protect our self-care and wellness. Incremental changes in how we deliver care can help, but we need to change the fundamental mindset that health care professionals are invincible. In reality, the stress and pressure of always caring for others means that we need the support of everyone on our teams, every step of the way.
Marschall S. Runge, M.D., Ph.D.
Dean, Medical School
Executive Vice President for Medical Affairs, U-M
CEO, Michigan Medicine
Photo by Leisa Thompson Photography