by adgrooms on July 23, 2019

In today's email, the main article, "How “Burnout” Went From A Casual Expression To A Weighted Word" caught our attention. Burnout is a highly discussed topic in healthcare in the U.S. as well as Europe, but the article describes burnout as a trending, mainstream, societal problem worldwide. Why is burnout affecting so many people? What is it about our society and organizations that leads to this?

Burnout is defined as “fatigue, frustration, or apathy resulting from prolonged stress, overwork, or intense activity.” People are working longer hours and taking their work home with them. This can be especially frustrating for salaried employees who are not compensated for the additional time. We allow work to encroach on weekends and vacations, out of a sense of duty to always be available to the job. Are employers' as well as individuals' expectations to be "on" all of the time exceeding the limits of what is possible?

The amount of time one can work has been regulated in the commercial transportation industry as mistakes due to fatigue can have disastrous consequences for others. In healthcare, it seems that the opposite has happened. Regulations meant to increase patient safety have in turn increased the workload on the physician though added EHR documentation demands. There are no regulations to limit a doctor from working three consecutive weeks with no break. Meanwhile, EHR input regularly has to be completed during non-working hours. Is this truly in the interest of patient safety? Is a work hour restriction like the ACGME's 80-hour week limit for residents a viable option?

It has been shown that physicians in small independent practices report much lower rates of burnout (13.5%) than the national provider average (54.4%). What is this saying about the size of a healthcare facility? Are the larger organizations more concerned about the bottom line? Do the independence and autonomy enjoyed by the smaller practices factor into burnout? The individual physicians in a small practice have greater control over the flow of patients as well as their schedule to regulate fatigue. Is this due to greater visibility and communication within a smaller group? A hospital is open all of the time with a flow determined by how many sick patients come in. Fatigued physicians may be more reluctant or simply unable to take time off due to strict staffing constraints or a culture of pushing through no matter what. Is it possible for a large healthcare institution to fully eliminate burnout?

Of course, most occupations don't compare to the role of a physician who may be responsible for many human lives in a single shift. But if burnout is prevalent in society at large, what does this mean for the pressures and demands on physicians? How do we turn the tide against this worldwide occupational phenomenon?