December 19, 2018
Broken Health Care System Is Causing Rampant Burnout Among Doctors, Nurses.
William Wan, The Washington Post
Published 2:07 pm PDT, Wednesday, October 23, 2019
Imagine a health-care system in which doctors and nurses are so exhausted and beaten down that many of them work like zombies - error-prone, apathetic toward patients and at times trying to blunt their own pain with alcohol or even suicide attempts.
That is what America's broken health care system is doing to its health workers, according to a 312-page report released Tuesday by the National Academies of Sciences, Engineering and Medicine, one of the country's most prestigious science institutions.
The report found that as many as half of the country's doctors and nurses experience substantial symptoms of burnout, resulting in increased risks to patients, malpractice claims, worker absenteeism and turnover, as well as billions of dollars in losses to the medical industry each year.
"It's a moral issue, a patient-care issue and a financial issue," said Christine K. Cassel, professor of medicine at University of California at San Francisco, who co-chaired the committee of experts that wrote the report. It is alarming and tragic, she and other committee members noted, that the system is hurting the very people we have put in charge of healing us as a society.
In recent years, as the medical community has grown increasingly alarmed over the problems of burnout, the proposed solutions have focused on increasing the resilience of individual doctors and nurses. "What this report is saying is that this is a systemic problem that requires systemic solutions," said Cassel, a former president of the American Board of Internal Medicine. "You can't just teach doctors meditation, yoga and self-care. We need big, fundamental changes."
The committee's experts - which included doctors, nurses, health executives and leaders in bioethics, neurology and pharmacy - spent 18 months wading through mountains of research on clinician burnout. They found that between 35% and 54% of nurses and doctors experience burnout. Among medical students and residents, the percentage is as high as 60%.
Symptoms, they said, include emotional exhaustion, cynicism, loss of enthusiasm and joy in their work and increasing detachment from their patients and the patients' ailments. The problem has been linked to higher rates of depression, substance abuse and suicide. The suicide rate among physicians, for example, is twice that of the general population and one of the highest among all professions.
Health-care workers are especially prone to burnout, the report found, because of the workload, pressure and chaos that they deal with each day. As the country's health-care system has become increasingly dysfunctional, the bulk of that dysfunction has landed on them - resulting in long hours, mounting paperwork and bureaucratic hurdles, fear of malpractice lawsuits and insufficient resources.
The problem often starts with a well-intentioned, perfectly reasonable law, explained co-author Vindell Washington, chief medical officer at Blue Cross and Blue Shield of Louisiana. That is turned into a regulation, which is interpreted and made into a policy, often taking the most conservative path possible for legal protection.
"At every step, the original intent gets a little misinterpreted or picks up an unexpected effect," Washington said. A law about patient privacy, for example, becomes a quirk on a doctor's terminal that ends their sessions every few minutes, requiring them to repeatedly log in throughout the day - adding frustration and burden to their days.
Complex regulations on hospital reimbursement gives rise to a long list doctors must tic through in physical exams, even as they try to figure out what's ailing a patient, so hospitals can charge more or less based on the exam's complexity. "The problem is we're not workers in a factory making widgets," Washington said.
"It's incredibly inefficient, and the workload is unsustainable," said Liselotte Dyrbye, a doctor and researcher at the Mayo Clinic. "The system is built for billing and not taking care of patients."
Burnout is also expensive. One study cited by Wednesday's report, for example found it costs the medical system $4.6 billion a year. Some of that cost comes from doctors reducing their hours, quitting their jobs or leaving medicine altogether. With each doctor affected by burnout, the estimated average cost to the medical industry in America is roughly $7,600. Those numbers did not include the costs of increased medical errors, malpractice lawsuits and other doctors' having to pick up their burned-out colleagues' work.
That financial incentive is imperative, because alleviating burnout will require significant buy-in from federal regulators, insurance companies, medical schools and the country's health-care systems. Wednesday's report outlined a hefty list of needed changes:
- Health-care organizations should create executive-level chief wellness officers to monitor and protect clinicians' well-being and develop IT programs to reduce repetitive and redundant paperwork.
- Medical and nursing schools should train students to deal with burnout. Federal and state regulators should identify and eliminate overlapping regulations.
- Medical licensure agencies should find ways for doctors to seek help without having it used against them, such as in malpractice litigation.
- Federal officials should develop a coordinated research agenda to understand the problem and how to alleviate it.
W. O. Belfield, Jr.