Avoiding Physician Burnout
Much has been written about the significant burnout in physicians over the past 20 years. I think there are several reasons why that might be:
Immature Electronic Health Systems (EHRs) - when EHRs became commonplace in the late 2000s as a result of the American Recovery and Reinvestment Act (ARRA), most of the systems were relatively immature and riddled with challenges such as poor user interfaces, click fatigue challenges, and challenges to physician productivity.
Shift to Employed Physician Model - Over the past 20 years, we have had a huge shift from solo practitioners and small groups to where we now have the majority of physicians employed (frequently by a large hospital or healthcare system). While this was new for physicians, it was also relatively new for some of the administrators to employ physicians and there was a unique learning curve with employing physicians.
Change in Practice Models - There has also been a dramatic shift in how many specialties practice. For example, the term “hospitalist” wasn’t coined until 1996 and now the majority of patients hospitalized in America are cared for by a hospitalist. This created a number of different changes to the practices of many physicians and required changes to how medicine was delivered in America.
Previous Lack of Resilience Training - When I went through medical school and residency training in the late 1990s and early 2000s, there was very little resiliency training for physicians. My generation (Generation X) was classically known for the “latch key kids”. The culture of medicine back then was fueled by seemingly inexhaustible work ethics and terms like “power through” reined the zeitgeist.
Changing Reimbursement/Political Advocacy - This period of time was a time of significant changes in reimbursement and legislation affecting physicians. Physicians were encouraged by their membership associations to be involved with political advocacy. There are some fascinating suggestions in the literature that political advocacy is associated with depression - this is an area ripe for research.
We are now seeing suggestions that there is less burnout among physicians and the news couldn’t be more welcomed.
Anecdotally, I am seeing this all the time. The physicians that I encounter are much happier than they have been in years. I recently came back from a conference after seeing a former student who was the happiest that I had ever seen him after his practice had adapted an ambient AI and his “pajama time” (time spent on EHR after practicing all day) had dropped to zero.
I also see folks extremely satisfied with their EHRs after gradual incremental improvements (and shifting to better systems) over time and the introduction of AI has great promise.
I am also very impressed with the current cohort of hospital and healthcare system leadership. Overall, they have adapted mostly servant leadership skills, and many report seeing better satisfaction in employees than in previous years. The systems for the various specialties have also matured. For example, nearly every hospitalist group has adopted a 7-on/7-off model for their hospitalists, which is generally favorably accepted.
Nearly every medical school and residency program has resiliency training and programs that are aimed towards having happier and well-balanced physicians in the future. The results that I am seeing are very promising.
I am also convinced that the current generation of medical students will be the best generation of physicians. Their desire to serve is dramatically more than I have seen in previous generations, and I truly believe that they are going into medicine for all of the right reasons, and I am optimistic for careers filled with the satisfaction that altruism brings.
Overall, I am inspired by where medicine and medical education are headed. I am convinced that the physician and practice environments of the future will be the happiest, healthiest, and most fulfilling that we have ever seen, and I look forward to seeing all of the great things that will occur in medicine in the future.
