I saw Dr. George Dawson’s post about Dr. Michael Weinstein’s commentary entitled “Out of the Straitjacket” in the NEJM published on March 1, 2018. I agree that Dr. Weinstein’s experience is compelling and he specifically mentions burnout, a key factor critically important in his depression. Physician burnout fits with National Patient Safety Awareness Week, March 11-17, 2018. Burnout can lead to problems with maintaining patient safety, according to many sources one can easily find on a cursory internet literature search.
Physician burnout rates probably exceed 50% according to Shanafelt and colleagues (reference below). There are both physician-related and health care system-related factors involved in making doctors vulnerable to burnout. The systems factors probably don’t get enough press, although I found one well-written article about it by Markian Hawryluk, published February 22, 2018 on line in the BendBulletin, an Oregon newspaper. Hawryluk mentions a study which speaks to the relationship between burnout and patient safety:
“In a study of some 7,100 U.S. surgeons, burnout was an independent predictor of medical errors and medical malpractice suits. While the researchers said it was unclear whether burnout led to mistakes or the mistakes led to burnout, they concluded it was likely a two-way street. Burnout led to errors, which in turn fueled greater burnout.”
Physician burnout is one factor contributing to the shortage of psychiatrists, according to the NPR article “Severe Shortage Of Psychiatrists Exacerbated By Lack Of Federal Funding” by Samantha Raphelson, published March 9, 2018 on line.
The shortage is keenly felt across the Midwest, including Iowa, despite the recent listing in U.S. News and World Report as the best state in the nation for health. That said, the state medical and psychiatric societies are working diligently to generate solutions to the shortage and also are committed to addressing burnout. I’m eagerly anticipating the Match Day results coming this Friday, March 16, 2018. The University of Iowa Hospitals and Clinics typically does very well in the Match every year, including the Psychiatry residency. And I’m also wishing the new Psychiatry Residency programs well at Mercy Medical Center and Broadlawns in Des Moines.
The shortage of psychiatrists is likely to get worse before it gets better, according to Raphelson. That’s because of the graying out effect, which refers to the upcoming retirement of the 59% of us who are in the baby boomer age range.
There are organizational factors which can be addressed to manage burnout. As Shanafelt and colleagues point out:
“The evidence indicates that actions at the organization and individual level can counter a national problem. Substantive progress, however, is unlikely to occur until there is a coordinated effort to address this issue at the national and state, organization, leader, and individual levels.”
However, I think they don’t go far enough on the issue of Maintenance of Certification (MOC):
“Organizational policies that require physician maintenance of their certification must be accompanied by appropriate allocation of professional time for physicians to complete these tasks.”
I have zero time for the empty busy work of MOC, as anyone can clearly see from my post about a day in the life of a C-L Psychiatrist. And I refuse to allocate “pajama time” to it, which means even more time at home working on medical documentation (see the Hawryluk article):
“And every hour spent at home on work-related tasks — a phenomenon doctors call pajama time — increases the risk by 2 percent” [of burnout-J.A.].
There is plenty to do for Patient Safety Awareness Week–fifty two weeks a year.
Shanafelt, T. D., et al. (2017). “Addressing Physician Burnout: The Way Forward.” JAMA 317(9): 901-902.