Support for physician mental health must be made more widely available. We must remove the stigma associated with accessing this support.
Physician burnout has been recognized in recent years as a massive issue adversely impacting healthcare systems around the world. In the United States, 2017 rates of burnout symptoms linked with key outcomes approach 50%, and rates of positive depression screens exceed 40%. Burnout has been linked with poorer patient care outcomes, lower patient satisfaction, mental health issues among physicians, reductions in work effort and early retirement, and many other consequences, each of which harms patients and costs the U.S. health care system billions of dollars every year.
As reported recently, the statement from the Harvard T.H. Chan School of Public Health, the Harvard Global Health Institute, the Massachusetts Medical Society and Massachusetts Health and Hospital Association adds to numerous prior Calls to Action (in UME, GME, and more broadly) on these issues. Recognition of the problem is a critical first step, but meaningful progress requires tangible efforts to improve the work lives of physicians. Thankfully, such efforts are beginning to gain momentum. One summary statement to this end is the Charter on Physician Well-Being, endorsed and supported by a diverse host of organizations.
The Charter offers guiding principles and key commitments to effectively promote physician well-being. These guiding principles and key commitments include several elements noted in the Harvard statement and NPR segment, three of which I’ll highlight:
1) Burnout is rooted primarily in our medical systems and culture, rather than being a result of individual shortcomings.
Much as To Err Is Human emphasized the importance of system-level solutions for patient safety, addressing burnout requires system-level solutions rather than solely individual-focused approaches that risk being seen as “blaming the victim.” That said, while larger system improvements are underway there remains an individual responsibility to optimize our well-being in areas within our own spheres of influence. Physician well-being is a shared responsibility, and all stakeholders in medicine must work together across all levels of the health care system to promote the change we need.
2) Support for physician mental health must be made more widely available.
A major need is to remove stigma associated with accessing this support. An example of a step in the right direction is the recent alteration of policies in several states in response to evidence of inconsistency of medical licensure application questions with established standards and federal law. The goal should be to optimize physician performance proactively, by any and all means of support necessary.
3) The EHR is not the only driver of burnout, but inefficiencies that detract from physicians’ sense of meaning and purpose are commonly cited as chronic irritants for physicians in their work lives (often infringing on time away from work as well). Demands on a physician’s time that do not require the physician or do not benefit patients should be eliminated from the physician’s day, and systems violating these principles should be viewed as fatally flawed in the design phase, before they ever impact actual practice.
Physician well-being is necessary for our patients and our healthcare system to thrive. The growing number of calls to action is encouraging, and this momentum must now translate into results physicians feel in their daily practices. Our profession and our patients depend on it.