2023 should become the year of action against burnout

  • Support mental health and reduce stigma.
  • Addressing compliance barriers, regulations and policies for day to day work.
  • Use effective technical tools.
  • Institutionalizing luxury as a long-term value.
  • Recruit and retain a diverse and inclusive health workforce.

The following text has been edited for length and clarity.

Medical Economics (ME): Why was it important for the National Academy to come up with a plan?

VJD: Several years ago, it was already clear that burnout was a huge problem. And then, 30 days prior to COVID, 40% of doctors and nurses reported burnout. So the community started to get nervous and worried about this, but this effect was not known. A number of my good colleagues have asked me to say, can you really be the advocacy organization that brings that out, increases visibility, looks at the causes of burnout, and looks for solutions? We started a collaborative project called Collaborative Work on Physician Wellbeing and Resilience. That was in 2017. Over the years, we’ve been working on many issues related to burnout, like removing the stigma. We have this campaign called Breaking the Culture of Silence, where people talk about this, and we also have an art gallery for people expressing meaning. We have a resource center that looks at best practices in different hospitals and settings that address the problem. But most importantly, we had a place where people would come together, say what do we need to do together? This includes working alongside CMS, looking at E/M and coding, working with electronic medical record vendors, Epic, and talking about redesign. I think in the end, we decided that the problem would be primarily a systems issue, not an individual failure or vulnerability. So we wrote a report on this whole field saying systems failures, like quality and security, like we wrote 20 years ago about systems failures. But this was not enough. Pointing out a problem is different from telling people the solutions. So in the last year and a half, we’ve worked with co-chair Vivek Murthy, Surgeon General, as well as Tom Nasca, Darrell Kirsch, and a full student committee and planning group, to put together a national plan. The National Plan talks about areas where action needs to be taken, seven priorities, who the actors should work on, hospitals, executives, regulators, etc. What do they need to work on? And with that map clearly articulated, we can now go on to say, let’s now take action along that plan.

I: Our primary audience is primary care physicians. Maybe they were struggling there. What do you want to tell them or what do you want them to know?

VJD: Tell them we really appreciate the work you do. It is very important to the well-being of patients, to the entire healthcare delivery system, and we really appreciate it. And I know that primary care has some of the highest rates of burnout. Some studies report that 79% of primary care physicians have experienced symptoms of burnout compared to about 68% of all physicians surveyed. So it is higher. The problem is that, given the kind of work they have to do in the front line, the amount of workload and the demand, it’s very difficult. But I would note that no matter where, whether it’s a primary care physician working in health systems, a private practice, they both sense burnout, so, I think solutions have to look very carefully at the context in which they work. Some people work in small rural clinics, while others work in large urban hospitals. But I think the key thing is, no matter where you work and what kind of population you serve, we have to look at the issues facing primary care as a whole and how to address some of those issues to reduce burnout.

I: How important is culture and learning environment for clinicians?

VJD: At the end of the day, people have to work somewhere they feel supported. They should all feel that their well-being is important. It is clear that the learning environment and culture sets the tone that people feel that this is the right place for their well-being. So I think it’s really important. Culture needs to embed wellbeing into all aspects of the system, whether it be HR services, processes, mission, vision, values, all of those things. So as you can imagine, when people come into the work or learning environment, that culture trumps everything.

I: Can you talk about the role of technology in making things easier? Not to reduce patient care, but as a way to reduce medical and physician burnout?

VJD: Technology should be there to help, not to create more problems, right? I mean, in the future, when technology becomes really effective, artificial intelligence and whatnot, maybe they can quickly help doctors access information, make a good decision, and save more time with their patients. But we are not in that position today. Technologies seem to create more work than less work. We’ve been advocating for the code approach, which is that as we talk to Epic and Cerner and others, if you’re going to do the next generation, you have to bring the doctors there into Codeign to make sure that they’re easy to use, that they’re effective, because we’re actually, the customers at the end of the day. We buy these technologies to help us. At the end of the day, I think the key message is, don’t ask doctors to do things that aren’t related to patient care. Try to simplify the amount of work they need to do, but give them a chance, a voice at the table, to design the technology and use innovative technology to reduce the workload rather than increase the workload. This certainly could be in the future.

I: What would you like to see as a New Year’s resolution for 2023 dealing with the well-being of the doctor and doctors?

VJD: First of all, of course, I want every doctor, front-line worker, to feel that they are appreciated, that in fact their well-being is taken care of, that they can go and do their work without any restrictions. But the question is how do we get there. This national plan must be implemented on a large scale, right? What is the purpose of the plan if it is not implemented? We have been working on a campaign idea and movement to move forward with organizations that adopt these plans. First and foremost the Seven Priorities, we have now identified Leading Changemakers. Let’s look, what are those large organizations that have a lot of members? The American Medical Association, the American Hospital Association, and the American Nurses Association, where if they say yes, we embrace the plan — and by the way, they were all part of the steering committee and planning group anyway. They have to come and say we support the plan they have. Now members will work together to deliver on those commitments. So that’s point number one. Second, committed to what? to commit to work. Seven priorities is a lot. We’re hearing from hospital CEOs and others: We’re under siege from coronavirus, with financial stress, with all of these things. We can do no more. So we say ok, out of the seven, pick two or three. And if you can just tell us what you’re going to do in the next two or three years that we can track and measure, we know we’re making progress. But the idea is that we end up with a ton of people joining this, and then we end up with groups. Each priority will have a few, many institutions, more than several, that have considered this. This way, we have groups so we can look, do these things work? So can we implement all of that, and what path do we apply? This is what we are trying to do next year. I’m quite committed in fact that this plan has to be implemented through an organized and well-strategic movement, a plan going forward, and that’s what we’re going to do.

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