Confronting Clinician Burnout: How To Boost Physician Resilience

Physician burnout has risen to epidemic proportions within the United States healthcare system. The American Medical Association’s 2022 National Burnout Benchmarking report indicated 51% of respondents experienced clinician burnout, an increase from previous years. With rising burnout, physicians and healthcare systems struggle to identify and improve contributing factors.   

Resources offering innovative strategies to help physicians and their staff reduce burnout and thrive in the healthcare system are available for implementation. All stakeholders in healthcare must work together to effectively implement these strategies for medicine to fulfill its commitment to patients and public health.  

Recommended podcast: Post-Traumatic Stress in Healthcare Workers  

What is clinician burnout?  

Physician and clinician burnout is a work-related syndrome resulting from a long-term stress reaction characterized by emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Emotional exhaustion is the feeling of being emotionally drained and unable to offer others anything on an emotional level. Depersonalization refers to a loss of one’s self-identity and the devaluing of patients as human beings. A reduced sense of personal accomplishment negatively affects the ability to evaluate one’s worth and reliably assess one’s ability to perform one’s job, resulting in poor professional self-esteem.    

Various studies have identified clinician burnout in all physician specialties and physician-practice models. A 2021 survey suggests burnout occurs more commonly in women and younger physicians. Given the widespread nature of burnout, how can it be identified?  

Clinician burnout statistics: Measurements and assessments  

Experts from around the profession consider the Maslach Burnout Inventory (MBI) as the standard in assessing physician burnout. However, its length limits its use in situations outside of clinical trials. Simplified assessments utilizing one question to assess emotional exhaustion and one for depersonalization have shown promise. While other abbreviated assessment tools exist, the MBI remains the gold standard.   

Contributing factors to burnout  

Many factors can contribute to physician burnout. These factors belong to two main categories: organizational and individual factors.   

Organizational or systemic factors of clinician burnout 

Inefficient work processes, computerized order entry, and increased clerical responsibilities place excessive demands on an already busy schedule. These all contribute to stress and burnout. As reimbursements decrease and physician shortages become more prevalent, excessive workloads on physicians affecting work-life balance can lead to additional home-life stressors. These stressors, in addition to less time doing clinically meaningful tasks, can lead to physician burnout.  

Individual risk factors of burnout 

Age and gender are consistent risk factors affecting burnout, with physicians younger than 55 and female physicians having a higher risk of burnout. Characteristics such as personality and interpersonal skills play a role in how a physician may handle stress and the susceptibility of a physician to burnout. Regardless of individual factors, work-related, organizational, and healthcare system factors often play the most significant role in causing physician burnout.  

Taking action against clinician burnout  

Effective prevention of clinician burnout requires the implementation of organizational-level and individual-level solutions.   

Organizational-level solutions  

  • Fair productivity objectives and reduced duty hours  
  • Improved efficiency of electronic medical record documentation  
  • Employment of more staff to handle the clerical duties of the physician  
  • Improve training and awareness of leadership regarding physician burnout  
  • Promote physician engagement and leadership  
  • Respect home responsibilities in setting schedules and meetings  

Individual-level solutions  

  • Stress management and resiliency training  
  • Part-time work   
  • Efficiency and skills training  
  • Delegation of non-clinical tasks  
  • Reflection and mindfulness of meaningful clinical duties  
  • Engagement in small-group programs that promote community and connectedness  

Combating clinician burnout by building resilience   

Resilience is the ability to manage stress in a healthy way. Ultimately, resilience reduces the psychological and physical impact on the physician. It allows physicians to bounce back from challenges while growing stronger and better apt to handle future situations. Building resilience falls into three key categories: self-awareness and self-monitoring, self-regulation and resilience, and communities of care and healthcare institution accountability.  

Self-awareness and self-monitoring  

Identifying and understanding one’s adaptive and maladaptive behaviors in response to stress is essential to building resilience. The awareness to recognize the early warning signs of stress—fatigue, irritability, and feeling outside their comfort zone—allows physicians to become more skilled in responding to and altering stressful situations before they get out of hand.  

The cultivation of self-awareness and self-monitoring skills requires formal and informal practices to obtain mindfulness-stress reduction and observe one’s responses to stress. Participation in Balint groups is an additional option to increase the awareness of one’s biases and emotional reactions in a confidential group setting.  

Self-regulation and resilience  

Once recognizing the stresses that exist, physicians need to understand the degree to which their choices in handling stresses can help them self-regulate their own cognitive and emotional reactions. Setting boundaries between work and outside-of-work activities, such as exercise, meditation, sleep, and family time, can enhance a physician’s capacity for self-regulation.   

Clinicians must also identify ways to engage in work such that it builds and nourishes one’s vigor to respond to the harsh realities of the workplace. This engagement allows physicians to build strength and healthy habits that help with future challenges. In essence, this is the true achievement of resilience.  

Communities of care and healthcare institution accountability  

Active support and investment from healthcare institutions in providing the training of skills is necessary to promote the resilience of physicians. Developing programs to develop a more self-aware, resilient healthcare workforce can benefit the healthcare institution’s self-interest and the public’s interest. Implementing curriculum changes within medical school education has shed more light on physician self-awareness and self-care. However, this should also be a focus throughout physician training and continuing education.  

Importance of a resilient physician  

A physician’s ability to respond positively to the stresses of practice may prevent burnout. It may also improve the clinician’s overall well-being. Physicians exercising appropriate self-care are better equipped to care for their patients. They are less likely to make errors, use substances of abuse, and leave medicine. Overall, this can lead to a more productive physician, a lower turnover rate, improved patient access, and a higher quality of care.   

Physicians devote a significant portion of their lives to caring for others. It is imperative that they also allocate time to improving their mental well-being. Identifying strategies and participating in programs to improve work-life balance and meaningful engagement in one’s work will benefit the physician and translate into a higher level of patient care.