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Our Take: Physician burnout increased in the pandemic’s second year, survey indicates

Sep 19, 2022

Physicians experienced a “striking” increase in occupational burnout during the second year of the COVID-19 pandemic as compared with the first year, according to a study published last week in Mayo Clinic Proceedings.

The findings were based on a survey conducted online between Dec. 9, 2021, and Jan. 24, 2022 (the 2021 survey), and a separate survey conducted from November 2020 through March 2021 (the 2020 survey).

Of the 2,440 physicians who participated in the 2021 survey, 63% had at least one manifestation of burnout in 2021 — a significantly higher proportion than the 38% reporting such issues in 2020.

Mean exhaustion scores and mean depersonalization scores also increased significantly from 2020 to 2021 (increases of 39% and 61%, respectively).

The percentage of respondents who agreed or strongly agreed that their work schedule allowed enough time for their personal and/or family life decreased sharply, from 46% in 2020 to 30% in 2021.

The study authors noted that the differences in respondents’ mean depression scores at the end of both years were only “modest,” suggesting that the increase in physician distress was primarily the result of greater work-related distress.

Female physicians were twice as likely as male physicians to experience burnout in the 2021 survey. The authors said this finding suggested that the pandemic has exacerbated the “long-documented increased risk for burnout and work-life conflict” in female physicians when compared with male physicians.

Among medical specialties, physicians practicing emergency medicine, family medicine, and general pediatrics were at increased risk for burnout, even after adjusting for other personal and professional characteristics.

When asked whether they would choose to become a physician again if they could go back and revisit their options, 57% of the respondents in the 2021 survey said they would. In the 2020 survey, 72% said they would.

The authors mentioned several likely reasons for the higher rates of burnout and lower rates of career satisfaction, including workplace staffing shortages and people’s “attitudes of anti-science and incivility.” These, combined with various societal issues (e.g., gun violence, inflation, and school/childcare challenges for those with children), appear to have had a “profound” effect on the country’s physician workforce, the authors said.

The latest survey results could have critical implications for the nation’s health care system, the authors noted, pointing to the association between burnout and problems such as medical errors, staff turnover, poorer quality of care, and higher health care costs.

Although federal funding is being made available to address clinician burnout and protect the well-being of health care workers, the authors said the funding initiatives focus largely on individuals’ resilience. But evidence indicates that resilience is not the predominant issue, they added.

Further, hospitals, health systems, and other health care organizations have a tendency to react to worker burnout, providing support to those who are already distressed rather than taking a preventive approach, according to the study authors.

What is called for, they said, are “system-level interventions implemented by government, payers, regulatory bodies, and health care organizations.”

Our Take:  Medscape conducted a similar survey of 13,069 physicians from June 29, 2021, through Sept. 26, 2021. To a large extent, those results echoed the findings of the study above.

In the Medscape survey, 47% of the respondents reported being burned out; in the previous year’s survey, 42% said they were burned out.

More female physicians than male physicians reported being burned out in both years, and the percentages increased for both sexes in the later survey (56% of women and 51% of men in 2021 vs. 51% of women and 36% of men in 2020).

The number one cause of burnout, which Medscape said is consistent year after year, was too many bureaucratic tasks.

The respondents’ top choices for reducing burnout, in descending order, were a more manageable work schedule, higher compensation to avoid financial stress, more respect in the workplace, greater control/autonomy, lighter patient loads, more support staff, and fewer government regulations.

Medscape cited a physician who backed up what the authors of the study above wrote about burnout being a symptom of the health care system rather than an individual shortcoming.

“The rhetoric around burnout, for years, has been about individual frailty, rather than about system dysfunction,” said Dr. Wendy Dean, president of Moral Injury of Healthcare. “But in our conversations with hundreds of physicians, they have said, repeatedly, that the constraints of the system which prevent them from getting their patients the care they need — moral injury, in other words — are the primary source of their distress.

“It’s time to stop holding individual clinicians responsible for the dysfunction of the U.S. health care system,” she added.

What else you need to know
Blue Cross Blue Shield of North Carolina said its Blue Premier program has saved nearly half a billion dollars in health care costs during the program’s first three years, while also improving the quality of care. Providers participating in the value-based care model have earned almost $321 million in shared savings during that time. The $130 million saved in 2021 includes $19.5 million in savings from the Blue Premier Advanced Kidney Care program, which is designed to slow or stop the progression of kidney disease. The insurer said in a press release that Blue Premier agreements are in place with 12 major hospitals and health systems and nearly 800 independent primary care practices throughout the state.

After initially rejecting Advocate Aurora Health and Atrium Health’s exemption application for their proposed merger by a 3-2 vote, the Illinois Health Facilities and Services Review Board agreed to postpone its decision and requested additional information from the health systems on how the combined organization would be run. Advocate Aurora said it remains confident of meeting the original timeline for completing the deal by the end of the year, even though the state board is not scheduled to meet again until December. If the merger takes place, the resulting entity would be one of the largest non-profit health systems in the U.S., generating estimated income of $27 billion annually.

The University of Chicago Medicine will acquire a controlling interest in four AdventHealth hospitals located in the western suburbs of Chicago. Advent Health will continue to manage daily operations at the hospitals, which were part of the Amita Health joint venture between AdventHealth and Ascension before the joint venture was dissolved earlier this year. UChicago Medicine and AdventHealth aim to complete the transaction late this year or early next year if regulatory approvals are obtained, according to the announcement. Financial terms were not disclosed.

The House has passed a bipartisan bill that would streamline the prior authorization (PA) process for patients enrolled in Medicare Advantage plans. The Improving Seniors’ Timely Access to Care Act would establish an electronic PA process for these plans and limit the amount of time that plans can consider PA requests; decisions on routinely approved services could be made in real time. Health plans would also be required to report on their PA use, including rates of approvals and denials. The bill now goes to the Senate.

Separately, new bipartisan legislation was introduced in the House that would stave off the reduction in Medicare payments to physicians scheduled to take effect in 2023. The Supporting Medicare Providers Act would increase the conversion factor that Medicare uses to calculate those payments by 4.42% to offset the planned 4.42% cut in payments mandated by Congress’ PAYGO budget rule.

Warner Thomas is leaving Ochsner Health for Sutter Health. Thomas has been with New Orleans-based Ochsner for 24 years, serving as president and the first non-physician CEO for the last decade, according to an Ochsner news release. Effective Dec. 1, he will take on those same roles at Sacramento, Calif.-based Sutter Health. Gubby Barlow, who chairs Sutter’s board of directors, said in a separate statement that Thomas will be the organization’s first external CEO in more than 40 years. James Conforti has been serving as interim president and CEO since Sarah Krevans retired at the start of this year.

Pete November will step into the roles that Thomas is vacating at Ochsner Health, effective Nov. 1. He joined the health system in 2012 and currently serves as executive vice president and chief financial officer.

What we’re reading
Hospitals Divert Primary Care Patients to Health Center ‘Look-Alikes’ to Boost Finances. Kaiser Health News, 9.9.22Comprehensive Medication Management: A Missing Ingredient In Value-Based Payment Models. Health Affairs Forefront, 9.9.22Optimizing Investment in Housing as a Social Determinant of Health. JAMA Health Forum, 9.15.22

What else we’re reading
Hooking Up, by Tom Wolff. It may be 100 degrees in Scottsdale, but as kids go back to school and the rest of the country cools down, it’s time to wrap up our summer beach reading recommendations. (It’s fair to ask why someone who lives in a desert is making beach-reading recommendations.) This lesser-known essay collection is from the author of Bonfire of the Vanities and The Right Stuff, a master chronicler of American culture.
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