Friday, July 6, 2018

Active Participation in Health Care Governance Said to Combat Physician Burnout

The loss of autonomy for physicians—as many have begun working in large health systems rather than as solo or small group practitioners—has been a key driver of physician burnout, according to the authors of a Viewpoint article in the July issue of JAMA Psychiatry.

While efforts to improve self-care have been moderately effective in addressing burnout, they fail to address its underlying cause—namely, the lack of physician autonomy in today’s large health care systems, write Frederick S. Southwick, M.D., a professor of medicine at the University of Florida College of Medicine, and Steven M. Southwick, M.D., the Glenn H. Greenberg Professor of Psychiatry at Yale University School of Medicine. In small group and solo practices, physicians were largely free to dictate how they practiced medicine, but large health care systems, by contrast, tend to be impersonal and controlling, leaving little room for physicians to decide what tests to perform, what treatments to administer, and how much time to spend with patients. 

Physicians often feel frustrated by today’s broad array of mandated regulations, required use of electronic health records, and performance expectations imposed by insurance companies, government agencies, and hospital administrators. These conditions leave many physicians feeling overwhelmed and relatively powerless. In animal and human studies, chronic stress that is experienced as uncontrollable can have highly toxic effects, the authors write. “The degree of control that an animal or human can exert over a stressor has a substantial impact on the emotional, behavioral, neurobiological, and physiological effects of that stressor.”

How can physicians take control of their work lives and prevent or reduce burnout and at the same time contribute to improvements in every process that affects patient care? The authors recommend that “health care organizations adopt a distributive leadership model that encourages physicians to actively participate in governing and improving the systems in which they work. Modern health care is highly complex and interdependent, and it is crucial to effective service provision that physicians share administrative and policy leadership positions with nonphysician health care administrators.” Also needed are “the allocation of sufficient administrative time, resources, training, and administrative support to empower physicians to lead the adaptive changes needed to fix health care delivery.” 

The authors conclude that high rates of burnout among physicians will persist until health care systems find ways to increase doctors’ sense of control and autonomy.

For related information, see APA’s Well-being and Burnout Resources, including an online well-being self-assessment tool.

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