Introduction
Physician burnout can be described as a work-related syndrome characterized depersonalization, emotional exhaustion, and a feeling of diminished personal accomplishment. Physician burnout is not only prevalent in the United States as research continues to show that it has global implications. The rates of burnouts among physicians can vary depending on a host of factors, including the geographic location, specialty, experience, age, and sex. Studies continue to show that the rates of burnout are more prevalent in selected areas, including emergency medicine, acute care setting, general neurology, and family medicine. Physician burnout is a significant challenge in the care setting because it comes with both personal and professional consequences. At the personal level, it could lead to a host of problems, including medical issues such as stress and cardiovascular conditions. On a broader perspective, it could adversely impact the quality of care and the overall reputation of a care facility. Physician burnout is arguably the most significant challenge in care facilities associated with diminished altruism, medical issues on the physician, increased cost, and reduced quality of care.
Causes of Physician Burnout
Before assessing the effects of physician burnout, it is crucial to address the causes. From a general standpoint, physician burnout results from excessive work-related stressors. Patel et al. (2018) classify the factors for causation as work-related, personal characteristics, and organizational aspects. The work factors that could lead to physician burnout include long working hours, huge workloads, and frequently call duties, especially in the night. The use of electronic health records is also associated with increased burnout. The second factor that the authors discuss relates to the personal characteristics that could increase burnout. Some of the aspects identified in this regard include the tendency to be self-critical, overcommitment, deprivation of sleep, poor work-life balance, and perfectionism (Patel et al., 2018). Females are more affected by personal characteristics compared to their male counterparts. The third set of factors can be classified as organizational. First, poor leadership behaviors by the facility management could adversely affect the welfare of the physician as far as working is concerned. Insufficient rewards also contribute to the burnout as the employees lack the much-needed incentive to work. It is, therefore, crucial to leverage the work environment to achieve the best out of the physician.
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Impact of Physician Burnout on Altruism
Today, physician burnout is regarded as an epidemic. Research by Del Carmen et al., (2019) concluded that "it is estimated that at least 35% of physicians in the developing world and 50% in the United States experience burnout." Altruism is regarded as one of the most important characteristics associated with medical practitioners. The roots of altruism are traced back to the Hippocratic Oath. It is defined as the promotion of another individual's self-interest at the expense of oneself. Generally, physicians, nurses, and other health professionals need to demonstrate high-level altruism in a bid to improve the condition of the patient (Feldman, 2017). However, recent research has shown that altruism continues to diminish, and one of the factors implicated is the physician burnout. Several studies have shown that burnout can lead to less altruism among physicians. The work life slowly changes from being a source of passion to a source of agony. They lose interest in playing the role of the custodian of the patient's health and wellbeing. Studies in the US have reported that every physician has exhibited at least one sign of burnout. Reduced altruism has turned physicians and allied health professionals to mere employees who lack the inherent commitment to ensuring that the health of the patient is restored (Nazir et al., 2018).
Impact on the Medical Issues to the Physician
Patel et al. (2018) emphasize that "physician burnout can lead to severe personal and professional consequences if left unaddressed." For the physician, the consequences can broadly be classified into the physical and the psychological. The symptoms can range from mild to severe and differ from one person to another. Impairment remains a significant factor that comes as a result of the burnout. Physicians tend to complain of exhaustion, tiredness, irritability, fatigue, and inattentiveness. Patel et al. (2018) further outline that burnout can expose physicians to an increased risk of motor vehicle accidents, including the near miss events. As a result, this could lead to increased injury and death on the physician. Also, the physician could suffer from a wide range of psychological problems due to burnout. The psychological problems could manifest in the form of mood disorders, disruptive behavior, stress, and depression. All these could disrupt both their personal and professional life hence decreasing their efficiency. The psychological disorders can easily act as an antecedent for other risky health behaviors such as alcohol and substance abuse. It is also essential to appreciate that some physicians have failed to acknowledge and accept that they are suffering from the problem of burnout.
The failure to acknowledge the problem characterized by the low underreporting means that the physicians are at an increased risk of engaging in self-harm behaviors, including suicidal ideation. Patel et al., (2018) provide a statistical overview of this information by saying, "Physicians are at an increased risk of suicide (28–40 per 100,000) compared to the general population (12.3 per 100,000)." The rate of suicide is even higher for professionals working in areas such as primary, emergency, and preventive medicine. The probability of suicide is higher in both males and females (Hare & Pratt, 1988). However, the rate appears to be higher in the females than the males. This could be associated with the better coping and adjustment skills associated with the male physicians. It is common knowledge that physician burnout leads to a reduced concentration due to the increased fatigue. As such, a physician might engage in hospital accidents that carry a life-threatening implication. A good example would be the self-inflicting injuries causes by piercing with infected needles. The physician is also likely to fail to take into consideration the basic fundamental protective measures such as wearing gloves and proper garments which would eventually expose them to deadly diseases.
Reduced Quality of Care
West et al. (2018) that studies have shown that physician burnout is heavily linked with subpar patient care services and an increased risk of medical errors. Burnout has a significant impact on the wellbeing of the patient. The distress that the physicians undergo increase their chances of engaging in medical errors, which not only risks the life of the patient but also puts the care facility at a risky position as regards legal lawsuits. The authors utilize a longitudinal study which concludes that "Higher levels of burnout were associated with increased odds of reporting a major medical error in the subsequent 3 months" (West et al., 2018). Research has also shown that patients working in outpatient facilities have a higher probability of experiencing physician burnout compared to the ones based on the inpatient sections (Patel et al., 2018). Therefore, this demonstrates that patients in outpatient care facilities are more likely to suffer due to the reduced quality of care. Other than the medical errors, the physicians have a reduced concentration and productivity due to the physical and mental exhaustion. As such, they can easily fail to accord the patient necessary and timely care that follows the laid down standards.
Physician burnout leads to a reduced interpersonal relationship between physicians. The poor relationships will, in turn, affect synergy and collaboration leading to poor management of the patient. The increased burnout also leads to an increased risk of malpractice as the physician has lost a sense of altruism discussed earlier. Gardner et al. (2018) asserted that research has also shown that burnout can easily lead to poor patient satisfaction rates. It adversely impacts quality and leads to deteriorating patient outcomes. While working with the patient, it is imperative for the physician to demonstrate ethical practice by respecting their autonomy and enhancing beneficence and non-maleficence. However, achieving these aspects could be difficult if the physician suffers from burnout. More fundamentally, research has shown that burnout is a major cause of poor workforce retention. Many physicians resign citing the burnout and fatigue as the major reasons behind their quitting. As such, this has adverse health impacts on the patient due to a reduced number of caregivers in the hospital facility. Therefore, physician burnout has a direct impact on the increased morbidity and mortality in the care setting.
The Impact of Physician Burnout on Cost
Physician burnout has been associated with a plethora of factors including diminished productivity, dissatisfaction with the job, and the intention to leave a career for reasons other than retirement. Researchers have also found that burnout is a major cause of reduced efficiency in the healthcare system, which in turn reduces the hospital's ability to provide safe and high-quality care to the patients. The high turnover has an overbearing impact on the wellbeing of the healthcare industry. As more physicians quit their jobs, they leave behind a huge gap that needs resources to fill. The medical errors originating from physician burnout can also be costly for the hospital due to the legal implications involved. Hospitals will spend more money on recruiting new physicians and training them to configure to the needs of healthcare. Han et al. discuss the statistical data associated with physician burnout. In their research, they conclude by saying, “On a national scale, the conservative base-case model estimates that approximately $4.6 billion in costs related to physician turnover and reduced clinical hours is attributable to burnout each year in the United States” (Han et al., 2019).
Research has also shown that physicians experiencing burnout tend to work for lesser hours compared to their counterparts. The reduced number of hours has significant economic implications on the entire healthcare system. In some instances, they might need time off from their duties to seek medication or rest from their work. Similarly, this jeopardizes the hospital's ability to deliver to the patient needs. It should be noted that although hospitals are care facilities, they are also business at the end of the day. The physicians are at the center in ensuring that these facilities generate the much-required income to offer the best care possible to its prospective clients. However, with the problem of burnout, the ability of the hospital to achieve these demands significantly lowers.
Preventing Physician Burnout
West et al. (2019) assert that solutions to the problem of physician burnout can be achieved through individual-focused and organizational solutions. At the individual level, physicians can engage in a wide array of aspects such as skills training, stress management, mindfulness, and resilience. Physicians must understand the implications that come with burnout not only for themselves but also the entire hospital system. Therefore, they should focus on working on their personal characteristics to better deal with the challenges that come with burnout. The second solution will be based on organizational changes. The hospital facility must work on several factors to prevent the occurrence of burnout. The first strategy would be to ensure that the hospital has enough staff members to prevent per capital workload. Secondly, the management should provide the physician with incentives such as rewards and pay increases to improve their morale (Gardner et al., 2018). For work-life balance to be achieved, the organization must demonstrate a strong commitment towards it. As such, this will demand the creation of strong policies that protect the workers and ensure that they have time to engage in other activities that are not work-related.
Conclusion
In conclusion, physician burnout is arguably the most significant challenge in care facilities associated with diminished altruism, medical issues on the physician, increased cost, and reduced quality of care. Altruism is the passion with which medical practitioners handle their jobs. However, burnout reduces this impact, a factor that is closely associated with the proper management of patients. Secondly, the health of the physician can also suffer due to increased stress, psychological problems, and predisposition to accidents. With many physicians opting to quit their jobs, the healthcare system will suffer significant cost implications as they need to recruit new employees and train them. Lastly, and most significantly, the care deteriorates as the physicians are not mentally or physically capable of dealing with issues in the healthcare environment. Solutions will begin by identifying the sources of the burnout which scholars identify as person, workload, and organization. Solutions should include self-adjustment by acquiring a host of coping skills. Organizational factors will include training, increasing the physician staff, and creating appropriate policies that promote work-life balance.
References
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Feldman, M. D. (2017). Altruism and Medical Practice. Springer
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Nazir, A., Smalbrugge, M., Moser, A., Karuza, J., Crecelius, C., Hertogh, C. ... & Katz, P. R. (2018). The prevalence of burnout among nursing home physicians: an international perspective. Journal of the American Medical Directors Association, 19(1), 86-88.
Patel, R., Bachu, R., Adikey, A., Malik, M., & Shah, M. (2018). Factors related to physician burnout and its consequences: a review. Behavioral Sciences, 8(11), 98.
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