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Burnout’s Overused and Underdefined

Recently, John hosted a #HITsm chat on using technology to fight physician burnout. The topic’s certainly timely, and it got me to wondering just what is physician burnout. Now, the simple answer is fatigue. However, when I started to look around for studies and insights, I realized that burnout is neither easily defined nor understood.

The Mayo Clinic, among others, defines it this way:

Job burnout is a special type of job stress — a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. 

So, it is fatigue plus self doubt. Well, that’s for starters. Burnout has its own literature niche and psychologists have taken several different cracks at a more definitive definition without any consensus other than it’s a form of depression, which doesn’t have to be work related.

Unsurprisingly, burnout is not in the DSM-5. It’s this lack of a clinical definition, which makes it easy to use burnout like catsup to cover a host of issues. I think this is exactly why we have so many references to physician or EHR burnout. You can use burnout to cover whatever you want.

It’s easy to find articles citing EHRs and  burnout. For example, a year ago April, The Hospitalist headlined, “Research Shows Link Between EHR and Physician Burnout.” The article then flatly says, “The EHR has been identified as a major contributor to physician burnout.” However, it never cites a study to back this up.

If you track back through its references, you’ll wind up at a 2013 AMA study, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Developed by the Rand Corporation, it’s an extensive study of physician job satisfaction. Unfortunately, for those who cite it for EHR and burnout, it never links the two. In fact, the article never discusses the two together.

Not surprisingly, burnout has found its way into marketing. For example, DataMatrix says:

Physician burnout can be described as a public health crisis especially with the substantial increase over the last couple of years. The consequences are significant and affect the healthcare system by affecting the quality of care, health care costs and patient safety.

Their solution, of course, is to buy their transcription services.  What’s happened here is that physician work life dissatisfaction has been smushed together with burnout, which does a disservice to both. For example, Medscape recently published a study on burnout, which asked physicians about their experience. Interestingly, the choices it gave, such as low income, too many difficult patients – difficult being undefined — are all over the place.

That’s not to say that all physician burnout studies are useless. A recent study, Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative, used a simple, five item scale to ask physicians how they viewed their work life. See Figure 1.

Figure 1 Single-Item Burnout Scale.

Their findings were far more nuanced than many others. EHRs played a role, but so did long hours. They found:

EHR proficiency training has been associated with improved job satisfaction and work-life balance.14 While increasing EHR proficiency may help, there are many potential reasons for physicians to spend after-hours on the EHR, including time management issues, inadequate clinic staffing, patient complexity, lack of scribes, challenges in mastering automatic dictation systems, cosigning resident notes, messaging, and preparing records for the next day. All of these issues and their impact on burnout and work-life balance are potential areas for future research.

There’s a need to back off the burnout rhetoric. Burnout’s overused and under defined. It’s a label for what may be any number of underlying issues. Subsuming these into one general, glitzy term, which lacks clinical definition trivializes serious problems. The next time you see something defined as physician or EHR burnout, you might just ask yourself, what is that again?

So, what do you think?

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