Burnout In US Healthcare: New Data, Surprising Insights

Suprising new data about doctor burnout suggests that the disfunctional U.S. healthcare system isn’t … [+] entirely to blame.

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In medicine, when an ICU patient fails to get better after a week of intensive care, doing more of the same treatment proves futile and frequently harmful. Instead, it’s better to take a step back: reassess both the initial diagnosis and treatment plan. Doing so, doctors usually find that earlier assumptions were incorrect and that they’ve overlooked something vital.

This same notion applies to clinician burnout in medicine. Despite heightened awareness of this urgent issue and widespread calls for relief, the burnout crisis continues to escalate. After a decade of failing to solve the problem, it’s time for a diagnostic reevaluation.

The Paradox Of Clinician Burnout In America

Doctors and nurses today are the beneficiaries of groundbreaking advancements in science, technology and disease treatments. With so many sophisticated tools available to diagnose and cure patient problems, you’d think this would be the golden era of clinician fulfillment. And yet, this period of radical advancement is marked by growing dissatisfaction and an exodus of physicians. Last year alone, 71,309 doctors quit the profession.

At a press briefing last month, Dr. Debra Houry, Chief Medical Officer at the Centers for Disease Control and Prevention, highlighted this growing threat to healthcare professionals.

“Burnout among these workers has reached crisis levels,” she said, noting that the COVID-19 pandemic had intensified long-standing challenges within the workforce. Fatigue, depression, anxiety, substance use disorders and suicidal thoughts are on the rise, according to the CDC.

In self-reported surveys about the causes of burnout, medical professionals point to the profit-centric American healthcare system that burdens them with countless bureaucratic tasks, endless prior authorization requirements, and a revolving door of patient visits.

All these complaints are valid, but new data on burnout from the nonprofit Commonwealth Fund raise another possibility and shed light on a potential solution.

Burnout: A Distinctly American Problem?

If the main drivers of burnout were indeed greedy insurance execs and a for-profit healthcare system, then you would expect that the Western nations with universal healthcare (which is paid for and provided by the government) would have dramatically lower physician burnout rates than in the United States.

But the Commonwealth Fund report tells a different story. Surprisingly, primary care physicians in the U.S. are in the middle of the pack when it comes to burnout. They report higher rates of satisfaction than their peers in the UK, Germany, Australia, New Zealand and Canada (but trail the Netherlands, Sweden, France and Switzerland in satisfaction).

If physician burnout isn’t a distinctly American phenomenon, deriving from unique aspects of the U.S. healthcare system, then what is causing doctor dissatisfaction around the world?

If we look at the biggest change to global medical practice in the 21st century, it’s not the corporatization of care or the administrative burdens heaped on clinicians. It’s the evolution of illness, itself.

Chronic Disease Drives Unprecedented Demand

For most of medical history, and throughout the 20th century, most patients went to doctors with acute conditions, urgent and sudden in their onset. These problems ranged from broken bones and appendicitis to heart attacks and pneumonia. When surgery or antibiotics proved successful, patients typically healed up and returned to good health. And when the limitations of medicine in the past proved too great, patients quickly succumbed to injury or illness, and died.

Back then, medicine was a simpler profession with fewer clinical problems to solve and fewer treatments available.

Today, chronic illnesses like cardiovascular disease, cancer, diabetes and respiratory illnesses are the most frequent and fastest growing problems doctors treat. Unlike patients with acute problems, people with multiple chronic conditions must be seen three to four times a year for life. And for doctors, this rapid shift from acute to chronic illness has a serious impact on clinical demands and workplace satisfaction. It’s akin to the difference between lifting a heavy weight once (challenging but manageable) and lifting a heavy weight repeatedly over a lifetime (completely exhausting).

Industrialized nations everywhere are experiencing spikes in diseases that require lifelong care. The World Health Organization estimates that, by 2050, these chronic diseases will account for 86% of the world’s 90 million deaths each year (a staggering 90% increase in absolute numbers from 2019).

Today, chronic illness affects an alarming 60% of Americans. Obesity and diabetes are reaching epidemic levels with clinicians’ efforts to reverse these trends proving largely ineffective. Particularly concerning is the medication burden among senior citizens: 40% of Americans over 65 are on five or more prescription drugs, a rate that has tripled in the past two decades (20% are taking 10 or more drugs).

Rethinking U.S. Physician Burnout: What We Missed

The list of medical challenges doctors must deal with is ever-expanding. With the severity and volume of these problems today, it’s no surprise clinicians are feeling exhausted and overwhelmed.

As clinical pressures have risen over the past 20 to 30 years, doctors have been forced to see more patients a day, with less time for each. And when physicians have no choice but to cut corners in medical care delivery, they end the day feeling they haven’t done their best. The result is “moral injury,” a term that describes the pain physicians experience when circumstances put them in a position to fail, resulting in harm to patients.

For more than a decade, we’ve thought of burnout as something inflicted on the medical profession by money-hungry villains. When we take a step back and reassess the situation, perhaps the best way to think about burnout is as an affliction caused by the evolution of disease and the exponentially greater burden it has created for clinicians. Unless we can find ways to reduce the demand for medical care, physicians, particularly in primary care, will be even more burned out a decade from now.

But improvement is possible. Just imagine what would happen to doctor’ daily workload if Americans experienced 30% fewer chronic diseases and had 30% fewer heart attacks, strokes, and cancers, as a result. Imagine how much more fulfilling medicine would be if physicians had more time with patients and less pressure to race through the day.

Fortunately, there is a tech-driven solution on the horizon to significantly lessen clinical pressures and reduce burnout without raising healthcare costs. What is this technology, and how best to apply it, will be the focus of my next article.

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