By - December 20, 2021
When clinicians are burned out, patients suffer. That’s the message that has prevailed over the past decade, as the subject of physician burnout has steadily risen and dominated conversations in healthcare. Gone is the argument that “doctors knew what they were signing up for,” or “they chose the wrong profession.” The fatigue and depression that can accompany medical practice isn’t something that can be shunted aside, and there is no doubt that there is a need for more balance for those in healthcare.
In 2012, the Mayo Clinic, in partnership with the American Medical Association, published a survey that provided the first national-level data on physician burnout. What they discovered was 44 percent of physicians surveyed endorsed symptoms of burnout at a level that correlated with important outcomes, such as medical errors.1
Burnout, the report clearly stated, “has detrimental effects on not just physicians and their families, but also on patients, the physicians’ employers, and the healthcare system as a whole,” says Colin West, MD, PhD, professor of medicine, medical education, and biostatistics at the Mayo Clinic in Rochester, Minn., and who was an author of the study.
Since that study, more research has surfaced, and it has become clear that the issue of burnout isn’t unique to clinicians, but threads through the entire healthcare workforce. A 2001 study of nurses showed 43 percent experience burnout symptoms.2 For medical residents, the numbers are even higher, according to a 2016 study, with an overall burnout rate of 69 percent for residents, and a 2018 study of 16,000 medical students showed that 44 percent experienced burnout.2
For the laboratory, new studies provide more targeted data on burnout. Three newly released studies from the American Journal of Clinical Pathology (AJCP) provide up-to-date data on burnout specific to laboratory professionals,3 pathology residents and fellows,4 and pathologists.5 The three reports explored job stress, work-life balance, burnout, well-being and job satisfaction among these three groups, looked at the source points for stress and burnout, and identified resources that would help mitigate stress and reduce feelings of burnout while promoting a healthier work-life balance. And the numbers showed a stark reality. Overall, 71 percent of pathologists reported having felt burnout at some point, and one third reported currently experiencing burnout. Of all the laboratory professionals, 85 percent reported having felt burnout, while half of them reported burnout as a current issue. For pathology residents, more than 74 percent reported they had ever experienced burnout, and more than a third reported currently experiencing it.
The implications of a heavy workload
Those numbers indicate that burnout is common among medical laboratory practitioners, and the studies cite myriad contributing factors, such as lack of support from administrations, and lack of appreciation or recognition. But two of the sources for burnout common to all three groups are workload and not being adequately staffed.
According to the AJCP papers, the top two issues contributing to laboratory professional burnout are “lack of adequate staffing” (36 percent), and “heavy workload and pressure to complete all testing” (31 percent).3 For residents and fellows, more than one-third reported feeling moderately or very overwhelmed by their workload, mainly due to the number of tasks/cases they were responsible for, as well as being understaffed and having additional responsibilities.4 For pathologists, 42 percent felt burned out by an increased volume/case workload.5
Despite these high numbers, job satisfaction is overall high among the three groups (62, 66 and 71 percent satisfaction for laboratory professionals, residents and pathologists, respectively).3,4,5 However, as laboratory professionals are increasingly asked to do more with less, and as positions in the laboratory are left vacant by a high retirement rate, a high satisfaction rate may be unsustainable and could have longer-term consequences.
Looking at laboratory professionals, for example, 44 percent considered changing their careers completely because of burnout.3 Of the pathologists surveyed, 34 percent considered leaving the profession.5 Couple that with the workforce shortage many laboratories are already experiencing, and not addressing burnout among laboratory professionals could be disastrous for the future of the profession.
Understanding the fuel of the burnout fire
The more that is understood about burnout for pathology and laboratory medicine—and for healthcare as a whole—the better organizations will be able help employees when they need it. That starts with understanding what pathology and laboratory professionals find meaningful about their work, and why, despite the heavy workloads and inadequate staffing, many continue to build their careers in the profession.
Christina Pierpaoli-Parker, a clinical psychology resident at the University of Alabama at Birmingham specializing in health psychology, has been observing burnout, and notes that a lot of cases of burnout stem from an increased premium on healthcare efficiency, performance metrics and reducing healthcare costs. And that fuels the factors that initiate and maintain burnout syndrome, she adds, including excessive time documenting, limited and non-meaningful patient interactions, or low reimbursement for other meaningful activities beyond clinical care.
But organizations that work to change that and embrace the tasks that are meaningful to their employees can better aid in reducing burnout among employees.
“A Mayo Clinic study found that physicians who spend at least 20 percent of their time on the part of their work that they find most fulfilling significantly lower their chances of burning out,” Ms. Pierpaoli-Parker says. “That really matters because activities can either drain or energize us. When we protect time systematically for physicians to engage in the work that energizes them, it pays off in dividends—in the quality and accuracy of their clinical care, fewer medical errors, psychological well-being, the novelty of their research, even the comprehensiveness of their charting. Protected engagement in valued professional activities helps providers to restore the psychological and emotional bandwidth needed to tackle the parts of the job they may not enjoy as much.” Increasingly, she adds, larger medical systems and private practices have started acknowledging the importance of protecting time and inviting physicians to inventory what they value and enjoy most to help them allocate time more effectively.
What’s more, Ms. Pierpaoli-Parker notes that giving healthcare professionals the time and opportunity to work with a health psychologist to identify their needs, clarify their values, and to build coping skills can empower the individual to participate in the programs their organization might offer, to practice assertiveness with administration, and to set boundaries at work.
The key here is that institutions need to lead the charge in reducing burnout. “There has to be a greater leadership role of practices and healthcare organizations recognizing that they’ve got to make the work environment more fulfilling,” says Mayo’s Dr. West. And to that end, more and more care practices are focusing on the support structures in place to better help the clinician focus on the patient. “It’s pretty consistent when you allow physicians to spend time on the core aspect of what being a physician means—focusing on the patient—and provide the proper resources for other elements like documentation support, ordering support, support with navigating prior authorization with insurance companies, that the physicians are much more satisfied,” says Dr. West.
Better structuring of workloads and environments that foster a sense of well-being is needed, and institutions that don’t foster this type of environment risk higher turnover and lower productivity.6
But, institutions also need to provide employees with opportunities to take individual control in dealing with and healing burnout. Heeding this call, many organizations across the country have appointed Chief Wellness Officers, and have started implementing in-house programs such as yoga classes, stress-management courses or resilience training to help relieve stress and mitigate burnout.
But the individual component of preventing burnout can’t work without that institutional piece. The problem arises when, as data from the AJCP studies show, workloads are too heavy, and there isn’t enough support, and laboratory professionals and pathologists simply cannot partake of these preventative programs without further adding to their stress levels. As the study of residents and fellows notes, “Encouraging more trainees to manage their time effectively and engage in recreational activities if their work schedules continually encroach on their personal time.”4 Thus, it’s not a one-pronged approach to mitigating burnout, but rather, a multipronged one where institutions and individuals must work in concert to reduce the experience of burnout and decrease the symptoms of it.
The health systems and the programs they develop are needed to promote change, notes Ms. Pierpaoli-Parker, but they’re not drivers of change alone. “We certainly need institutional support, but a person’s motivation to interrupt their cycle of burnout and to adopt a new cycle of behavior more aligned with their health goals and values plays a large contributory goal.”
The need for change
As more and more research surfaces about the implications of burnout, it’s clear that the solutions are only beginning to evolve. Key to helping that evolution is shifting the mindset about how to develop the needed solutions.
One of the biggest hurdles has been altering leadership mindset around the cost of providing solutions for employees experiencing burnout or preventing burnout in the first place. It’s a common concern, Dr. West notes, compounded by the thought of how this type of care for employees can be afforded in a healthcare system that has so many financial challenges in so many other areas. The good news, he adds, is that increasingly leaders are recognizing that “by not addressing these issues, we’re actually wasting billions of dollars in our healthcare system without accounting for them, without even recognizing the impact of burnout and distress on physicians and other healthcare professionals. We know that when physicians are burned out, they’re more likely to retire early and they’re more likely to reduce their clinical contact time.”
In other words, organizations that let cost be the determining factor of whether or not to help their employees is ultimately detrimental to the health of their patients, as over the course of a career, there are fewer people to take care of patient in the system, fewer researchers advancing care or education to the next generation of learners, and a talent drain on the health care system overall, Dr. West says.
“It’s recognizing that the question isn’t, ‘Can we afford to invest in physician and healthcare professional well-being?’” Dr. West notes. “It’s actually ‘How can we afford not to invest in their well-being?’” Enlightened organizations, he adds, see that more clearly, and know that it’s a moral and financial responsibility to take care of their workforce. What’s more, it offers organizations a competitive advantage in recruitment by providing an environment where healthcare professionals can thrive and feel their skill sets are valued and honored.
“It’s better for patients, it’s better for the employees, and it’s better for the healthcare system,” Dr. West says. “But you have to have the courage to recognize that it’s going to look like it costs money up front because what you’re doing—just like preventive medicine—is preventing downstream costs that you haven’t measured yet.”
ASCP Director of Communications + Editor of Critical Values