National Physician Burnout Expert Shares Insights: ‘We Can Certainly Do Better’

He has helped lead several national surveys of physicians to gauge the level of clinician burnout across the country—most recently in 2017 and the latest survey is being conducted this month. In 2008, Shanafelt became the first director of Mayo Clinic’s Department of Medicine Program on Physician Well-Being, where he launched an effort to address physician burnout through programs focused on physician autonomy, efficiency, collegiality, and a sense of community.

He earned his medical degree at the University of Colorado and performed his residency in internal medicine at the University of Washington Medical Center.

Shanafelt recently talked with HealthLeaders about a range of issues related to physician burnout. The following is a lightly edited transcript of that conversation.

HealthLeaders: Gauge the extent of physician burnout during the coronavirus pandemic.

In healthcare settings, there have been many challenges, including susceptibility to becoming infected, being a portal of transmission to your family, and a lack of answers for caring for patients with this disease. I am anticipating that we may see higher prevalence of physician burnout in the survey this month compared to 2017, which showed a slight improvement compared to 2014.

Although burnout has been the dominant occupational form of distress over the past decade, with other dimensions such as fatigue and problems with work-life integration, the pandemic has also caused an uptick in PTSD-like phenomena for physicians who went through events such as what happened in New York. There has been depression, anxiety, and sleep disorders. So, the pandemic is associated with a category of more traditional mental health disorders that probably have been exacerbated more than burnout has been exacerbated.

HL: What has inspired you to devote much of your professional career to studying and addressing physician burnout?

Shanafelt: It has been the witnessed suffering of colleagues. I have watched a dedicated and altruistic group of people become discouraged, demoralized, and sometimes worse. I have had colleagues consider leaving the profession or experience personal life repercussions because of some of the challenges in the work environment and healthcare delivery system. Witnessing these things made me care and want to drive change. We can certainly do better.

HL: When it comes to addressing physician burnout, which is more important—organizational approaches such as improving the work environment or individual approaches such as resilience training?

Shanafelt: First, we know that burnout is an occupational syndrome caused mainly by characteristics and stressors in the work environment, not deficits in individual resilience. About 80% of the burnout challenge is triggered by characteristics of the work environment, organizational culture, and professional culture. So, we certainly need to focus a lot of effort as a healthcare delivery system and healthcare organizations on addressing the primary problems.

That said, I encourage individual physicians that we are not victims and there is a component of burnout that includes choices we can make about integrating our personal and professional priorities, optimizing our own sense of meaning and purpose in work by shaping our career, and making sure that we are attending to personal things around self-care that we can control.

HL: In the United States, how does the culture of medicine impact physician burnout?

Shanafelt: It is a huge factor.

It is easy for us to point to some of the tangible manifestations of inefficiency, administrative burden, loss of control and flexibility, and a productivity-based reimbursement system, then say, “These are the problems.” Those are problems; but in many ways, those problems are really manifestations of much deeper issues in the culture of our healthcare delivery systems and the view of the role of the physician in healthcare organizations.

In that sense, we often have incongruities between what we claim and our actions. We claim that physicians are professionals who are highly trained, and we want to minimize administrative burden. We claim that quality of care is our top priority, along with serving our communities. But oftentimes, we have a healthcare delivery system that operates in a way that is the antithesis of those things.

We have preauthorization and a whole bunch of documentation that is required to support billing, which says, “We do not trust you as a physician.” We have administrative burdens that say, “We do not value your time.” We have short visits that may not allow physicians to deliver optimal care. In a sense, we are suggesting that our economic priorities are more important than our quality priorities, our social justice priorities, or treating our physicians as professionals.

HL: If there were two causes of physician burnout that could be eliminated, which ones would you choose?

Shanafelt: For organizations, one of the most important things to think about initially is to address the loss of control and lack of flexibility. These are things that show up in many ways—physicians feel that they have no control and that they have no input in the way that their practices run.

Restoring a sense of control brings about the sense that physicians can drive change. When change seems possible, it brings a sense of hope, which can be a powerful first step on the journey to improvement.

At the level of individual doctors, we need to get rid of the mindsets of perfectionism and harsh self-criticism. What we find is that physicians are very compassionate with others but very critical and harsh in the way they treat themselves. They expect nothing but perfection in themselves.

For physicians, being compassionate with themselves is a skill that can be learned. Instead of a mindset of being perfect, there needs to be a mindset of always learning and getting better, and that is how we can get to being a better physician a year from now than we are today. It is a commitment to excellence and a growth mindset, rather than a self-critical mindset.