The Underlying Cause of Physician Burnout

Patient assignment software can improve care.

In a recent opinion article in JAMA Psychiatry, authors Frederick Seacrest Southwick, MD, and Steven Mark Southwick, MD, suggest that loss of control may be the underlying cause for physician burnout and stress.

The effects of stress and burnout are well known. According to the authors, uncontrollable stress sets off a cascade of chemical events that can damage neural connections in the prefontal cortex, which in turns weakens connections and the capacity to concentrate, plan, make decisions, regulate emotions, resist cravings, and inhibit the stress response.1

What’s causing all of this stress? They suggest that the switch from solo or small group practices to the move towards larger health systems has left little room for individual autonomy to decide what tests to perform, what treatments to administer, and how much time to spend with patients. Physicians are frustrated, they say, from an array of regulations, computer entries, and performance expectations.

Sound familiar?

To combat this loss of control, the authors suggest two approaches. First, develop active coping behaviors that revolve around goal-directed behaviors such as gathering information, acquiring skills, problem solving, making decisions, confronting when necessary, and seeking social support. They say high levels of perceived control and autonomy are consistently associated with high levels of job performance, job satisfaction, and well-being, as well as low levels of work-related stress.

Another suggestion is for organizations to adopt a distributive leadership model that encourages physicians to actively participate in governing and improving the system in which they work.

For example, they tout the efforts by the Virginia Mason Medical Center, which has adopted a variation of the Toyota production system in which all employees actively contribute to creating the organization’s continuous improvement plan. This creation of standardized operating procedures and value streams, they argue, establishes predictability and a sense of control over the work environment. They say these changes also increase production and improve quality metrics, in addition to better financial performance.

Physician burnout may have no easy fixes, but as the authors suggest—the first place to start is for physicians to gain greater control and autonomy, supplemented with increased input into local and national health care policy and expanded leadership roles. Hospitals, they say, will need to do their part in allocating sufficient administrative time, resources, train and administrative support to “empower physicians to lead the adaptive changes need to fix health care delivery.”

1 Arnsten  AF.  Stress weakens prefrontal networks: molecular insults to higher cognition.  Nat Neurosci. 2015;18(10):1376-1385.