Exhausted surgeon resting his head on operating theatre table (Photo by Universal Images Group via … [+]
Working long hours day after day, month after month, buried endlessly under a mountain of paperwork and glitchy administrative software. Not only do many healthcare professionals think this is normal, but many don’t even consider the need to change.
Despite the increased attention to the burnout crisis among physicians, Medscape’s 2023 U.S. physician burnout and depression report showed the problem has increased by 11 percentage points, to 53%, compared to the 2018 report. If the industry doesn’t remedy this crisis, physicians will go from being burned out to being burned in, which will be an even bigger crisis.
Burn-in is a phenomenon well understood by those in tech. It occurs when a static image remains on a screen for so long it becomes etched in and appears as a permanent or semi-permanent watermark. Ways to avoid avoid burn-in with monitors include using screensavers, varying content on the screen, periodically turning it off, cleaning it and avoiding temperature extremes and humidity. Once the image is burned in, people either discard the monitor or continue to use it and carry on as if the watermark is completely normal.
Burn-in on a monitor, when severe, is visible even when the monitor is switched off.
I fear that a similar phenomenon could start—or perhaps already is—plaguing our physicians, who have been experiencing burnout for far too long. They, too, can become permanently scarred like the old television screens and computer monitors. Much like there are ways to avoid burn-in with monitors, there are strategies to help physicians avoid such a fate.
Symptoms
Burn-in sets in among physicians who have been experiencing burnout for a long time. They feel no need to take breaks from work because life is work. There may not be much talk about work-life balance because the two have become one; work is life. The burned-in physician may even take a burnout survey and answer the questions as if they’re unaffected because this is their normal. Indeed, it may take a colleague, manager, supervisor, caring friend or family member to recognize these signs since the physician may not be capable of doing so.
Physicians have been crying out for help for many years, and the screams grew louder during the Covid-19 pandemic. Others have become silent. If nothing has changed yet they’ve stopped screaming, it may be because they are now burned in.
The top reasons for burnout from the survey were, “too many bureaucratic tasks,” “lack of respect from coworkers” and “too many work hours.” Others included frustration with electronic health records, government regulations, staff shortages, lack of autonomy and being on call. Physicians also expressed concerns about uncompensated labor, which includes time spent responding to patient messages, completing forms and other administrative tasks.
These concerns are the equivalent of disease risk factors. When identified, it is important to modify them or the problem can get worse and you will transition from being burned out to being burned in.
Prevention And Treatment
While some of these tasks are unavoidable, there are ways to make them more palatable. Many of the concerns are structural and systemic issues that should be addressed so that we can salvage our physician workforce. For example, automation can help with some of the bureaucratic tasks, as can hiring other professionals to address the tasks that do not require a physician’s attention or expertise.
Of particular concern in the Medscape report is the fact that many physicians expressed feeling overloaded and said they were being forced to work at an unsustainable pace.
For many years, resident physicians were seen as working at an unsustainable pace, but no serious action was taken until patients like Libby Zion died. She was a college freshman who in March 1984 was admitted to a New York City hospital and died while being cared for by resident physicians who had been working long hours. During her admission, she was placed on a medication that was later found to have a lethal drug interaction with another medication she had already been taking. She died just hours after her admission to the hospital.
Despite the significant changes made to limit resident physician work hours after the Libby Zion case, concerns remain regarding physician work schedules. A recent study demonstrated that residents made more errors when they worked excessive hours, and medical errors are increasingly reported among burned-out attending physicians. The burned-in physician may wreak even greater havoc on the healthcare system.
Burn-in Is All Around Us
This problem is not isolated to physicians. Nurses, nurse practitioners, PAs, pharmacists, dentists and people in all areas of healthcare have been sounding the alarm regarding burnout. And the problem extends beyond health care to people like teachers in crowded classrooms with inadequate resources to support their students. People in all industries stay in jobs despite unrealistic demands, or in jobs they no longer like but have gotten so accustomed to that they don’t even contemplate quitting. Examples of being burned in are all around us.
While burn-in and burnout may seem similar, the difference is in the level of insight one has about the condition. Indeed, the two conditions are along a spectrum. In fact, burnout is one of the risk factors for burn-in. We can prevent burn-in by addressing the issues that contribute to burnout and by taking care of our bodies: eating healthy, exercising, spending time with friends and engaging in hobbies. That variability in the day can go a long way toward self-preservation. And the industry needs to listen to and act upon the screams from physicians. Just like screensavers prevent burn-in by keepings things fresh, we need to make changes to heal physician burnout so it doesn’t get burned in to our industry’s collective psyche.