Physician Burnout, COVID-19, and the Paradox of Excellence

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There are many culprits when it comes to burnout — cumbersome electronic health records, overwhelming administrative tasks, long hours, a lack of physician engagement and empowerment, and various other factors that are outside of our control as physicians — to say nothing of the current coronavirus pandemic. Between the risk of transmission, concern for patients’ welfare, and financial strain caused by COVID-19, data shows that one-third of providers feel that “burnout is at an all-time high.” 

However, I propose that — paradoxically — our greatest strengths as physicians can also increase burnout, a concept I introduced in “How Our Dedication to Service Can Cause Burnout.” In particular, our striving for excellence and desire to cure not only our patients but also our diseased healthcare system, also exacerbates the epidemic. 

Here’s how our commitment to excellence may amplify burnout (and what we can do to stop it).  

The Problem With Excellence

Many of us joined the profession because we are competitive, talented, and wanted to help our fellow human beings live happier, healthier lives. Those traits and calling got us through the demands of med school, the difficulties of residency, and the long hours of practicing medicine. 

But, as the saying goes, “Perfect is the enemy of good.” In trying to optimize everything — engaging patients, adopting the latest technologies, advocating for healthcare reform — we end up with too many spinning plates. This leads to imbalance and neglecting priorities, namely, our own well-being. 

Eventually, our pursuit of excellence can lead to feelings of invincibility that turn into emotional exhaustion when we recognize that we don’t have all the answers and cannot provide the cure for all our patients. In the era of COVID-19, a disease state we have never faced before or learned about in our pathology class, this uncertainty and ambiguity leads to further feelings of inadequacy. 

Redefining Excellence

What if we redefined excellence so that caring for ourselves was a criteria? And what if I told you that, in doing so, we could actually improve our patients’ health and the healthcare system? 

Here are two statistics to illustrate my point. 

  • Physician burnout costs the healthcare system between up to $17 billion every year. 
  • According to NetCE, “For each 1-point increase in the score in the emotional exhaustion domain, there was a 44 percent increase in the likelihood of reporting a medical error.”

It’s readily apparent that burnout actively harms patients and the healthcare system. That’s why the Triple Aim was expanded to include a fourth tenet addressing the need to reduce burnout. 

So how do we start redefining “excellence”? I think a great place to start is the American Medical Association’s “Code of Medical Ethics.” 

“To preserve the quality of their performance, physicians have a responsibility to maintain their health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities and occupational stress.”

Further, the code of ethics states that “collectively, physicians have an obligation to ensure that colleagues are able to provide safe and effective care, which includes promoting health and wellness among physicians.”

Every physician will have their own redefinition, but each and every one of us should consider the self-care angle in our definition.

Scheduling an Appointment — With Ourselves

We already have packed schedules, but we should make time to check in with ourselves. In fact, schedule time as you would an appointment and show up for yourself. After all, in doing so, we can spot issues that may make it difficult for us to be there for our patients. 

The next step is to practice mindful self-compassion and inner-critic awareness can reduce burnout’s symptoms. To start cultivating these practices, I like to ask myself these questions:

  • What did I learn today? Would I do anything differently?
  • What three things am I grateful for today? What inspired me? How did I make a difference?
  • How did I talk to myself today? Did I take myself too seriously? Did anything surprise me? 

The simple but continued exercise these questions foster is useful in lowering the “mental distance from one’s job, or feelings of negativism or cynicism related to one’s job” that the World Health Organization includes in its diagnostic criteria for burnout

From there, we can address the external factors and processes that contribute to burnout. 

  • Improve workflows and practices. Introducing virtual visits, patient portals, and online scheduling can save time and energy. For instance, virtual visits allow you to meet patients without having to be in your office. (As an added bonus, it is more convenient for patients.) Similarly, patient portals allow patients to access information easily, request prescription refills, and other features through a self-serve model. Virtual visits also allow us to fill in gaps in our schedule created by patients reluctant to visit our offices due to exposure to COVID-19, which helps to bolster our revenue stream during these lean financial times. 
  • Enlist help. Whether it’s a physician assistant, a subscription to a virtual scribe service, or a partnership with an organization that can alleviate administrative tasks, a little help goes a long way. Doctors face more demands in this day and age, more than any one person can handle on their own. A management services organization (MSO) can alleviate many of the IT, coding and documentation, payer contracting, and other nonclinical, time-consuming tasks. 

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