How Does Provider Burnout Impact Patient Care Quality, Care Access?

Provider burnout affects clinicians at 83 percent of healthcare organizations. How does this impact patient care quality?

Provider burnout has reached staggering levels, leaving healthcare professionals to consider the impacts the issue will have on patient care quality and care access.

“The health care environment—with its packed work days, demanding pace, time pressures, and emotional intensity—can put physicians and other clinicians at high risk for burnout,” according to the Agency for Healthcare Research and Quality (AHRQ). “Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of sense of personal accomplishment.”

And as providers face more occupational stressors – new technology, shifting workloads, changing payment models – provider burnout is becoming more common and more detrimental.

A 2018 report from NEJM Catalyst found that provider burnout is a problem at 83 percent of healthcare organizations.

Burnout is not only applicable to physicians, but to other healthcare professionals, as well, the report found. Seventy-eight percent of registered nurses feel burnout, while 64 percent of advanced practice registered nurses and 56 percent of clinical leaders feel the same.

But how does this impact patient care? Does an overworked provider deliver the same care quality to her patients? And do swaths of providers retiring or cutting their hours impact patient access to care? Below, outlines how provider burnout impacts patients.

Impacts on Outcomes Measures

As providers encounter more job stressors, care quality wanes, industry research has shown.

A September 2018 study published in Health Affairs found that provider burnout doubled the odds of an adverse patient safety event. Providers who felt symptoms of depression associated with their burnout saw more pronounced patient safety risks, the researchers found.

Patients receiving care from a provider suffering from burnout were also doubly likely to report low provider professionalism or low satisfaction with the care encounter.

Data published in the British Medical Journal echo those findings, stating that patient safety decreases when a provider feeling burnout treats the patient. However, the study did acknowledge that patient perceptions of care quality remain consistent when receiving treatment from providers with and without burnout.

Care quality likely deteriorates because providers experiencing burnout have more pressing emotional issues. Emotional exhaustion, lethargy, and lack of attention often leave providers looking exclusively at the most pertinent tasks, researchers from ARHQ said in a 2015 report.

“Clinicians with burnout may also have impaired attention, memory, and executive function that decrease their recall and attention to detail,” the AHRQ researchers continued. “Diminished vigilance, cognitive function, and increased safety lapses place clinicians and patients at higher risk for errors.”

Providers experiencing burnout are also often “cynically detached” from their work, leaving them liable to have more agitated or aggressive attitudes toward their patients, their work, or their colleagues. Such attitudes can harm patient satisfaction and care team communication, both of which are essential to quality healthcare.

Limited Patient Care Access

As noted above, provider burnout is resulting in more providers cutting down their practice hours or even entering early retirement.

Just about half of all physicians experience at least one symptom of burnout, according to 2015 data from the Mayo Clinic.

These providers are considering leaving the medical industry as a result of burnout, according to a 2016 report from the Physician’s Foundation.

Forty-eight percent of physicians plan on cutting out of the medical industry in coming years. Doctors are considering cutting back their hours, entering early retirement, taking a non-clinical job, or switching to concierge medicine to reduce the feelings of burnout.

“Many physicians are dissatisfied with the current state of medical practice and are starting to opt out of traditional patient care roles,” Walker Ray, MD, President of the Physicians Foundation and chair of its Research Committee, said of the findings.

“By retiring, taking non-clinical roles or cutting back in various other ways, physicians are essentially voting with their feet and leaving the clinical workforce,” Ray added. “This trend is to the detriment of patient access. It is imperative that all healthcare stakeholders recognize and begin to address these issues more proactively, to support physicians and enhance the medical practice environment.”

How can organizations support providers?

An industry filled with overworked employees who run the risk of making medical errors or who are poised to exit the profession is not sustainable. Medical industry leaders must find a way to address provider shortages to ensure better patient access to quality care.

In a 2017 Health Affairs blog post, executives from 11 large healthcare institutions said the onus is on them, as organization leaders, to address provider burnout.

“Leadership is needed to address the root causes of this problem and reposition the health care workforce for the future,” wrote the CEOs of leading institutions such as the Mayo Clinic, the AMA, the Cleveland Clinic, Vanderbilt University Hospitals and Clinics, Southern California Permanente Medical Group, Sutter Health, Johns Hopkins Health System and the School of Medicine, Duke University Hospital, Atrius Health, Partners HealthCare, and Northwestern Memorial HealthCare.

“As leaders, we must recognize burnout in physicians and other health care workers as a serious problem and respond vigorously. This is especially true if we want to maximize the effectiveness, productivity, and longevity of clinicians.”

The leaders highlighted the importance of addressing the mental and emotional needs of providers, the toll evolving technology takes on providers, and continuous evaluation of provider well-being.

A separate paper published in the Journal of Internal Medicine outlined various organization-level changes that can help preserve providers’ wellbeing. Fair productivity targets, duty hour limits, appropriate job roles and functions, ample support staff, better work-life balance, physician engagement initiatives, and revamped organizational values are potential solutions to growing provider burnout.

As medical professionals continue to face an onslaught of industry demands, the risk of provider burnout is likely not going away. Organizations must consider best practices for their provider populations to foster wellbeing and encourage more engagement with their jobs. In doing so, organizations can work to preserve a positive patient experience and better care quality.

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