George E. Thibault, MD
Clinician burnout has reached alarming proportions. In various reports, up to half of practicing doctors and nurses experience some manifestations of burnout, and learners in these professions are almost equally affected. Thankfully, this has gotten the attention of leaders in our professions.
Three years ago, the National Academy of Medicine (NAM) established an Action Collaborative on Physician Well-Being and Resilience with over 190 participating organizations. In October 2019, NAM published a Consensus Study Report, “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being.” This report was the result of a year-long study conducted by an interprofessional group of educators, practitioners, policy makers and system engineers, and it made concrete recommendations for the system changes that are needed to address this serious problem.
I was privileged to be on that study group. As a physician, clinician and educator, I have been very concerned about the toll that burnout is taking on our clinicians and learners and how it is preventing them from realizing their full potential for professional satisfaction and effectiveness. Through my work on the study and our review of the literature, my concerns deepened and broadened. I came to appreciate that the negative consequences of burnout were experienced not only by the affected health professionals but also by society at large.
In a recent Joint Commissions Journal on Quality and Patient Safety article, I outlined the reasons why clinician burnout is a societal issue and why addressing it needs to be a national priority:
1. We will only have an optimally functioning health care system that effectively serves the needs of our patients when all members of the system are functioning at the highest level and achieving their maximum potential.
Literature establishes that there is a direct link between clinician burnout and poorer quality of health care. Steps to treat, mitigate and prevent burnout will therefore improve the quality of patient care. Furthermore, it was the belief of our committee that the steps taken to address burnout will improve the functioning of all the members of the health care team and further improve care.
2. If we tolerate a further erosion of professionalism, we will undermine clinician-patient relationships and the public’s confidence in our institutions.
There is good evidence the real and perceived assaults on professionalism contribute to clinician burnout; and that burnout, in turn, leads to a decline in the professionalism of the clinicians experiencing it. Importantly, this applies to our learners as well as our active clinicians, and that makes it particularly important to address the contributing factors to burnout as early as possible in the education and training of health professionals. Loss of professionalism will weaken the social contract between the professions and the public we serve.
3. A further decline in humanism will diminish all the health professions and contribute to a decline of humanism in our society.
Learning and work environments in which burnout is prevalent are not humanistic. We want all clinicians to be humanists – that is, they make human interests, values and dignity their guiding philosophy. Humanism must be modeled and practiced in the health professions in order for all health professionals to be humanists. We need health professionals to be a positive influence against the increasing dehumanizing forces in health care and in society at large.
I am passionate in my belief that we must address clinician burnout in order to improve patient care, preserve professionalism and promote humanism. To do this we must mobilize leaders and society at large to call for and enact the systemic changes that will be needed.
George E. Thibault, MD, is past president, Josiah Macy Jr. Foundation, New York City, and the first Daniel D. Federman Professor, Emeritus, Harvard Medical School, Boston. Dr. Thibault previously served as vice president of Clinical Affairs at Partners Healthcare System, chief medical officer at Brigham and Women’s Hospital, chief of medicine at the Harvard-affiliated Brockton/West Roxbury VA Hospital, and associate chief of medicine at Massachusetts General Hospital in the Boston area. Throughout his career, Dr. Thibault has played leadership roles in many aspects of undergraduate and graduate medical education.