Physician roundtable: Burnout continues to escalate

Physician burnout is “very disturbing,” “quite worrisome,” and “a crisis” in U.S. health care, according to three leaders of the Physicians Foundation. In a 2021 survey by the Physicians Foundation, 56% of independent physicians and 66% of primary care physicians reported frequent burnout symptoms. Physicians Foundation President Gary Price, M.D., PC, and Physicians Foundation board members Joseph Valenti, M.D., an obstetrician-gynecologist, and Ripley Hollister, M.D., a family medicine specialist, responded to Medical Economics® questions about levels of physician burnout and ways to help, especially for independent practitioners and those in small communities and rural and underserved areas. Valenti: Physician burnout is a complex challenge but at its core it is caused by physicians losing clinical autonomy and navigating burdens impeding the physician-patient relationship, such as prior authorizations, electronic health record (EHR) challenges and barriers to addressing patients’ social drivers of health. The Physicians Foundation’s studies shown a consistent reduction in percent of physicians who have ownership in their practices over the past decade, and the 2021 survey found that physicians expect there will be even fewer independent physician practices after the pandemic. Although the number of independent practices has consistently decreased, physician burnout has consistently risen. During the COVID-19 pandemic, 68% of independent practices reported decreased incomes; 44% of employed physicians reported that in our survey. Valenti: Independent physicians, especially those in rural and underserved areas, are absolutely spread too thin.

This adds another dimension to the work of independent physicians compared with their employed counterparts at large health care systems. Valenti: Physicians in smaller and independent practices do have more control and autonomy, which can help alleviate burnout, but the problem is that they don’t have the necessary resources. This is a problem that requires a paradigm shift from a system where physicians think that burnout is something they must overcome by themselves to one where they see the support systems around them willing to help. For example, Travis County Medical Society Foundation in Texas, a Physicians Foundation grant-supported partner, developed and released a free toolkit to help health practice establish their own physician well-being program. The American Medical Association’s Practice Transformation Initiative, another Physicians Foundation grant-supported partner, provides a framework on how to create the conditions where joy, purpose and meaning are possible for physicians. The main point is to understand that small practices are completely able to develop teams similar to large practices, and that physicians should ensure that they unload mundane issues, which impair their efficiency in practice, to team members who have the time to accomplish this process. Our survey data would suggest that smaller and independent practices do experience a greater economic burden and stress with these issues, as reflected in the practice income stress with COVID-19 cited above, and the rapidly diminishing numbers of independently employed physicians.

Price: Primary care physicians are the backbone of our health system, and the Physicians Foundation recognizes their importance in making that system work properly.