Over the past decade, healthcare has seen a significant rise in provider burnout. Many have suggested it is reaching epidemic proportions, and with more than half of anesthesia professionals suffering from its effects, it is clear our specialty is not immune. We will explore some of the symptoms, contributing factors, and consequences for our patients, professionals and practices. We will also look at one institution’s experience and efforts to recognize and reduce its effects. With appropriate education and awareness, we can arm ourselves with the tools needed to ameliorate this growing trend.
As anesthesia professionals, we are confronting challenging times. Our specialty is experiencing a period of mergers, rapid consolidation of practices, and a trend toward employed providers that has dramatically affected our autonomy. Bundled payments, declining reimbursements, electronic health record systems (EHRs), and acronyms like merit-based incentive payments (MIPS), and Medicare Access and CHIP Reauthorization Act (MACRA) consume our daily vernacular. We are experiencing rising demand for anesthesia services while simultaneously facing a national shortage of nurses and physicians.1 Furthermore, our practices are inundated with internal and external pressures to meet or exceed national benchmarks in hospital quality indicators and patient satisfaction/loyalty ratings to effectively compete with local competitors.2,3 Over the past decade, health care has also seen a significant rise in provider burnout, and it is clear that anesthesia professionals are not exempt from this growing epidemic. This article will review the causes of burnout and potential solutions to reduce risk.
What is Burnout and what contributes to it?
Burnout is a pattern of symptoms, with providers reporting extremely low physical and emotional energy levels, cynicism, and decreased work effort.2 This can lead to significant consequences, both personally and professionally. For example, studies have shown physicians who are burned out are more likely to have broken relationships, increased incidence of alcohol and drug abuse, and a higher risk of depression and even suicide.3
The Mayo Clinic outlines a handful of dimensions that can play an important role in burnout, such as workload, work-life balance and sense of community (Table 1).3 According to Shanafelt et al., anesthesiologists report higher than average rates of burnout than other physicians. In fact, over 50% of anesthesiologists reported feeling burned out in 2014, a marked increase from 2011, and a rate twice as high as the general working population.4,5
Table 1. Dimensions that can play an important role in burnout3
|Workload and job demands
|Control and flexibility
|Social support / community at work
|Alignment of individual and organizational values
|Degree of meaning derived from work
Over the past few years, our workplaces have seen a significant increase in number of cases, hours, and work effort per provider. The Medical Group Management Association (MGMA) data support this as a larger trend across our specialty.6 Anesthesia professionals are working longer hours, spread over more locations, spending more time in front of electronic health records, and have less control over their schedules. Adding to this challenge is the fact that work/life balance is a top priority for Millennials, the fastest growing segment of our anesthesia workforce.7
Professionals with burnout are less productive, have a higher likelihood of turnover, and are more likely to reduce their work effort in the coming years. Not surprisingly, this can have a significant impact on patients. Providers experiencing burnout may deliver lower quality care with associated lower patient satisfaction scores and are more likely to make medical errors.8 Therefore, health care professional distress may be a quality indicator that is worth measuring in medical centers.3
At the bedside, one study showed a dose-response relationship between burnout scores and medical errors.8 Burnout is represented here in a bidirectional relationship where errors lead to stress and stress leads to errors.9 As anesthesia professionals, we are not immune to poor patient outcomes or patient death. One study suggested that 84% of anesthesiologists were involved with at least one unanticipated death or serious injury of a patient, leading many to feel personally responsible.10 These experiences can lead to provider depression, alcohol abuse, or even consideration of a career change. Despite 67% of respondents feeling as though their practice could be compromised in the immediate future, only 7% were given time off to collect their thoughts and begin personal recovery.10
Our efforts to reduce Burnout
A variety of studies performed at the Mayo Clinic, Rochester, MN, suggest that the factors listed in Table 1 may influence overall satisfaction and provider engagement, and should be addressed at an organizational level. A careful focus on each dimension can help to minimize burnout while creating a culture of highly engaged professionals.11
Mitigating Burnout at Our Institution
Our practice has experienced rapid growth and now covers four hospitals and five ambulatory centers. This necessitated increasing creativity in how we schedule our professionals. During a typical week, our anesthesia professionals may have to travel to three or four different locations. This became a significant source of dissatisfaction, in particular for our Certified Registered Nurse Anesthetists (CRNAs) who were primarily responsible for the increased travel to different locations.
To address this, we developed a novel system that allows our CRNAs to rank the locations where they prefer to work. A real-time decision support algorithm now prioritizes which CRNAs should provide care in each facility, balancing the location desires of each individual against their peers. With the present system, we are now able to send CRNAs to their first or second choice over 80% of the time. Most importantly, a recent survey (with scale from 1–5, 5 being extremely satisfied) of our CRNAs (of which 36 out of 70 responded) suggested that 86% are either very satisfied or extremely satisfied with the locations they are assigned to work, a marked improvement from baseline.12
We also believe it is important to foster a culture of candor by educating our providers on the causes and symptoms of burnout and encouraging open discussion. Our practice has experienced several significant, personal tragedies recently. We expeditiously sought the counsel of outside wellness experts to help provide departmental leadership with the necessary expertise to successfully navigate these unexpected events. It is too soon to conclude if the wellness initiatives will result in long-term benefits, but a recent survey suggests cause for optimism. Of those anesthesiologists and CRNAs surveyed (N=90), 70% planned to attend future wellness events, and 42% stated that the event provided at least some information or skills that will improve their overall job satisfaction.13
Flexibility in hours worked is also becoming increasingly critical to our changing workforce demographic. Studies show this can increase provider satisfaction, yet does not adversely impact patient satisfaction, quality of delivered care or efficiency.14 Over the past 15 years, our department has seen a considerable change in the proportion of professionals who work full-time. Part-time employment has offered our professionals additional flexibility as to when they work, as well as enabled our practice to flex up or down depending on daily staffing needs.
We surveyed our staff to assess risk factors for stress and burnout, after our efforts to increase satisfaction and work life balance (N=90).13 Results revealed that 54% of our department is satisfied with their job and 36% report they are very satisfied with their job. In addition, 70% of our anesthesia professionals reported they usually or always have an adequate work/life balance.13 We also surveyed our staff to assess their average stress levels at work, their overall impression of how run down or drained they feel, their sympathy towards patients, and achievement at work. Forty-seven percent of the respondents reported a moderate amount of stress, and 24% of staff reported experiencing a lot of stress. In addition, 20% of the respondents noted feelling run down a lot, and 32% reported being run down a moderate amount. The survey results also revealed that only 8% of the respondents reported moderately less sympathy for their patients and 52% reported no decrease in their sympathy towards patients since they started working. Lastly, when asked if they are achieving less at work than they feel they should, 38% reported experiencing this sometimes, and 57% reported they rarely or never experienced these feelings.13
Greater than half of our anesthesia professionals are suffering from burnout.4,15 With appropriate education and awareness, we can give our professionals, practices, and organizations the tools needed to ameliorate this growing trend. We need to confront the ever-changing health care landscape with focused attention, creativity, and an open mind. As former US Surgeon General Vivik Murthy, MD, said, “If health care providers aren’t well, it’s hard for them to heal the people for whom they are caring.”16 More than ever, it is imperative that culture, morale, and provider well-being become part of our core values.
Natalie Tarantur is currently a certified registered nurse anesthetist at NorthShore University HeathSystem.
Dr. Deshur is currently vice chairperson of Operations in the Department of Anesthesiology at NorthShore University HealthSystem and is clinical associate professor in the Department of Anesthesiology at the University of Chicago Pritzker School of Medicine.
Neither author has conflicts to declare as they relate to this article.
- Dall T, West T, Chakrabarti R, et al. The complexities of physician supply and demand: projections from 2016 to 2030 Final Report: Association of American Medical Colleges. Washington, DC: IHS Markit Ltd; 2018.
- Maslach C, Jackson S, Leiter S. Maslach. Burnout Inventory Manual. 3rd ed. Palo Alto, CA: Consulting Psychologist Press; 1996.
- Shanafelt T, Noseworthy J. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 2017; 92:129–146.
- Shanafelt T, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377–1385.
- Shanafelt T, Hasan O, Dyrbye L, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600–1613.
- Medical Group Management Association. Provider Comp Surveys 2016, 2017, 2018. Accessed on July 1, 2018—www.mgma.com.
- Deloitte Millennial Survey, 2016. Accessed on July 1, 2018- https://www2.deloitte.com/global/en/pages/about-deloitte/articles/millennialsurvey.html.
- Williams E, Manwell L, Conrad T, et al. The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO Study. Health Care Manage Rev 2007;32:203–212.
- Moss M, Good V, Gozai D, et al. An official critical care societies collaborative statement: burnout syndrome in critical care health-care professionals. CHEST 2016;150:17–26.
- Farnaz M, Gazonai P, Amato Z, et al. The impact of perioperative catastrophe on anesthesiologists: results of a national survey. Anesth Analg 2012;14:596–603.
- Shanafelt T, Gorringe G, Menaker R, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc 2015;90:432–440.
- Deshur M, Shear T. Unpublished data from NorthShore University HealthSystem; 2017.
- Tarantur N, Katz J. Unpublished data from NorthShore University HealthSystem. 2018.
- Fein OT, Garfield R. Impact of physicians’ part-time status on inpatients’ use of medical care and their satisfaction with physicians in an academic group practice. Acad Med 1991;66:694–698.
- Kumar S. Burnout and doctors: prevalence, prevention and intervention. Healthcare (Basel) 2016;4:pii:E37.
- “Surgeon General Concerned About Physician Burnout,” MedPage Today: Web. April 10, 2016. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/57280 Accessed on August 20, 2018.