Why Family Medicine Burnout Is Different (and How Docs Fight Back)

Interviewer: Laurie Scudder, DNP, NP; Interviewee: H. Clifton "Clif" Knight, MD, FAAFP


September 06, 2017

Editorial Collaboration

Medscape &

Editor's Note: Recognizing the growing issue of physician burnout and the need to promote strategies that support physician well-being, the American Academy of Family Physicians (AAFP) has launched a web portal that will include numerous resources for family physicians. Medscape spoke with Clif Knight, MD, senior vice president of education at AAFP, about the twin issues of burnout and well-being. We then asked a range of family physicians—from residents to those in practice for a long time—how they maintain their own resilience and joy in practice. To hear from each of them, click on the links next to their names throughout the text.

Clif Knight, MD, FAAFP

Medscape: While we want to talk about well-being today, I think we first have to set the stage by talking about why that is so important. The focus on well-being and resilience is a response to the crisis of physician burnout. How much of an issue is burnout in family medicine?

Dr Knight: It's very important to think about the concepts of burnout and well-being as part of a continuum. The absence of burnout is not the presence of well-being. Interestingly, the presence of well-being does not mean that someone isn't burned out. It is a little confusing at times. At the AAFP, we recently surveyed our members and found that some of the same members who report feeling burned out also report a high sense of well-being. Approximately 80% of survey respondents reported that they had a good sense of well-being. However, 50% said they had burnout. There is this overlap of people who state that they feel well overall but are burned out.

Burnout is a work-related phenomenon. At the AAFP, we really are focused on trying to figure out the issues that lead to burnout and, more important, the things that folks can do to help themselves personally prevent being burned out, even if they practice in a stressful situation that at times isn't particularly satisfying.

What Causes Burnout?

Medscape: What have you found about those factors that seem to cause burnout?

Dr Knight: We know through the research conducted by the American Medical Association and the Rand Corporation[1] that physicians value the opportunity to provide high-quality care. Physicians who feel like they're providing high-quality care have higher levels of satisfaction than physicians who feel like they aren't able to provide high-quality care because of barriers that they're encountering.

One of those barriers can be the electronic health record (EHR). That same study found that physicians who report that they are able to effectively use the EHR to help improve care have higher levels of satisfaction than physicians who feel that the EHR is a barrier to being able to provide the care they want to provide.

Another systemic factor is related to the issue of performance metrics, which are increasingly common and important to physician evaluation. Physicians who believe in the credibility of the measures to which they are held and report that they are impactful to the health of a patient are more likely to report that these measurements support their ability to provide the quality of care that they want. If the measures don't feel genuine, then it feels like it's just checking boxes or reporting for the sake of reporting, rather than for truly improving quality of care. The whole issue of measures is complicated. Just because you can measure something doesn't mean it's important. And, unfortunately, there are a lot of important things that aren't particularly measurable.

Physicians want to feel that they are practicing in an autonomous fashion and that they are engaged in what they are doing, in their relationships with patients. External measures that are not relevant can feel transactional and lead to a sense of being a commodity in an organization. Unfortunately, if physicians don't feel respected, engaged, heard; if they don't feel that they're really a part of fulfilling the mission of care, then what they are doing becomes a job rather than the calling that medicine is meant to be.

When it's a job, then the focus can become pay. And that is when you hear a lot of physicians saying that they need to be paid more, and also when you hear hospital or practice administrators say that all physicians care about is money. When I hear those things, it tells me that the root cause is that doctors aren't being heard about the level of respect, autonomy, fulfillment of mission, and purpose—and the only thing left that can be controlled to some extent is money.

To circle back to the topic of quality measures, physicians have to feel engaged and confident in those measures if they are really going to lead to improvements in performance. And it is important for organizations to be aware of that.


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