Position Statement Tackles Sleep to Prevent Physician Burnout

Megan Brooks

April 06, 2020

There is a pressing need to evaluate the role of sleep disruption, sleep deprivation, and circadian misalignment in physician well-being and burnout, the American Academy of Sleep Medicine (AASM) says in a new position statement.

This may pave the way to develop effective countermeasures that promote healthy sleep, "with the goal of reducing burnout and its negative impacts such as a shrinking physician workforce, poor physician health and functional outcomes, lower quality of care and compromised patient safety," the AASM says.  

The position statement on sleep and burnout in physicians was developed before the current COVID-19 pandemic hit, but it's even more relevant now with healthcare workers on the frontlines working long shifts back-to-back for days, Indira Gurubhagavatula, MD, MPH, who chairs the AASM public safety committee that developed the position statement, told Medscape Medical News.

Hospital leadership need to take a proactive role to make sure frontline workers have the opportunity for restorative sleep between shifts. This may mean rest breaks, nap rooms, counseling to reduce stress-related insomnia, and education about healthy sleep habits, she said.

"Helping them operate at their best by supporting healthy sleep means healthcare workers may be more effective at work," said Gurubhagavatula. Unfortunately, "we live in a society that tends to undervalue sleep," she said.

The position statement was published online February 28 in the Journal of Clinical Sleep Medicine.

Burnout Underappreciated, Overlooked

Physician burnout is a "significantly underappreciated public safety issue, and sleep loss is often overlooked as a contributing factor," the statement notes.

While burnout prevalence is unknown, "recent estimates of physician burnout  are quite high, approaching 50% or more, with mid-career physicians at highest risk," the statement authors note.

"Even before the COVID-19 pandemic, we were facing an epidemic of burnout among physicians. Surveys have revealed that around half of all practicing physicians are experiencing burnout," said Gurubhagavatula, with the Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia.

There is a wide body of research on sleep deprivation and burnout among residents, but far less is known about sleep and burnout among practicing physicians, she noted.

"Burnout is leading some of the most experienced physicians to exit the workforce and retire prematurely, further worsening the physician shortage," she said.

In a companion article, Gurubhagavatula and colleagues outline research priorities that include quantifying the impact of sleep loss, circadian misalignment, and sleep disorders on burnout.

They also want to determine the efficacy of institutional interventions to mitigate burnout by assessing sleep as a modifier. Such tactics could include  promoting autonomy in scheduling to enhance circadian alignment; implementing duty-hour limitations; reducing cognitive demand by eliminating nonessential tasks; improving meaningful engagement by limiting documentation needs; providing debt relief; and consolidating continuing medical education (CME) and maintenance of certification (MOC) requirements.

Other priorities include evaluating the effectiveness of direct sleep-related countermeasures on burnout and examining the impact of improving sleep quality and quantity on physician burnout and related patient outcomes.

"If we find that the lack of healthy sleep is a key factor that contributes to burnout in healthcare workers, then we can take steps to restore healthy sleep and see how well those interventions can ultimately improve burnout," said Gurubhagavatula. "Doing so helps not only our healthcare providers, but our patients as well."

This research had no commercial funding. The authors have disclosed no relevant financial relationships.

J Clin Sleep Med. Published online February 28, 2020.
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