A new report shows that endless administrative tasks and stigma around seeking help have created a culture of fatigue among doctors and nurses.

Tired doctor rests her head on her hand in front of a computer. ©Getty Images

Piles of paperwork. Unpredictable work schedules. Being surrounded by suffering. Frustrating technology.

It’s no surprise that doctors and nurses experience job-related stress. But a recent report published by the National Academy of Medicine found that 35 to 54 percent of nurses and doctors, as well as 45 to 60 percent of medical students and residents, have experienced symptoms of a serious condition known simply as “burnout.” The report, which examines the safety, health, and well-being of health professionals and shows how clinicians’ fatigue can impact patients, was written by a committee of 17 health experts, including José Pagán, professor and chair of the Department of Public Health Policy and Management at the NYU College of Global Public Health. 

Burnout—which is characterized by emotional exhaustion, detachment, and a low sense of personal accomplishment—is a job-related condition that results from chronic workplace stress. For doctors and nurses, burnout can be attributed to the mounting pressures of the US health care system, including long hours, inadequate staffing, and having to spend an excessive amount of time on documentation and other administrative tasks, rather than caring for patients. A 2017 study of family medicine doctors found that they spend an average of 5.9 hours each day tending to electronic health records—or more than 60 percent of their 11.4-hour workday.

That’s bad news for both clinicians and patients, according to the authors of the new National Academy of Medicine report. For doctors and nurses, burnout can increase their risk for depression, alcohol use, and suicide, and can cause them to leave the profession altogether. For patients, having exhausted clinicians may profoundly impact the quality of care they receive and can boost the likelihood of medical errors. 

Pagán and his coauthors note that the problem should be addressed through organization-wide improvements in workload, workflow, and technology geared toward clinician needs, plus complementary efforts to support individuals, such as by offering mindfulness education. “Given the importance of burnout to health care quality and safety and the pervasiveness of burnout, there is a strong imperative to take a systemic approach to reduce it, focusing on the structure, organization, and culture of health care,” the authors write in the report.

NYU News asked Pagán to outline some of the biggest challenges for addressing burnout, as well as some solutions that could help protect health professionals, and ultimately, their patients.

Hospital leaders need to make burnout a priority.
"Executive leaders and governing boards of health care organizations can commit to monitor the work environment more carefully. Health care organizations can also go further by, for example, creating an executive leadership role—a chief wellness officer—whose main function is to improve and sustain professional wellbeing among the health care workforce."

José Pagán

José Pagán

Electronic health records (EHRs) can be a time suck, but don’t have to be.
"The problem is not the use of EHRs, but how EHR systems have been implemented by many health care organizations. Some doctors spend an inordinate number of hours per day doing documentation and managing their inbox. There is evidence that spending too much time doing this kind of work is associated with burnout. The need for sustained collaboration between EHR vendors, health information technology system developers, and clinicians is necessary to optimize how EHR systems are used to improve health care quality and clinician wellbeing."

Stigma keeps clinicians from getting help, but can be addressed through changing the culture and attention to privacy.
"Health care professionals often struggle when they need to seek emotional or mental health. Some of the difficulties are related to the culture and training in health professions, but some of the struggles are also related to fears about how, for example, licensure boards react to the need for help from clinicians, or how personal health information may be used in the future. There is a need to change the culture and the way in which we train health care professionals so that they feel comfortable seeking the help they may need. State licensing boards and insurance carriers can also be more protective of personal health information."

Medical and nursing schools can help address burnout, too.
"Training to be a physician or nurse is intense. Coping strategies to deal with stress may not be fully developed early in the career of clinicians. There are also issues such as accumulated school debt that may add stress early in a career. Medical and nursing schools can help by providing resources such as teaching coping strategies or helping students decrease the level of debt related to their training."

To read the full report, visit nam.edu/ClinicianWellBeingStudy.