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Burnout is Overused and Under Defined

Posted on December 8, 2017 I Written By

When Carl Bergman isn’t rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

Recently, John hosted a #HITsm chat on using technology to fight physician burnout (Read the full transcript from the chat here). The topic’s certainly timely, and it got me to wondering just what is physician burnout. Now, the simple answer is fatigue. However, when I started to look around for studies and insights, I realized that burnout is neither easily defined nor understood.

The Mayo Clinic, among others, defines it this way:

Job burnout is a special type of job stress — a state of physical, emotional or mental exhaustion combined with doubts about your competence and the value of your work. 

So, it is fatigue plus self doubt. Well, that’s for starters. Burnout has its own literature niche and psychologists have taken several different cracks at a more definitive definition without any consensus other than it’s a form of depression, which doesn’t have to be work related.

Unsurprisingly, burnout is not in the DSM-5. It’s this lack of a clinical definition, which makes it easy to use burnout like catsup to cover a host of issues. I think this is exactly why we have so many references to physician or EHR burnout. You can use burnout to cover whatever you want.

It’s easy to find articles citing EHRs and burnout. For example, a year ago April, The Hospitalist headlined, “Research Shows Link Between EHR and Physician Burnout.” The article then flatly says, “The EHR has been identified as a major contributor to physician burnout.” However, it never cites a study to back this up.

If you track back through its references, you’ll wind up at a 2013 AMA study, “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy.” Developed by the Rand Corporation, it’s an extensive study of physician job satisfaction. Unfortunately, for those who cite it for EHR and burnout, it never links the two. In fact, the article never discusses the two together.

Not surprisingly, burnout has found its way into marketing. For example, DataMatrix says:

Physician burnout can be described as a public health crisis especially with the substantial increase over the last couple of years. The consequences are significant and affect the healthcare system by affecting the quality of care, health care costs and patient safety.

Their solution, of course, is to buy their transcription services.

What’s happened here is that physician work life dissatisfaction has been smushed together with burnout, which does a disservice to both. For example, Medscape recently published a study on burnout, which asked physicians about their experience. Interestingly, the choices it gave, such as low income, too many difficult patients – difficult being undefined — are all over the place.

That’s not to say that all physician burnout studies are useless. A recent study, Electronic Health Record Effects on Work-Life Balance and Burnout Within the I3 Population Collaborative, used a simple, five item scale to ask physicians how they viewed their work life. See Figure 1.

Figure 1 Single-Item Burnout Scale.

Their findings were far more nuanced than many others. EHRs played a role, but so did long hours. They found:

EHR proficiency training has been associated with improved job satisfaction and work-life balance.14 While increasing EHR proficiency may help, there are many potential reasons for physicians to spend after-hours on the EHR, including time management issues, inadequate clinic staffing, patient complexity, lack of scribes, challenges in mastering automatic dictation systems, cosigning resident notes, messaging, and preparing records for the next day. All of these issues and their impact on burnout and work-life balance are potential areas for future research.

There’s a need to back off the burnout rhetoric. Burnout’s overused and under defined. It’s a label for what may be any number of underlying issues. Subsuming these into one general, glitzy term, which lacks clinical definition trivializes serious problems. The next time you see something defined as physician or EHR burnout, you might just ask yourself, what is that again?

The Whole Healthcare System is Burnt Out

Posted on November 2, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


We’ve all seen charts and graphs like the one above. Physician burnout has become a real problem. The EHR has largely become the scapegoat for the physician burnout, but I believe it’s much more complex than that. There are a lot of pressures on doctors that are causing burnout and even physician suicide (a topic which many don’t like to talk about).

Physician burnout is indeed an important topic and one that needs to be addressed. However, I recently saw someone tweeting about physician burnout and in response, someone suggested that we should be talking about Patient Burnout as well. The idea really resonated with me. Especially because I’d never heard anyone talk about patient burnout despite it being a real problem. To better understand the effort, I asked Erin Gilmer to host this week’s #HITsm chat on Patient Burnout. I think we’ll learn a lot about this topic during the chat.

This week I’m at the CHIME Fall Forum with a wide variety of healthcare CIOs. During one of the keynotes, the speaker mentioned physician burnout and it prompted the following tweet:


Indeed. Many healthcare CIOs are burnt out as well. They have so many regulations, so many intiatives, cybersecurity issues, and much much more that’s hitting them from every angle. it’s no wonder that they’re burnt out.

This all made me realize, the whole healthcare system is burnt out. Is there anyone in healthcare that isn’t a little burnt out? Some deal with it better than others, but there’s a lot of burnout all around in healthcare.

This tweet captured the issue of burnout nicely.


How then do we fix all this burnout? I wish I knew the answer. Acknowledging it is the first step, but that still leaves us a long way from a solution. Hopefully we can work towards it for everyone involved.

Physician Burnout Cartoon – Fun Friday

Posted on September 29, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you haven’t noticed, I love irony. That’s why this cartoon from Pediatrician and Cartoonist Dr. Maypole was perfect for a Fun Friday entry.

The sad part of this Fun Friday is that this is far too true for far too many doctors. The one good thing is that people are now recognizing it and working to address it in their workforce as Dr. Maypole suggests we do.