by Dennis Cooley MD, FAAP
Chair District 6
All of us know of colleagues who have suffered the effects of burnout. Many of you are probably experiencing it yourself. We all know the symptoms. The feeling of being overextended, emotionally exhausted, depersonalized and questioning our personal accomplishments. The more lack of control we have in our work the frustrations builds and we ask ourselves: “Why am I still doing this?”
Recognition of physician burnout has come to the forefront in recent years. ( The term ‘burnout’ is unpopular in many quarters but I am using it here because it is still commonly used and understood by most physicians) The numbers are staggering. Anywhere from 30-50% of American physicians exhibit symptoms. In a 2014 study done at Lucille Packard Children’s Hospital 50% of 1st year residents suffered signs of burnout by February of that first year. Suicide rates in physicians are higher than the general public. Internal effects of stress are now known to cause inflammatory responses, and impairment of the immune system affecting multiple organ systems and resulting in chronic health problems. And pediatricians tend to have characteristics, such as compassion, altruism, and perfectionism, that predispose to burnout.
Efforts from organized medicine, including the AAP, have centered on reducing stress and developing resilience and coping skills among physicians. These are extremely important because they can have an immediate impact. But what about changing the sources of burnout? Specifically I am looking at our practice environment. In the nearly 40 years that I have practiced pediatrics the biggest change that I have seen in our practice environment has been the introduction of the EHR. How is this impacting us?
According to a 2019 article from Journal of Pediatrics pediatricians on average are spending 3.4 hours daily on clinical documentation. In a recent AAP survey 52% of early and mid career pediatricians feel that finishing work from home after hours causes moderate to severe stress. Forty eight% of those same pediatricians listed documenting in EHR as being moderately or very stressful. Among other significant causes of stress were non- clinical activities and completing external regulatory requirements. In my opinion most of these sources of stress are caused by the inherent problems and inefficiencies that are found with EHRs.
This is not to say that the EHR is the sole cause of burnout and if we somehow eliminated the EHR we would be happy with work and burnout would vanish. Other causes of physician stress that contribute to burnout are numerous and have been around for a very long time. But many surveys indicate that EHRs are the number one cause of physician burnout. It is EHRs and all of the problems associated with them that in my opinion has been the tipping factor.
We are not going to eliminate the EHR. But we can try and adjust our practices to help ease these burdens by making EHRs more efficient and less time consuming. The AAP has a web site that may help you in these efforts. I have listed the link below. ( If this doesn’t work google AAP Wellness and you can find the sites). In addition it is up to the AAP and other organized medicine groups to work at the national level with EHR providers to make their products more physician friendly. They need to work at the national level also to reduce regulatory requirements that have no documented benefit to patient care and outcomes. In short we need to return to being pediatricians and not clerical workers.
Link to AAP Wellness Site:
https://www.aap.org › en-us › physican_health_wellness › Pages
