Burnout, Professionalism, and the Quality of US Health Care

Physician burnout is a major threat to health care quality, patient outcomes, and the vitality of the
medical workforce.1
More than half of US physicians report at least 1 symptom of burnout—nearly
twice the rate of the general working population—and many also experience depression, anxiety, or
suicidal ideation.2 Burnout is estimated to cost the health care system at least $4.6 billion annually,
with the greatest burden attributable to turnover and work-hour reductions among primary care
Many factors have been linked to burnout, including physician age, sex, and specialty;
workplace leadership and culture; and practice type and compensation model.1
however, 3 forces drive burnout: pressure to care for too many patients in too little time and with too
few resources; expectations to engage in activities felt to be rote, irrelevant, or counterproductive;
and an inability to meet the medical or social needs of patients. Each assails physicians’
professionalism and threatens the delivery of compassionate, high-quality care.
Critics sometimes portray professionalism as a self-serving myth, an ill-defined concept used to
ward off needed quality control from external entities. But professionalism may be among the most
effective tools we have to improve care.3 Physicians are not perfect, but they are deeply motivated to
do right by patients, to improve as clinicians, and to earn the respect of their colleagues. Moreover,
the inevitable asymmetry of information between physicians and patients—and between physicians
and regulators—requires the physicians’ enthusiastic (as opposed to grudging) support of health
system reforms.
But instead of taking professionalism seriously as a path to deliver better care, policy makers,
insurers, and organizational leaders have often sought to replace it with extrinsic penalties and
rewards, and in some cases, have abused it to fill gaps in a dysfunctional system. Many physicians
experience a disheartening lack of control over their time and attention, over what must be discussed
with patients, and over how clinical encounters are to be structured and documented. Payers have
introduced pay-for-performance programs that, in addition to increasing administrative burdens,
encourage physicians to focus on a limited set of process measures (many of which are not
supported by evidence) at the expense of holistic and personalized care. Meanwhile, physicians
often feel disconnected from or resentful of the organizations in which they work for failing to
support professional autonomy, reasonable work hours, and healthy relationships.

Concrete steps can be taken toward a better system. These include reforming payment models
to increase time with patients, reducing the burden of clerical tasks, and supporting physicians in
meeting the medical and social needs of patient..