Physician Burnout and Medical Liability Risk

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[To download a pdf version of this article on Physician Burnout and Medical Liability Risk, click here.]

Burnout among physicians is reaching epidemic proportions.

A major national study conducted by Dr. Tait Shanafelt and published in 2012 found that 45% of physicians report feeling at least one of the three principal symptoms of burnout.[i]

Those symptoms include: Emotional exhaustion, depersonalization and a reduced sense of personal accomplishment.[ii]

This is characterized by decreased empathy and connection with patients, which sometimes extends into sarcasm and cynicism, loss of enthusiasm and meaning for the work that they do, increased job dissatisfaction and increased medical errors.[iii]

The main causes of burnout among physicians are low reimbursement, low autonomy, patient overload, perceived lack of respect, as well as excessive hours and lack of control over the number of hours worked.

With pressure mounting in the landscape of medicine, this epidemic will only get worse, particularly among primary care and emergency room physicians who are burdened under The Affordable Care Act with greater patient load, increased clerical tasks due to EMR documentation requirements, increased emphasis placed on outcomes, and the almost impossible burden to keep up to date with the ever evolving medical literature and increasing complexity of medical decision making.

The question is, what is the risk posed by physician burnout and is there evidence to demonstrate that initiating resilience programs can mitigate that risk?

How does physician burnout affect medical liability claims?

The evidence indicating that burnout affects medical error and liability claims is strong and building.

A 2008 study of approximately 7900 surgeons found that major medical errors were strongly related to a surgeon’s degree of burnout.

Looking at depersonalization, one of the three big manifestations of burnout, the study found that on a scale of 0-33, each point increase in depersonalization resulted in an increase in self-reported error by 11%.

It further found that on a scale of 0 to 54, each one-point increase in emotional exhaustion increased self-reported medical error by 5%.[iv]

Studies also show a correlation between physician burnout and patient satisfaction, where patient dissatisfaction is correlated with an increase in medical liability.

A study of 353 physicians at Brigham and Women’s Hospital found that compared with physicians with the top patient satisfaction survey ratings, the middle tertile had 26% higher malpractice rates. The bottom tertile had malpractice rates 110% higher.[v]

The combination of increased medical error combined with increased patient dissatisfaction resulting from physician burnout is a recipe for increased medical liability claims.

This can ratchet up when you take burnout to an even higher level: that of the “disruptive physician.”

Examples of disruptive physician behavior include: degrading comments or insults, refusal to follow protocols, yelling, refusal to cooperate with others and profanity, among other things.[vi]

According to researcher Stephen D. Brown, “Disruptive physician behavior may diminish productivity, lead to medical errors and compromise patient safety.”[vii]

Disruptive behavior not only increases medical errors and preventable adverse outcomes, but also contributes to increased healthcare provider turnover and decreased patient satisfaction, and results in increases to the cost of care.

How implementing physician resilience programs can help reduce claims

Physician burnout poses a significant and growing risk of medical liability claims.

Conversely, physician satisfaction is strongly correlated with patient satisfaction (including patient confidence, adherence and perception of quality of care) and lower medical malpractice rates.

39169580-caring-doc-450x675So the question is, if stress, burnout and disruptive behavior increases the potential for medical error, adverse outcomes, patient dissatisfaction and ultimately medical liability claims, what if you could reduce stress, burnout and disruptive behaviors with physician resilience programs, and in the process create more engaged, focused, positive physicians?

Is there any evidence that implementing resilience programs can reduce risk?
In fact, there is. In a study evaluating the effect of a stress management program to promote physician well-being at the organizational level, researchers looked at 22 participating hospitals relative to 22 control hospitals matched for size, practice scope, geography, and baseline frequency of malpractice claims. They found malpractice claims over the ensuing year were reduced by 70% at intervention hospitals compared with a 3% reduction at control hospitals.[viii]

Another study shows that one of the most effective stress management programs for helping physicians deal with burnout, empathy and attitudes is a program based in mindfulness.[ix]

Mindfulness is a practice that cultivates awareness, compassion and emotional resilience. Mindfulness based stress reduction programs work to reduce stress and burnout and help physicians find more meaning and fulfillment in their lives.

Consequently adopting stress management programs at the organizational level, including programs based in mindfulness, could significantly reduce burnout among healthcare workers and ultimately reduce the risk it poses.

All it takes is leadership to address this element of stress and burnout in a comprehensive and meaningful way, which encourages and supports physicians to participate.

Medical liability insurance providers already play such a vital role in protecting the well-being of their clients. Sponsoring resilience programs for their insureds would add tremendous value which would not only to improve the quality of life of health care providers, but also to further mitigate the risk and thereby reduce the liability claims that result from burnout.

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Daniel Friedland, MD is Chair of the Academy of Integrative Health and Medicine and President & CEO of SuperSmartHealth, which delivers live and online mindfulness- and neuroscience-based physician resilience and conscious leadership programs to healthcare providers and corporate executives. To learn more about his physician resilience program, click here.

[i] Shanafelt, TD, Arch Int Med 2012 Aug 20: 1-9

[ii] Maslach, C. & Jackson, S.E. The measurement of experienced burnout. Journal of Occupational Behavior. 1981;2:99-113.

[iii] Dyrbye LN, Shanafelt TD. Physician burnout: a potential threat to successful health care reform. JAMA. 2011 May 18;305(19):2009-10.

[iv] Shanafelt TD, et al. Burnout and medical errors among American surgeons. Ann Surg. 2010 Jun; 251(6):995-1000.

[v] Stelfox HT, et al. The relation of patient satisfaction with complaints against physicians and malpractice lawsuits. Am J Med. 2005 Oct;118(10):1126-33.)

[vi] Disruptive Physician Behavior. Study of 842 physicians and physician leaders from QuantiaMD and the American College of Physician Executives (ACPE).

http://www.quantiamd.com/q-qcp/quantiamd_whitepaper_acpe_15may2011.pdf

[vii] Beyond Substance Abuse: Stress, Burnout and Depression as Causes of Physician Impairment and Disruptive Behavior, Stephen D. Brown, et al., J Am Coll Radiol 2009;6:479-475.

[viii] Jones JW, Barge BN, Steffy BD, Fay LM, Kunz LK, Wuebker LJ. Stress and medical malpractice: organizational risk assessment and intervention. J Appl Psychol.

1988;73(4):727-735

[ix] Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293.

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