June 2, 2020
Provider Burnout and the Risk of Malpractice
Healthcare providers are more likely to experience signs and symptoms of burnout
May 1, 2018
By Suze Kopynec, MPAS, PA-C, DFAAPA
Healthcare provider burnout is prevalent, and awareness of this serious issue is expanding. Studies have shown that over half of physicians in the United States admit to having at least one of its signs or symptoms1. The rate of burnout for physicians is nearly twice as high as other fields1. Burnout is most commonly measured by the Maslach Burnout Inventory. The Inventory has 22 items and measures three dimensions: emotional exhaustion, depersonalization, and lack of self-efficacy. Common indicators of burnout include a feeling of depleted resources, being detached or callous, harboring negative attitudes toward others, and diminished feelings of accomplishment. Depression can also be a problem for physicians; there are nearly 400 physician suicides each year2.
PAs, NPs, and Nurses Also Burn Out
While burnout studies typically focus on physicians, the burnout incident among PAs, NPs and Registered Nurses (RNs) is also quite high1. Many individuals who score high on the burnout scales (in limited studies) have relatively high levels of personal job satisfaction. Like physicians, PAs, NPs, and RNs have all the stressors associated with working and a busy personal life, plus they have patients with significant care needs. This leads to emotional exhaustion, an issue that impacts nearly 43% of RNs3. More research is needed to determine comprehensive burnout and depression rates for these medical professionals as well as the role that job satisfaction has on burnout and recovery.
Organizational Factors Contribute
Despite having busy clinical practices and home lives, healthcare providers do not cite these as reasons for burnout. Rather burnout’s highest contributors are organizational in nature such as too much charting, disrespect by others, mandated use of the EMR, feeling like a cog in the wheel, lack of autonomy, regulations, and maintenance of certifications4. Only one patient-related factor, ‘lack of respect from patients,’ was cited as a leading contributor4.
When providers are burned out they are often less productive5. Some voluntarily reduce their work hours5. This impacts financial indicators and puts added stress on those who have to cover shifts and patient cases. In some situations, burned out physicians terminate employment or retire early, thus leaving behind patients with access problems and an added workload for others. The cost to replace healthcare providers can range from $250,000 to millions of dollars if one factors in recruiting, onboarding, impact on those covering shifts, and loss of revenue or opportunity costs6. On a personal level, healthcare providers experiencing burnout may succumb to substance abuse, depression, and suicide7. Their interactions with other healthcare team members may also suffer. And, individuals who are burned out are more likely to make medical errors and be sued8.
Errors and Malpractice Suits
Medical errors are the third leading cause of death in the United States9. The rates for malpractice suits have dropped slightly for physicians although some specialties have over an 80% rate of being sued10. PAs and NPs also commit errors and are sued, although not as frequently as physicians11. Many physician-related studies have proven the association between burnout and errors12.Even when accounting for all personal and professional characteristics (specialty, gender, age, time in practice, hours worked, etc.) burnout is associated with malpractice suits13. And, the stress of the error and the lawsuit add to the burnout intensity in the form of the Malpractice Stress Syndrome8. Some individuals severely affected by burnout never recover. For others, it may take years.
The Cost of Burnout
Whether one is a healthcare provider, administrator, peer, or patient, burnout is a problem that affects us all. It takes both a financial and human toll on a system that is already running on thin margins, provider shortages, and access issues. Left unaddressed, burnout and its causative factors will continue to manifest at a personal level, with medical errors and lawsuits, terminations or early retirement, and generalized stress on an already at-risk workforce. With organizational factors leading the way of causative factors, we all must address as many system-related issues as possible.
AAPA’s 2018 Salary Survey reveals intriguing data on PA satisfaction at work and measures of fulfillment, exhaustion, disengagement and burnout.
- Klass, M. (11/13/17). Taking Care of the Physician. https://www.nytimes.com/2017/11/13/well/family/taking-care-of-the-physician.html
- Andrew L & Brenner B. (Updated: 6/12/17). Physician Suicide https://emedicine.medscape.com/article/806779-overview.
- Dyrbye L, Shanafelt T, Sinsky C, et.al. (7/5/17). https://nam.edu/wp-content/uploads/2017/07/Burnout-Among-Health-Care-Professionals-A-Call-to-Explore-and-Address-This-Underrecognized-Threat.pdf.
- Peckam C. (1/17/18). Medscape National Physician Burnout & Depression Report 2018. Medscape https://www.medscape.com/slideshow/2018-lifestyle-burnout-depression-6009235#5.
- Tuma, R.(10/27/17). Burnout May Be Costing Your Institution Millions Each Year, Medscape ttps://www.medscape.com/viewarticle/887195.
- Wright A and Katz, I (January 25, 2018). N Engl J Med 2018; 378:309-311 Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians.
- Phillips D. (8/30/17) Medscape. Surgical Residents Vulnerable to Malpractice Claims. https://www.medscape.com/viewarticle/885046. and Lu D, Dresden S, et. al. (2015 Dec; 16(7): 996–100). Impact of Burnout on Self-Reported Patient Care Among Emergency Physicians. West J Emerg Med.
- Sanbar S & Firestone M. Medical Malpractice Stress Syndrome. https://www.acep.org/globalassets/uploads/uploaded-files/acep/professional-development/faculty-development/medical-malpractice-stress-syndrome-article-for-web.pdf.
- Makary M, Michael, D. (5/3/16). Medical error 3rdleading cause of death in US. British Medical Journal.
- Charles, S. https://physicianlitigationstress.org/identifying-and-managing-stress/burnout-malpractice-litigation/.
- Dellabella H, ed. (5/16/16). PA malpractice case rates slightly increasing.
- Balch C, Oreskovich M, Dyrby L. et.al. (November 2011). Consequences of Malpractice Lawsuits on American Surgeons. J Am Coll Surg. 213(5):657-67;
- Barger L, Ayas N, Cade B, et. al. (12/12/06). Impact of Extended-Duration Shifts on Medical Errors, Adverse Events, and Attentional Failures. http://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.0030487&type=printable; Charles, S. https://physicianlitigationstress.org/identifying-and-managing-stress/burnout-malpractice-litigation/; Welp A, Meier L, and Manser S. (2015). Emotional exhaustion and workload predict clinician-rated and objective patient safety. Front Psychol.; SuperSmartHealth Staff. (8/14/14). Physician Burnout and Medical Liability Risk. http://supersmarthealth.com/physician-burnout-medical-liability-risk/; Hall HL, Johnson J. (2016; 11e0159015). PLOS ONE. Healthcare staff wellbeing, burnout, and patient safety: a systematic review.
Suze Kopynec, MPAS, PA-C, DFAAPA, is the Director of The Foundation of FirstHealth’s Center for Provider Wellbeing—an innovative program to address provider burnout by focusing on well-being through the lens of Positive Psychology. Contact her at [email protected]