Physician Burnout — and Resilience

Leadership Survey: Immunization Against Burnout

Insights Report · April 12, 2018

Analysis of the NEJM Catalyst Insights Council Survey on Leadership: Immunization Against Burnout. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

Download Full Report

Advisor Analysis

By Stephen Swensen, Steven Strongwater, and Namita Seth Mohta

We were not surprised that 83% of respondents — who are clinicians, clinical leaders, and health care executives — call clinician burnout a “serious” or “moderate” problem in their organizations. That could be considered a slight improvement from the findings of our fall 2016 survey on burnout, when 96% of Insights Council members said physician burnout was a serious or moderate issue. It is clear, however, that the problem remains prevalent.

This most recent survey also finds burnout a major concern for registered nurses (78% say it is a serious or moderate problem), advanced practice nurses (64%), clinical leaders (56%), and health care executives (42%).

With such a large swath of health care organizations affected, leaders and frontline clinicians have become thirsty for solutions. After all, the damage to their business and culture can be quite severe — from straightforward pocketbook issues (at Steven Strongwater’s employer, Atrius Health, it costs between $500,000 and $1 million to replace a physician) to a well-studied breakdown in patient satisfaction and the quality of care. Clinicians feel the impact of burnout by reducing their hours, switching to administrative roles, or leaving health care altogether, taking them away from why they chose medicine in the first place: to treat patients.

Physician Clinician Burnout Is Extensive

From the Leadership Insights Report: Immunization Against Burnout. Click To Enlarge.

While it might seem a trivial place to start, many organizations have stopped referring to the condition as “burnout,” realizing the word has something of a contagious effect. Instead, they are using more positive and aspirational nomenclature such as “esprit de corps” and “joyfulness in work.”

No one is under the illusion, though, that simply swapping to more optimistic language will solve this predicament. Instead, interventions must be targeted at multiple levels: provider organizations, regulators (specifically around payer/documentation requirements), the work unit leader, and individual clinicians. In the survey, 82% of respondents place the onus on organizations, through system and infrastructure improvements, but we believe interventions should be a shared responsibility with the individual (chosen by 47% of respondents).

What complicates the organizational approach to burnout is that physicians and nurses experience burnout in very different ways. We have found the drivers of physician burnout to be workload, work/life balance, cognitive dissonance, and clerical work, while nurses more often suffer burnout due to compassion fatigue, moral distress, and work environment issues such as psychological safety and hostility. There is also variation between specialties and practice locations.

There is broad agreement on the need for more face-to-face time between clinicians and patients and less time spent on the electronic medical record and documentation. A little over half of survey respondents recommend offloading clerical tasks to scribes, pharmacy technicians, or population health facilitators. That way, physicians and nurses (and all clinical team members) can work appropriately at the top of their licensure. The next most popular solution, chosen by 46% of respondents, is improving the functionality and interactivity of EMRs and other IT systems.

That theme came up consistently in verbatim responses to the survey, with one respondent hoping to “treat patients rather than treat the chart.” At Atrius, efforts are under way to improve clinician workflow in the EMR, ranging from reducing inbox messages to changing staffing patterns, but deployment of those processes is two years out. Some organizations have shared with us that they don’t have the resources to invest in better systems, workflow, and people to alleviate burnout, so it has fallen on clinicians to be more resilient.

In addition to improving IT systems, we believe organizations should focus on improving the communication and management skills of their point-of-care leaders. After all, employees don’t tend to leave organizations, they leave their managers.

Self-care is another important part of the solution to burnout. Clinicians cannot resolve these complex issues on their own, but neither are they helpless victims. Until structural changes are deployed, individual mitigation strategies can be effective. Just over half of survey respondents rate self-care as the top tool to reduce individual clinician burnout, which can include meditation, yoga, and engaging in a hobby.

Where organizations and individuals can work together is in creating incentive models and positive role models that encourage wellness. Together they can strengthen camaraderie, time for creativity, purposefulness, and personal resilience. Leaders can encourage self-care by setting up protected, guilt-free personal time for clinicians.

Leaders should get in the habit of measuring clinician joy, camaraderie, engagement, and satisfaction, just as you would a patient’s vital signs. You can use regular unit-based voluntary surveys to measure these characteristics. Only measure them, however, if you are committed to improving them. It may also be helpful to collect and manage metrics on the efficiency of EMR use, such as how many clicks are required for certain conditions and unit workflows. When there is substantial variation, super users can help colleagues improve their efficiency and reduce their work hours. Unless you measure it, it won’t get better.

While a majority (60%) of Insights Council members believe clinician burnout will worsen over the next two to three years, 15% of respondents believe the situation will improve over the next two to three years. Count us in the optimistic camp, as we already see EMR vendors trying to make improvements to their technology and organizations trying to return meaningfulness to clinician work.


What is the one thing you would do to reduce clinician burnout at your organization?

“It has to be more than one thing: 1) Does the organization have a robust improvement department and have all administrators, physicians, and clinicians agreed to actively pursue and participate in improvement, this is critical. 2) EMR optimization. 3) All clerical and documentation work (see #1 for how to fix). 4) Culture & camaraderie.”
— Director of a midsized community hospital in the Midwest

“Engage clinicians in decision making and innovation activities.”
— VP of a small university hospital in New England

“Develop a more team-based approach to care instead of our current model which places the burden of documenting and education on the physician. Reducing the clerical tasks currently burdening physicians will help considerably as will revamping physician compensation as the drive to see more patients to rack up RVUs is a contributing factor to physician satisfaction.”
— Chief Medical Officer of a large physician organization in the South

“Improve efficiency of busy work so they can focus on the real purpose.”
— Executive of a large nonprofit health system in the Midwest

“Improve ability to care for self.”
— Clinician at a for-profit organization in the mid-Atlantic

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council, who comprise health care executives, clinical leaders, and clinicians, about clinician burnout. The survey covers the extent of clinician burnout at their organizations, the extent of burnout among other groups at their organizations, the level of clinician burnout over the past 2–3 years and expected during the next 2–3 years, where interventions to reduce burnout should be targeted, and tools that individuals and organizations are using to reduce burnout. Completed surveys from 703 respondents are included in the analysis.

Physician Clinician Burnout Is Widespread Among Nurses

From the Leadership Insights Report: Immunization Against Burnout. Click To Enlarge.

Nearly all respondents (96%) say physician burnout is a problem in their organizations to some degree. Just over a third consider it a serious problem, while nearly half say the problem is moderate. Respondents at health systems (44%) are more likely to say it’s a serious problem than those at hospitals (36%). Executives, clinical leaders, and clinicians agree about the extent of the problem. In a written comment, one Insights Council member attributes burnout to the change in the business of medicine. “We are not a corporate culture. Medicine is a practice and tying a physician to a corporate model is the one driving force that leads to burnout,” the respondent says.

Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.

Download Full Report

Check NEJM Catalyst for monthly Insights Reports not only on Leadership, but also on the New Marketplace, Care Redesign, and Patient Engagement.

Join the NEJM Catalyst Insights Council and contribute to the conversation about health care delivery transformation. Qualified members participate in brief monthly surveys.

New call for submissions ­to NEJM Catalyst

Now inviting longform articles


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Nurse Leaders and Physician Leaders Should Be Considered Equals in Care Delivery - but Views of Nurses and Non-Nurses Differ

Leadership Survey: Nurses as Leaders: Broad Acceptance, Room to Grow

Nurses are traditionally the backbone of patient care. They form the largest percentage of the health care workforce, far outstripping physicians. But are nurses leaders as well as doers?

The CMO Role of the Future - Baptist Health Survey Results

Examining the Continuously Evolving Role of the Chief Medical Officer

Hospital and system leaders need to sharpen the focus of CMO roles to include system-wide considerations beyond the walls of the hospital.

Meyer01_header - Seven Challenges and Seven Potential Solutions for Large-Scale EHR Implementation

Seven Challenges and Seven Solutions for Large-Scale EHR Implementations

Salient lessons learned over multiple electronic health record implementations.

Zuckerberg San Francisco General Hospital ZSFGH A3 thinking Personal Development Plan A3 leader standard work improvement management example board

Changing Leadership Behavior Gets Real Results

Zuckerberg San Francisco General Hospital deployed its new leadership culture, which emphasizes staff decision-making, self-reflection, and clarity in defining problems and goals, to successfully address a crisis involving record-high patient volumes.

Khatri02_pullquote Connectors

The Crucial Role of Connectors in Large Health Care Organizations

Creating a truly collaborative community involves connecting the right people at the right time and in the right places.

Women of Impact Checklist - Advancing Workplace Equity

Lead In: Women of Impact in Health Care on Advancing Equity in the Workplace

Raising the standards of equity and wellness in our workplaces so we effectively advance health for the populations we serve.

Historical and Projected Numbers of Physicians, Nurse Practitioners, and Physician Assistants.

Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce

The number of NPs and PAs is growing rapidly, while physician supply has slowed. This research projects the number of NPs, PAs, and physicians through 2030.

IBM solutions to physician burnout roundtable participants: Christina Maslach, Paul DeChant, Tait Shanafelt, Namita Seth Mohta, Karen Weiner, Edward Prewitt

NEJM Catalyst Roundtable Report: Seeking Solutions to Physician Burnout

An NEJM Catalyst roundtable sponsored by IBM Watson Health brought together four experts, all deeply engaged in reducing physician burnout from different perspectives, to share in a robust discussion.

Pottharst01_pullquote - value-based health care leadership personas

Personas of Leadership in Value-Based Care

The deliberate nurturing of specific types of leadership personas seems to be a critical factor in the success of value-based care organizations.

Few Truly High-Performing Health Care Organizations

Survey Snapshot: What the High Performers Have to Say

NEJM Catalyst Insights Council members from high-performing institutions share their perspectives on what’s working and what needs improvement.


A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »


Leading Transformation

242 Articles

Prescription for an Ailing U.S. Health…

Three components for treating the unhealthy, uncompetitive U.S. health care market — beginning with a…

Team Care

100 Articles

Leadership Survey: Nurses as Leaders: Broad…

Nurses are traditionally the backbone of patient care. They form the largest percentage of the…

Physician Burnout

43 Articles

Patient Engagement from Both Sides of…

When patients and families are included in medical rounds as valued members of the team,…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now