Pharmacists and Burnout: The First Step Is to Acknowledge the Data about Providers

We know that burnout continues to plague health care professionals.

A study recently published in the Journal of the American Medical Association described physician burnout as an epidemic that affects health care delivery and patient safety.¹

Burnout is a trifecta of emotional exhaustion, depersonalization, and reduced personal accomplishment. Its symptoms include decreased job satisfaction, fatigue, insomnia, gastrointestinal issues, and increased drug or alcohol use. It can appear as irritability, isolation and withdrawal, absenteeism, or inattention to work.

We also know that burnout among pharmacists continues to increase. A 2014 National Pharmacist Workforce Study reported that two-thirds of participants described their workload as high or excessively high, and 45% reported that their workload had negatively impacted their emotional and mental health.²

Unfortunately, fewer studies specifically address burnout and its impact on pharmacists.

Despite the fact that pharmacists fall into virtually the same health care provider category, the pharmacy industry has less information available to explain the impact of burnout on pharmacists and their patients.

Despite the lack of research specific to pharmacists, all indications are that the industry won’t escape the impact of burnout. Pharmacists, after all, face many of the same challenges other providers do.

Electronic Health Records Increase Provider Stress, Pressure

Technology may be hurting the health care industry as much as it’s helping.

The Minimizing Error, Maximizing Outcome study, published in 2014, was the first to reveal that physicians reported increased stress and time pressure as a result of EHRs. Studies reported that one hour of direct-patient care generally results in 1 to 2 hours of EHR-related documentation.³

Additionally, the studies reported a direct relationship between after-hours documentation and higher rates of burnout. Specifically, physicians reported lower work-life satisfaction as a result of the increased EHR demands.

As pharmacists continue providing more patient care services, the EHR will continue to become more important in pharmacies, and the same consequences will likely emerge.

Walgreens’ pharmacy staff, for example, employs an EHR that gives its users at 8,200 locations a single view of a patient’s health records, including prescriptions and immunizations.

To provide the best possible patient care, pharmacists will eventually be connected with physicians via health information technology, which means they’ll face the same time challenges physicians do.

The pharmacy industry must work hard to ensure that pharmacists are included in the effort to develop health technology. Thround discussions like those at this week's Midyear meeting, organizations like the American Society of Health-System Pharmacists are working to ensure that pharmacists are included in the conversation about EHRs.

The rise of the informatics arm of pharmacy should help the industry contribute to the effort in hopes that the EHR improves the health care process instead of bogging it down.

Work Culture Contributes to Burnout

A study released in July of this year reported that health care providers’ tendency to experience burnout depended largely on their satisfaction with their worklife.⁴ Specifically, when there was a mismatch between professional goals and work life, the tendency for burnout increased.

On a daily basis, the study found that providers with positive social interactions at work were less likely to suffer burnout than those with negative work relationships.

Taken a step further, the study also found that the supervisor’s leadership style had a significant effect on burnout: when the supervisor was fair and supportive, burnout was less likely to occur. Finally, the study findings suggested that providers who felt insufficient personal control over the workplace or work goals were more likely to suffer from burnout.

These findings must matter to the pharmacy industry because pharmacists share many of these work experiences with other health care providers.

To start, pharmacists often report spending entire shifts working alone, without anyone to cover breaks or meals.

Aside from the fact that the workload is simply too heavy for a single person to safely accomplish, watchdog groups report that working without assistance is unsafe to both pharmacists and patients.

From a practical standpoint, pharmacists often operate in a setting that lacks any social interaction, much less positive ones.

When you account for the increasing demands on pharmacists’ time and the requirements to accomplish more work with fewer resources, pharmacists often experience the same difficult work conditions as other health care providers.

The pharmacy industry must be vigilant in caring for the mental and physical health of its pharmacists by creating a professional atmosphere that provides positive social interaction and a network of support for its providers.

Burnout Stigma Prevents Providers from Seeking Treatment

No one is more acutely aware of the stigma connected to burnout than health care providers. Like many other mental health issues, the emotional exhaustion, reduced sense of accomplishment, and cynicism associated with burnout carry a negative connotation, leaving providers hesitant to seek help.

In many cases, providers worry about the confidentiality of their health concerns and fear of repercussions from their colleagues and their employers. They fear, for example, having to disclose any mental health treatment during the application process for a medical license.

Additionally, health care providers are trained to be strong, and many fear that acknowledging a struggle translates to weakness.

Dike Drummond, CEO and Founder of TheHappyMD.com, believes the profession’s “patient-comes-first” approach may be a large contributing factor in that providers don’t turn that approach off at the end of the day. As a result, many fail to make time for the kind of self-care that could prevent burnout.

Drummond published a study in 2015 addressing the need to recognize burnout in order to effectively combat its impacts.⁵

He suggests a change to the Hippocratic Oath to more closely mirror the World Medical Association’s Declaration of Geneva, which was amended in 2017 to include the following statement:

“I will attend to my own health, well-being, and abilities in order to provide care of the highest standard.”

Perhaps the good news is that MD Magazine published an article last month addressing physician burnout and disability claims. Specifically, the industry is seeking ways for doctors to successfully file disability claims related to career burnout.

Drummond called the situation a “perfect storm” of providers focused on patients and an industry focused on everything but its workers, and he rightly argued that the industry must find a way to restore balance.

Burnout Impacts Medical Outcomes

The JAMA study of physician burnout found that providers suffering from the condition are twice as likely to deliver unsafe care in the form of incorrect diagnoses or inaccurate prescriptions. Burnout syndrome also doubles the likelihood that providers will engage in unprofessional behaviors, leading to malpractice or other negative consequences.

Finally, the study found providers suffering from burnout are three times more likely to experience low patient satisfaction. Specifically, the depersonalization common to those experiencing burnout was the greatest contributing factor for health care providers.

Additionally, the study researchers concluded that the incidence of unprofessionalism was greatest among early-career physicians.

Dr. Maria Panagioti, one of the study’s authors, noted that providers don’t bear responsibility for the current situation; instead, the study points to heavy workload, ineffectiveness of teamwork, and absence of mechanisms to improve provider well-being.

Limited Information Exists About Pharmacist Burnout

Earlier this year, 3 pharmacists published research in the American Journal of Health-System Pharmacy about burnout and pharmacists.⁶ The study, they said, was driven by the knowledge that provider wellness increases the likelihood of positive patient outcomes.

One of the problems, they said, is the lack of evidence addressing the frequency and degree of burnout syndrome in pharmacy clinicians based upon practice setting or expertise area.

There is, however, evidence to suggest that community pharmacists are the most susceptible to burnout and lower job satisfaction.

The solution begins when the industry recognizes the causes and the contributing factors in an effort to alleviate burnout and its consequences.

Specifically:

• Heavy workload
• Inadequate rewards
• Lack of workplace community
• Lack of control over the work setting

The pharmacy industry exists in a state of constant change, but it must take care of those who shoulder the largest burden. It must take note of the emerging research on burnout and healthcare providers and study the specific effects on pharmacists.

It is widely understood that unhealthy providers will struggle to care for their patients, so the pharmacy industry must do everything in its power to keep its providers well.

References

1. Panagioti M, Geraghty K, Johnson J, et al.

Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction. JAMA Intern Med. 2018;178(10):1317-1330. doi:10.1001/jamainternmed.2018.3713.

2. Midwest Pharmacy Workforce Research Consortium. 2014 National Pharmacist Workforce Survey

3. Sinsky C, Colligan L, Li L, et al.

Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4

Specialties. Ann Intern Med. 2016;

doi:10.7326/M16-0961.

4. Wiederhold BK, Cipresso P, Pizzioli D, Wiederhold M, Riva G.

Intervention for Physician Burnout: A Systematic Review.

Open Med (Wars). 2018; 13: 253—263.

5. Drummond D. Physician Burnout: Its Origin, Symptoms, and Five Main Causes. Fam Pract Manag. 2015;22(5):42-47.

6. Bridgeman PJ, Bridgeman JM, Barone Burnout syndrome among healthcare professionals. Amer J Health-System Pharm. 2017; ajhp170460; doi: https://doi.org/10.2146/ajhp170460