Could burnout from nonclinical tasks be a key cause of the maternal health crisis?

In recent years, the growing Maternal Health Crisis has become an increasingly urgent topic in Obstetrics and Gynecology. In 2019, the American College of Obstetricians and Gynecologists (ACOG) began partnering with the Alliance for Innovation on Maternal Health (AIM) to combat rising concerns about maternal care delivery. AIM is a national initiative focused on reducing preventable maternal deaths at the state level by bringing together stakeholders across care delivery to implement lifesaving best practices to treat common pregnancy-related conditions.

Initiatives like these seem to be working to address the crisis to some degree. The California Maternal Quality Care Collaborative (CMQCC) was able to reduce the state’s maternal mortality rate by half to an average of 7 deaths per 100,000 live births. However, not many organizations aimed at combating the Maternal Health Crisis have considered how the burnout epidemic may be contributing to the crisis.

The Care Environment: Burnout Among OB-GYNs

Now more than ever before, providers are facing a difficult care environment. A loss of physician autonomy, complex documentation requirements, bulky EHRs, and inflexible work environments are contributing to a massive physician burnout crisis.

Chart from Medscape's 2019 survey of OB-GYNS.This is especially true in the high-stakes world of obstetrics and gynecology care where physicians are managing labor and delivery in addition to a clinic. Consider the results of our scheduling complexity report which revealed that the OB-GYN specialty is the third most difficult specialty to schedule. Overall, we found that the average OB-GYN schedule requires 111 unique scheduling rules. Check out the full report on scheduling complexity by specialty here.

The difficulties of the current care environment are also reflected in recent burnout reports. A 2019 survey of OB-GYNs conducted by Medscape reveals that 45% of OB-GYNs are burned out. Another 22% indicate that they are either clinically or colloquially depressed. Both of these figures are higher than the averages for physicians overall. With those numbers in mind, let’s examine how OB-GYN burnout may be connected to the maternal health crisis.

Burnout and Bedside Manner

Some key characteristics of burnout are that providers feel disconnected or isolated from their work—exhausted, inattentive, perhaps even irritable. Research suggests that burnout leads to disruptive behavior, mood disorders, and depression. This interferes not only with physicians’ personal lives and well-being but also their professional abilities.

Think about it: Most OB-GYNs are responsible for covering labor and delivery and running a clinic, all while trying to see more patients than ever due to payment structures—not to mention burdensome documentation and longer shift hours. It’s a recipe for disaster, and it could be the reason for declining patient care.

The data supports this. In the same survey, OB-GYNs indicated that their burnout and depression impact their interactions with patients. 39% noted they are easily exasperated with patients and 13% said they express their frustrations in front of patients.

Burnout and Medical Error

Despite how common medical errors are in the United States—they lead to about 100,000 to 200,000 deaths a year—there hasn’t been much research done to explore whether or not these errors are related to burnout. However, a recent Stanford study reveals that roughly 9% of physicians who experience burnout have made at least one major medical error in the past three months. Additionally, physicians experiencing burnout receive lower patient-physician satisfaction scores.

Stress leads to errors, which leads to stress and more errors. The study goes on to suggest that burnout may be a bigger cause of medical error than an unsafe working environment. In addition to how these errors impact patients, they also have grave consequences for physicians. The study shows that burnout and medical errors double the risk of suicidal thoughts among physicians.

Medscape’s survey of OB-GYNs supports these findings. 15% of those surveyed indicated their burnout and depression causes them to make errors they might not ordinarily make, while 20% of those surveyed have had prior thoughts of suicide.

Improving Provider Wellness Will Improve Patient Care

So, what does all this data tell us? We can’t evaluate the maternal health crisis in a vacuum. We need to better understand all of the underlying causes of these alarming statistics, including burnout. While training and new safety resources for OB-GYNs certainly are a step in the right direction for solving the maternal health crisis, we also need to look at improving the care environments OB-GYN providers are working in. If we advocate for improving providers’ working conditions, we’ll end up improving patient care as well.

Learn more about the growing physician burnout crisis and Lightning Bolt’s mission to combat burnout with optimized shift scheduling here.

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