Practice ManagementPerspective

Leadership, camaraderie, joy needed to combat physician burnout

With 54% of American physicians reporting burnout, the topic consistently comes to the forefront of discussion. Experts at a recent NEJM Catalyst live web event called for leadership to work toward finding the camaraderie and joy in medicine again, giving physicians a vaccine for burnout.

“If you look at the fundamental drivers of professional burnout, one of the drivers is moral distress and values dissonance,” Stephen Swensen, MD, MMM, FACR, medical director of professionalism and peer support at Intermountain Healthcare, said in his keynote speech. “If we work in systems that promote the rendering of care that we wouldn’t choose for ourselves, that creates moral distress and values dissonance and professional burnout. Not only is it good for patients to put their interests first. It’s good for us.”

Swensen explained that patients have three wishes that work to the benefit of not only those patients but to the physicians serving them: Care about me; Care for each other; and Put my interests first.

“You can’t give what you don’t have. If we don’t have empathy, if we are emotionally exhausted, if we are socially isolated, then our patients suffer for that. Even if we get the mechanics of care right, we don’t get the relationship right,” Swensen said.

Steven Strongwater, MD, president and CEO of Atrius Health, put the responsibility for this dissonance on the workflow and expectations put upon physicians, especially in areas like primary care and emergency medicine, and the leadership of health care organizations.

“We have fallen down in the workflow and the work itself. The model needs to change,” Strongwater said. “Thank God our primary care docs are purposeful and driven and often guilty when they’re not doing everything they think they should be doing. But we have forced them to make a trade: Clicks before care. We have forced them to stare into computer screens and not into the eyes of their patients. We have disrupted that physician-patient bond.”

Yet many physicians are trying to fulfill the 18 to 21 hours of work per day that they feel is required. They do not have the time or bandwidth to push for change, they said.

“There are very few individual physicians than can actually impact the current state. They are employees. They do not control the resources,” Strongwater said. “It’s wonderful that we’re having this conversation today, but unless leadership walks away and says I am committed to finding solutions ... and committed at the very least to ongoing measurement and reporting to their boards in the same way we report patient satisfaction scores, we will never get ahead of this. It is fundamentally the role of leadership to take on this challenge.”

Brent James, MD, MStat, executive director of the Institute for Healthcare Delivery Research, and vice president and chief quality officer at Intermountain Healthcare, echoed that sentiment: “You can’t succeed as a stand-alone individual. You’re always going to be effectively part of the team. So, find a good team. Find a good team that knows how to manage clinical knowledge.”

In quoting W. Edwards Deming, James added: “Put joy back into work.”

Swensen summed it up: “One of the most important vaccines for burnout is camaraderie.”

Camaraderie combined with belief in one’s work and a feeling of autonomy will be the only ways for physicians to dig out from the current state of burnout.

“The physicians and NPs and PAs and managers and nurses respect each other, trust each other, they have fun together as human beings,” Swensen said. “There’s meaning and purpose. They’re connected and they have a system that makes the right thing to do for patients the easy thing to do. So that the care they’re giving is the care they want.”

Lastly, he added, “We have to have standard work that enables choice and flexibility. You want to have flexibility in the when, how, where, and with whom you do your work so you’re not totally ‘widgetized’ and an employee. You want to be an architect and not a construction worker.”

In recent months, Healio.com covered various viewpoints of physician burnout. Please see how colleagues throughout the medical field have undertaken these goals.

Simple strategies can lessen, eliminate physician burnout

Acknowledging stress, accepting help and addressing fatigue are useful strategies for clinicians facing burnout, according to recommendations published in Obstetrics and Gynecology Clinics of North America.

“Burnout is physical or mental collapse that is caused by overwork or stress and all physicians are at risk,” Roger P. Smith, MD, assistant dean for graduate medical education and professor in the department of integrated medical science at Florida Atlantic University’s Charles E. Schmidt College of Medicine, said in a press release. “Professional burnout is not new, but what is new is the wider recognition of the alarming rates of burnout. Physicians in general have burnout rates that are twice the rate of working adults.”

Read more.

BLOG: Avoiding burnout is your choice

The burnout prevalence rates continue to increase with no apparent end to this disturbing trend. One recent study cited the prevalence of emotional exhaustion amongst orthopedic surgeons approached 60%.

The onset of burnout is not inevitable. Emotional depletion can be sidestepped. The answer lies in the power of decision. We have the power to choose what we direct our attention to and in these choices, lay our growth and happiness or lack thereof.

Read more.

AMA revisits issue of physician burnout

On the final day of its annual meeting, AMA delegates adopted a new policy designed to improve medical student and physician access to mental health care, according to a press release.

“We are concerned that many physicians and physicians-in-training are dealing with burnout, depression and even suicidal thoughts, and we find it especially concerning that physicians have a higher rate of suicide than the general population,” AMA board member Omar Z. Maniya, MD, said in the release. “We are committed to supporting physicians throughout their career journey to ensure they have more meaningful and rewarding professional experiences and provide the best possible care to their patients.”

Read more.

VIDEO: Incorporating mindfulness into medical practice

SAN DIEGO — By using mindfulness themselves, clinicians and mental health professionals can establish a compassionate attitude, increase empathy for patients, improve their ability to serve patients and decrease burnout, according to Seema Desai, MD, of NYU School of Medicine.

In this video, Desai illustrates ways in which the clinician or trainee can integrate mindfulness into their psychiatric practice.

“The clinician practicing mindfulness themselves and being familiar with these practices can benefit the clinician and patient,” Desai told Healio.com.

Read more.

AAFP addresses physician burnout

The AAFP recently announced a new initiative to combat physician burnout, called Physician Health First, that will commence in a few months.

According to the AAFP, more than 50% of family physicians suffer from at least one symptom of burnout and previous research published in the Journal of the American Board of Family Medicine suggests the frequency of burnout among board-certified family physicians is just under 25%, with younger family physicians and women at particularly high risk.

Read more.

Disclosures: The researchers report no relevant financial disclosures.

With 54% of American physicians reporting burnout, the topic consistently comes to the forefront of discussion. Experts at a recent NEJM Catalyst live web event called for leadership to work toward finding the camaraderie and joy in medicine again, giving physicians a vaccine for burnout.

“If you look at the fundamental drivers of professional burnout, one of the drivers is moral distress and values dissonance,” Stephen Swensen, MD, MMM, FACR, medical director of professionalism and peer support at Intermountain Healthcare, said in his keynote speech. “If we work in systems that promote the rendering of care that we wouldn’t choose for ourselves, that creates moral distress and values dissonance and professional burnout. Not only is it good for patients to put their interests first. It’s good for us.”

Swensen explained that patients have three wishes that work to the benefit of not only those patients but to the physicians serving them: Care about me; Care for each other; and Put my interests first.

“You can’t give what you don’t have. If we don’t have empathy, if we are emotionally exhausted, if we are socially isolated, then our patients suffer for that. Even if we get the mechanics of care right, we don’t get the relationship right,” Swensen said.

Steven Strongwater, MD, president and CEO of Atrius Health, put the responsibility for this dissonance on the workflow and expectations put upon physicians, especially in areas like primary care and emergency medicine, and the leadership of health care organizations.

“We have fallen down in the workflow and the work itself. The model needs to change,” Strongwater said. “Thank God our primary care docs are purposeful and driven and often guilty when they’re not doing everything they think they should be doing. But we have forced them to make a trade: Clicks before care. We have forced them to stare into computer screens and not into the eyes of their patients. We have disrupted that physician-patient bond.”

Yet many physicians are trying to fulfill the 18 to 21 hours of work per day that they feel is required. They do not have the time or bandwidth to push for change, they said.

“There are very few individual physicians than can actually impact the current state. They are employees. They do not control the resources,” Strongwater said. “It’s wonderful that we’re having this conversation today, but unless leadership walks away and says I am committed to finding solutions ... and committed at the very least to ongoing measurement and reporting to their boards in the same way we report patient satisfaction scores, we will never get ahead of this. It is fundamentally the role of leadership to take on this challenge.”

PAGE BREAK

Brent James, MD, MStat, executive director of the Institute for Healthcare Delivery Research, and vice president and chief quality officer at Intermountain Healthcare, echoed that sentiment: “You can’t succeed as a stand-alone individual. You’re always going to be effectively part of the team. So, find a good team. Find a good team that knows how to manage clinical knowledge.”

In quoting W. Edwards Deming, James added: “Put joy back into work.”

Swensen summed it up: “One of the most important vaccines for burnout is camaraderie.”

Camaraderie combined with belief in one’s work and a feeling of autonomy will be the only ways for physicians to dig out from the current state of burnout.

“The physicians and NPs and PAs and managers and nurses respect each other, trust each other, they have fun together as human beings,” Swensen said. “There’s meaning and purpose. They’re connected and they have a system that makes the right thing to do for patients the easy thing to do. So that the care they’re giving is the care they want.”

Lastly, he added, “We have to have standard work that enables choice and flexibility. You want to have flexibility in the when, how, where, and with whom you do your work so you’re not totally ‘widgetized’ and an employee. You want to be an architect and not a construction worker.”

In recent months, Healio.com covered various viewpoints of physician burnout. Please see how colleagues throughout the medical field have undertaken these goals.

Simple strategies can lessen, eliminate physician burnout

Acknowledging stress, accepting help and addressing fatigue are useful strategies for clinicians facing burnout, according to recommendations published in Obstetrics and Gynecology Clinics of North America.

“Burnout is physical or mental collapse that is caused by overwork or stress and all physicians are at risk,” Roger P. Smith, MD, assistant dean for graduate medical education and professor in the department of integrated medical science at Florida Atlantic University’s Charles E. Schmidt College of Medicine, said in a press release. “Professional burnout is not new, but what is new is the wider recognition of the alarming rates of burnout. Physicians in general have burnout rates that are twice the rate of working adults.”

Read more.

BLOG: Avoiding burnout is your choice

The burnout prevalence rates continue to increase with no apparent end to this disturbing trend. One recent study cited the prevalence of emotional exhaustion amongst orthopedic surgeons approached 60%.

PAGE BREAK

The onset of burnout is not inevitable. Emotional depletion can be sidestepped. The answer lies in the power of decision. We have the power to choose what we direct our attention to and in these choices, lay our growth and happiness or lack thereof.

Read more.

AMA revisits issue of physician burnout

On the final day of its annual meeting, AMA delegates adopted a new policy designed to improve medical student and physician access to mental health care, according to a press release.

“We are concerned that many physicians and physicians-in-training are dealing with burnout, depression and even suicidal thoughts, and we find it especially concerning that physicians have a higher rate of suicide than the general population,” AMA board member Omar Z. Maniya, MD, said in the release. “We are committed to supporting physicians throughout their career journey to ensure they have more meaningful and rewarding professional experiences and provide the best possible care to their patients.”

Read more.

VIDEO: Incorporating mindfulness into medical practice

SAN DIEGO — By using mindfulness themselves, clinicians and mental health professionals can establish a compassionate attitude, increase empathy for patients, improve their ability to serve patients and decrease burnout, according to Seema Desai, MD, of NYU School of Medicine.

In this video, Desai illustrates ways in which the clinician or trainee can integrate mindfulness into their psychiatric practice.

“The clinician practicing mindfulness themselves and being familiar with these practices can benefit the clinician and patient,” Desai told Healio.com.

Read more.

AAFP addresses physician burnout

The AAFP recently announced a new initiative to combat physician burnout, called Physician Health First, that will commence in a few months.

According to the AAFP, more than 50% of family physicians suffer from at least one symptom of burnout and previous research published in the Journal of the American Board of Family Medicine suggests the frequency of burnout among board-certified family physicians is just under 25%, with younger family physicians and women at particularly high risk.

Read more.

Disclosures: The researchers report no relevant financial disclosures.

    Perspective
    Thomas Fekete

    Thomas Fekete

    Symptoms of stress and burnout have been increasing in all physicians and relate to increased patient volume and acuity as well as regulatory challenges. The complexity of electronic health records has increased the distance between patient and doctor and made the day longer with increased documentation. Infectious disease physicians are busier than ever before and there is no indication of relief on the horizon. Yet, ID physicians not only provide direct benefit to their patients by improving clinical outcomes but also, via antibiotic stewardship, stand as a bulwark against increased antibiotic resistance. They are also the front line against the incursion of new infections such as Zika and Ebola. Solutions will start with a more rational set of job expectations that allow for a return to focusing on patient satisfaction.

    • Thomas Fekete, MD
    • Professor of microbiology and immunology, Associate professor of clinical medicine, Section chief, infectious diseases, in the Lewis Katz School of Medicine, Temple University Spokesman, Infectious Diseases Society of America

    Disclosures: Fekete reports no relevant financial disclosures.

    See more from Focus On: Physician Burnout