In the JournalsPerspective

Mindfulness, stress management reduce physician burnout

Researchers identified several interventions that resulted in "clinically meaningful reductions" in physician burnout, according to findings published in The Lancet.

Mindfulness, stress management training and small group discussions demonstrated benefits in physicians combating burnout, Colin P. West, MD, of the division of general internal medicine at the Mayo Clinic, and colleagues reported.

"Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, has reached epidemic levels, with prevalences near or exceeding 50%, as documented in national studies of both physicians in training and practicing physicians," West and colleagues wrote. "Consequences are negative effects on patient care, professionalism, physicians' own care and safety (including diverse issues such as mental health concerns and motor vehicle crashes), and the viability of health care systems, including reductions in physicians' personal work effort."

The researchers noted previous evidence of reductions in suicidal ideation, work hours and perceived medical errors with lowered burnout scores.

They conducted a systematic review and meta-analysis of studies that covered interventions to prevent or reduce physician burnout. West and colleagues searched various databases, including PsycINFO, MEDLINE and Embase through January 2016. After various exclusions, the researchers identified 15 randomized trials and 37 cohort studies which included 3,630 physicians.

Results showed that overall burnout decreased from 54% to 44% (95% CI; 5-14; P < .0001; 14 studies); emotional exhaustion scores decreased from 23.82 points to 21.17 points (95% CI, 1.67-3.64; P < .0001; 40 studies); and depersonalization scores decreased from 9.05 to 8.41 (95% CI, 0.15-1.14]; P = .01; 36 studies).

In addition, rates of high emotional exhaustion decreased from 38% to 24% (95% CI, 11-18; P < .0001; 21 studies) and high depersonalization decreased from 38% to 34% (95% CI, 08; P = .04; 16 studies).

The researchers noted if their estimated 10% reduction in physician burnout were applied to 2014 data for physicians in the U.S., there would be an 18% reduction in relative risk for burnout.

"Our results substantiate that both individual-focused and structural or organizational interventions can reduce physician burnout," West and colleagues concluded. "Although no specific physician burnout interventions have been shown to be better than other interventions, both strategies are probably necessary."

They continued: "The most commonly studied interventions have involved mindfulness, stress management, and small group discussions, and the results suggest that these strategies can be effective approaches to reduce burnout domain scores. Duty hour limitation policies also appear effective, although, at present, these results are derived only from observational studies in the USA."

They called for more research on the efficacy of various burnout interventions, how to best implement them and their long-term benefits. – by Chelsea Frajerman Pardes

Disclosure: The authors report no relevant financial disclosures.

Researchers identified several interventions that resulted in "clinically meaningful reductions" in physician burnout, according to findings published in The Lancet.

Mindfulness, stress management training and small group discussions demonstrated benefits in physicians combating burnout, Colin P. West, MD, of the division of general internal medicine at the Mayo Clinic, and colleagues reported.

"Physician burnout, a work-related syndrome involving emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment, has reached epidemic levels, with prevalences near or exceeding 50%, as documented in national studies of both physicians in training and practicing physicians," West and colleagues wrote. "Consequences are negative effects on patient care, professionalism, physicians' own care and safety (including diverse issues such as mental health concerns and motor vehicle crashes), and the viability of health care systems, including reductions in physicians' personal work effort."

The researchers noted previous evidence of reductions in suicidal ideation, work hours and perceived medical errors with lowered burnout scores.

They conducted a systematic review and meta-analysis of studies that covered interventions to prevent or reduce physician burnout. West and colleagues searched various databases, including PsycINFO, MEDLINE and Embase through January 2016. After various exclusions, the researchers identified 15 randomized trials and 37 cohort studies which included 3,630 physicians.

Results showed that overall burnout decreased from 54% to 44% (95% CI; 5-14; P < .0001; 14 studies); emotional exhaustion scores decreased from 23.82 points to 21.17 points (95% CI, 1.67-3.64; P < .0001; 40 studies); and depersonalization scores decreased from 9.05 to 8.41 (95% CI, 0.15-1.14]; P = .01; 36 studies).

In addition, rates of high emotional exhaustion decreased from 38% to 24% (95% CI, 11-18; P < .0001; 21 studies) and high depersonalization decreased from 38% to 34% (95% CI, 08; P = .04; 16 studies).

The researchers noted if their estimated 10% reduction in physician burnout were applied to 2014 data for physicians in the U.S., there would be an 18% reduction in relative risk for burnout.

"Our results substantiate that both individual-focused and structural or organizational interventions can reduce physician burnout," West and colleagues concluded. "Although no specific physician burnout interventions have been shown to be better than other interventions, both strategies are probably necessary."

They continued: "The most commonly studied interventions have involved mindfulness, stress management, and small group discussions, and the results suggest that these strategies can be effective approaches to reduce burnout domain scores. Duty hour limitation policies also appear effective, although, at present, these results are derived only from observational studies in the USA."

They called for more research on the efficacy of various burnout interventions, how to best implement them and their long-term benefits. – by Chelsea Frajerman Pardes

Disclosure: The authors report no relevant financial disclosures.

    Perspective
    John D Kelly IV

    John D Kelly IV

    The systematic review and meta-analysis by West and colleagues on the effectiveness of interventions to reduce and prevent burnout gives hope to the 50% of physicians who are afflicted with the signs and symptoms of overwork. The review was conducted with excellent scientific rigor and showed both individual-based (mindfulness, stress management) and organizational interventions (duty hour restrictions) are effective in reducing signs and symptoms of burnout.

    Although the seemingly meager 10% reduction in burnout scores may not appear impressive, several studies have indicated minor reductions in physician stress translate to meaningful reductions in adverse outcomes.

    The study does not disclose the duration of the individual interventions, although one may surmise most stress management and mindfulness courses terminate in a matter of weeks. A remaining question would be the effectiveness of extended interventions and combination of individual- based and organizationally based treatments.

    Radical change is in order. The trajectory of emotional decline for physicians is ominous. This study affirms that interventions regarding physician self-care do work. The problem cannot be ignored; otherwise physicians, their families and their patients will continue to suffer.

    • John D Kelly IV, MD
    • Orthopedics Today Editorial Board member