American Association of Clinical Endocrinology Annual Meeting

American Association of Clinical Endocrinology Annual Meeting

Source:

Shanafelt T. Organizational efforts to cultivate healthcare professional well-being: Before and after the COVID-19 pandemic. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).

Disclosures: Shanafelt reports he is the co-inventor of the Well-Being Index instruments and the Participatory Management Leadership Index. Mayo Clinic holds the copyright for these instruments and has licensed them for use outside of Mayo Clinic. Shanafelt receives a portion of royalty payments made to the Mayo Clinic.
May 26, 2021
3 min read
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Organizations must lead in boosting well-being, reducing burnout among physicians

Source:

Shanafelt T. Organizational efforts to cultivate healthcare professional well-being: Before and after the COVID-19 pandemic. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 26-29, 2021 (virtual meeting).

Disclosures: Shanafelt reports he is the co-inventor of the Well-Being Index instruments and the Participatory Management Leadership Index. Mayo Clinic holds the copyright for these instruments and has licensed them for use outside of Mayo Clinic. Shanafelt receives a portion of royalty payments made to the Mayo Clinic.
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Health care organizations must take steps to reduce burnout and enhance the well-being of physicians, according to a keynote speaker at the American Association of Clinical Endocrinology virtual meeting.

“We can do better in the clinical environment that we create for physicians to provide the best possible care for patients, and we must do better,” Tait Shanafelt, MD, the Jeanie & Stewart Ritchie Professor of Medicine and chief wellness officer at Stanford University School of Medicine, told Healio. “We have numerous structural issues in the practice environment that are creating occupational distress in clinicians that is impacting the quality of care they provide — decreasing access, increasing errors, eroding patient satisfaction. Those challenges are driven by characteristics of the care delivery system.”

Shanafelt is the Jeanie & Stewart Ritchie Professor of Medicine and chief wellness officer at Stanford University School of Medicine.

More burnout among physicians

According to a study published in JAMA Internal Medicine, physicians work a median of 50 hours per week compared with a median of 40 hours for the general population (P < .001). Nearly 40% of physicians work more than 60 hours per week compared to 6% of the general population. Physicians also have a higher prevalence of burnout compared with the general population (38% vs. 28%, P < .001) and a higher prevalence of dissatisfied work-life integration (40% vs. 23%, P < .001).

A lack of personal resilience is not the reason for higher burnout among physicians, Shanafelt said. Incoming medical students have less burnout, lower rates of depression, and better quality of life than college students entering other fields, and practicing physicians have higher resilience scores than the general population.

“After [attending medical school] for 2 years, that profile completely reverses — higher burnout, higher depression scores, lower quality of life in every domain,” Shanafelt said during the presentation. “Burnout crescendos during residency, and once we enter practice, there’s what we refer to as the mid-career peak. We adjusted for hours, adjusted for age, adjusted for all other variables, and there’s this window of time, 10 to 20 years into a career, that burnout increases.”

Burnout isn’t just a concern for individual physicians, but also for the organizations they work for. Shanafelt said multiple studies have shown an association between physician burnout and decreased quality of care, decreased productivity, increases in medical errors and greater job turnover.

Although physician burnout has been a concern for years in the health care community, Shanafelt said, the COVID-19 pandemic put a spotlight on the problem. He noted providers have had to deal with the societal challenges all people have faced, such as lockdowns, social justice concerns and political tensions. In addition, physicians have faced job stresses, such as caring for COVID-19 patients and dealing with the heavy emotional toll that comes with it, as well as the ethical dilemma of caring for patients while also trying to keep themselves and their families safe.

“We had to swing the pendulum to just providing for very tangible needs — nutrition on site, rooms where people can rest, sometimes providing hotels near the hospital, psychologic first aid,” Shanafelt told Healio. “We had to really pivot back to providing for very fundamental needs for health care workers feeling so stretched.”

How to address physician burnout

To address physician burnout, 80% of the change must come from organizations, with the remaining 20% coming from physicians, Shanafelt said.

Individually, physicians should prioritize self-care, take breaks from work and get enough sleep. Long term, physicians should optimize their meaning in work, identify their core values, improve work-life integration, and emphasize self-valuation. Shanafelt said physicians can assess how their well-being compares with colleagues nationally using the Mayo Clinic’s Well-Being Index, a tool where physicians can receive feedback based on their answers to nine questions about their individual well-being. The index also includes links to resources, tools and exercises to help drive change in an individual’s well-being.

For organizations, Shanafelt discussed the Stanford WellMD Model of Professional Fulfillment, where organizations combine practice efficiency and a culture of wellness with the personal resilience of physicians to create better professional fulfillment. Creating a culture of wellness involves leadership, aligning the organization’s values with those of its employees, giving employees a voice, creating a sense of community and building a culture of compassion. In practice efficiency, organizations should focus on optimizing electronic health record usability, scheduling, documentation, team-based care and staffing.

An organizational focus on improving physician well-being decreased physician burnout and exhaustion at the Mayo Clinic, Shanafelt said. In 2013, 40% of Mayo Clinic physicians who responded to a survey had symptoms of burnout. After an organizational shift to focus on physician well-being, the percentage of physicians reporting emotional exhaustion dropped to 32% in 2015 and 30% in 2016, and the percentage of physicians reporting overall burnout dropped to 33% in 2015.

“We can drive change at the level of the organization,” Shanafelt said during the presentation. “It takes prioritization and a number of efforts I highlighted. It’s a journey and it begins where we are today.”

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