Leadership, camaraderie, joy needed to combat physician burnout
With 54% of American physicians reporting burnout, the topic consistently comes to the forefront of discussion. ACP has emphasized the importance of reducing physician burnout and has focused efforts on decreasing onerous administrative tasks that contribute to burnout.
Healio Internal Medicine spoke with Susan Hingle, MD, chair of ACP’s Board of Regents, about the risks associated with physician burnout and strategies to lessen the burden.
“Primary care internists who are on the front lines of patient care are experiencing burnout at alarming rates,” she said in an interview. “This is an issue not only for the doctors, but an issue for all. When physicians are burned out, they commit more medical errors, making it a patient safety issue. They are unable to adequately experience and demonstrate empathy, making it a patient satisfaction issue. They are more likely to be sued, have decreased productivity, increased absenteeism, and leave medicine, thus making it an institutional/organizational issue.”
“Physicians are suffering from depression and suicide. Between 20% and 30% of medical students screen positive for depression,” she said. “We lose up to 400 physicians annually to suicide. As human beings, that should be important to all of us. This is a shared responsibility. We all need to work together to ensure that primary care physicians have adequate social and community support, work in a flexible environment with adequate resources, and can find meaning in their work. When physicians are well, we are all better off.”
At a recent NEJM Catalyst live web event, experts 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, he 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.”
“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.
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.
Nine strategies to reverse physician burnout
Building upon a decade of research on the rise and cost of physician burnout, researchers at the Mayo Clinic proposed nine strategies that health care organizations can implement to reverse the trend, limit the risk and promote physician well-being, according to a recent news release.
“Research has shown that more than half of U.S. physicians are experiencing symptoms of burnout, and the rate is increasing,” Tait Shanafelt, MD, director of Mayo Clinic’s Program on Physician Well-being, said in the release. “Unfortunately, many organizations see burnout as a personal problem to be addressed by the individual physician. It is clear, however, that burnout is a system issue, and addressing it is the shared responsibility of both the individuals and health care organizations.”
VIDEO: ACP discusses efforts to reduce paperwork burden
SAN DIEGO – Recognizing the burdens that excessive administrative tasks put on clinicians, and how this stress can contribute to physician burnout, the ACP earlier this week released a paper offering guidance on strategies to lessen or eliminate some onerous tasks.
The ACP is also planning to work with external stakeholders, including public and private payers, to identify other means to ease some of the requirements on clinicians and allow them to spend more time on patient care, Shari M. Erickson, MPH, vice president of governmental affairs and medical practice for ACP, said in an interview with Healio Internal Medicine.
More than half of US physicians experiencing professional burnout
A survey analysis found that professional burnout is increasing among physicians in the United States, according to data published in Mayo Clinic Proceedings.
Tait D. Shanafelt, MD, at the division of hematology at the Mayo Clinic, and colleagues stated that 54.4% of physicians reported at least one symptom of burnout in their investigation.
Physician burnout is a risk to the physician and the patient
LAS VEGAS — Despite the “great recipe” for success, and the personal and professional fulfillment that a physician may have, physicians as a group experience burnout and there are consequences to patient care, a well-known researcher on physician burnout said at the Cardiometabolic Risk Summit.
“If I told you we have a system issue in the medical care delivery system in the United States that eroded quality of care, that limited access to care led to declines in patient satisfaction, we would assign a crack team of system engineers to try to figure out the root causes and fix the situation very quickly,” said Tait D. Shanafelt, MD, professor of medicine and medical education, and director of the Physician Well-Being Program, Mayo Clinic. “We have precisely that problem in our care delivery system.
ACP: Excessive administrative tasks adversely affect physicians, patients
It is time for physicians to put patients before paperwork by reducing administrative tasks that negatively impact patient care, according to a position paper by the ACP, published in Annals of Internal Medicine.
“There are growing numbers of administrative responsibilities that physicians are subject to, due to regulations, insurer requirements and other factors,” Nitin S. Damle, MD, MS, MACP, president of ACP, said in a related press release. “These tasks are a diversion of physicians’ and their staff’s time and focus away from more clinically important activities, such as providing actual care to patients and improving quality.”
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.”
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.
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.”
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.
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.
Disclosures: The researchers report no relevant financial disclosures.