3 ways to reduce burnout
PHILADELPHIA — Data indicate that rates of physician burnout are declining, but it remains a significant issue for clinicians, a speaker at the American College of Physicians Internal Medicine Meeting told attendees.
A study recently published in Mayo Clinic Proceedings suggested that 43.9% of physicians reported at least one symptom of burnout in 2017, down more than 10% from a similar report 3 years earlier, Richard M. Wardrop III, MD, PhD, professor and vice chair of education and faculty development at the University of Mississippi Medical Center said.
“Though the epidemic of burnout seems to have eased off a little ... we are still having problems with work-life integration. If you look at the data further, we are more burned out and more unhappy than most of the rest of the working population,” he told Healio Primary Care Today.
“The good news is that burnout is not inevitable in residency nor over a career, it is not terminal to your career and is not a personal failing of will, strength or spirit,” Wardrop continued.
He discussed three ways physicians can reduce burnout: promoting a culture of wellness, promoting efficiency of practice and promoting wellness and resilience.
Culture of Wellness
The ‘Culture of Wellness’ model initiated by Stanford University, consists of shared values, behaviors, and leadership qualities that put an emphasis on personal and professional growth, community and compassion for self and others, Wardrop said.
Burnout reduction programs following this model can be supported by “recognizing well-being as a professional competency, acknowledging that burnout is a national epidemic and not a personal failure and supporting peers’ healthy behaviors and help-seeking behaviors,” he added.
Wardrop said that the model can be promoted by including topics on professional satisfaction and well-being in continuing education, including peer support and reflection in meetings and group social events.
“These can be things like bike-riding or jogging together. Or storytelling, in which all the participants get a certain amount of time to talk about something that is important to them and their professional life,” he said.
Efficiency of practice
A significant source of burnout for many clinicians is long office hours and spending significant amounts of time on electronic health records, Wardrop said. He suggested that physicians and clinical practices “take ownership” of these common causes of physician burnout.
“There is a tendency at times for some physicians to say, ‘This isn’t my fault,’ or ‘Past generations did this to us,’ or other things along those lines,” he said in the interview.
“I’m not denying that there are a lot of administrative burdens and there are a lot of long hours. But we as a profession have to own what we do and have control over how we function within the culture of medicine rather than wait for someone to make these changes for us,” he continued.
This reduction method can be implemented in a number of ways, including “right-sizing the workload, practicing in optimized teams, hiring physician floats to cover predictable life events, making clinician satisfaction and well-being quality indicators and promoting physician control over the work environment,” Wardrop said.
He also referenced a meta-analysis in JAMA Internal Medicine that found organization-directed burnout interventions, such as assigning physicians to random sequences of 2-week shift rotations or fostering engagement and mitigating the drivers of burnout were associated with higher treatment effects compared with physician-directed interventions, as more evidence that practice efficiency can reduce burnout.
Wellness and resilience
Clinicians can also address burnout by adopting wellness and resilience, by asking themselves questions such as:
- What is your special purpose?
- What are your needs?
- What is it that you value?
- What is your ideal vision?
- How can you get back in touch with why you became a doctor?
- How can you show gratitude for the things in your life?
Wardrop said that achieving resiliency is a significant factor in reducing burnout. This can be accomplished by mindfulness, deep breathing exercises, coaching others, laughing and exercising. To achieve personal well-being, Wardrop suggested clinicians honor their personal values, do what they love, presume the best intentions, look for joy, evaluate their ergonomics, manage their time and energy and shirk cynicism.
He also suggested physicians focus on the positives that happen during the day, not the negatives.
“If we do one out of 10 things wrong, we are more likely to think about the one thing we did wrong all day than the nine things we did right. We need to stop doing that. Instead of thinking ‘I didn’t do one thing well’ think ‘I am proud of what I did and will look for ways to improve.’
He said that the strategies appearing in a systematic review and meta-analysis published in The Lancet, found individual-focused and structural or organizational strategies such as mindfulness, stress management training and small group discussions also demonstrated benefits in physicians combating burnout.
Reducing burnout is a team effort
Wardrop noted that many burnout reduction activities— taking vacations with family members, participating in a yoga class, eating lunch with co-workers — all have one thing in common: they involve the assistance of others.
“Overcoming physician burnout may start out as personal but it does ultimately lead to engagement of some kind. Overcoming it does not happen passively by reading something on the internet. You have to get up and move your feet.” – by Janel Miller
Reference: Wardrop RM. “Beyond surviving in medicine: Strategies to thrive, be well, and find joy in practice.” Presented at: American College of Physicians Internal Medicine Meeting; April 11-13, 2019; Philadelphia.
Disclosures : Wardrop reports no relevant financial disclosures.