Experts offer strategies to address, combat burnout in clinical settings
ORLANDO, Fla. — A session presented at Psych Congress 2018 educated health care professionals about the risk for burnout in the health care setting, factors contributing to this risk, strategies for addressing burnout and tools for regular assessment to prevent burnout in the future.
Clinicians, nurse practitioners and physicians can implement personal and organizational burnout prevention practices. Some key take-aways to avoid burnout included identifying areas of control, creating meaning and purpose in life, staying connected to others, refreshing skills and practicing self-care, according to the presenter.
“If you’ve never been burned out, you’re not paying attention, or you haven’t been in practice long enough. Health care is a difficult profession,” W. Clay Jackson, MD, DipTh, assistant professor of clinical psychiatry and family medicine, University of Tennessee College of Medicine, said. “It’s okay to understand that doctors are not a sophisticated tool; you are a sophisticated person who uses tools. That makes you worthy of respect yourself and worthy of managing yourself.”
Characteristics of, contributors to burnout
According to 2015 Physician Lifestyle Report data, about 38% of physicians in the field of psychiatry and mental health care are “burned out.”
Erin Tolbert, MSN, FNP-C , an emergency nurse practitioner and the founder and president of MidlevelU.com, talked about the core characteristics of burnout, which include emotional exhaustion, depersonalization and low sense of personal accomplishment.
“Burnout, at its core, is a disconnect between what we’re doing in the clinic and what we’re expected to do. A lot of us want that human connection, but our employers want us to meet quality metrics and patient satisfaction scores, and to do this in less time than you’re already taking for a patient visit,” she said. “This really leads to an erosion of the soul — we miss that human connection. In burnout, there’s always someone in front of us expecting another piece of us. As psychiatrists, you are part of your clinical toolset, so you’re particularly prone to this phenomenon where you give and give until you have nothing else left.”
By the mid-career stage, physicians saw the highest rates of emotional exhaustion and burnout, Jackson said, while those in their early career see the highest rates of work/home conflict.
Commonly reported causes of burnout included too many bureaucratic tasks, spending too much time at work, sleep deprivation, work-life balance conflict and lack of control over work environment, according to the presenters. Burnout is also more common in private practice than academic practice. In addition, Jackson said it’s important to stay challenged so clinicians do not get bored and then get burned out.
“You can actually be burned out when you’re overqualified for your job because your job doesn’t engage your whole self and it becomes shift work. You’re not receiving energy from your jobs, you’re just giving away energy. You feel underappreciated — you feel underchallenged,” Jackson said.
Tolbert discussed the effect of burnout on female health care professionals. Female physicians were found to be 60% more likely to report burnout while also dealing with increased vulnerability to sexual harassment and taking on most of the domestic responsibilities at home.
Although nurse practitioners and physician assistants are being asked to take on much of the work physicians do and the quality of care is about equivalent to that given by physicians, they are paid less money and are less educated, which sets up the equation for burnout, Tolbert explained. Nurse practitioners may receive just 5% to 10% of the number of clinical practice hours as part of their education, which can result in job stress and frustration, according to the presenters.
“The system is different for some of our nurse practitioner and physician assistant colleagues, and this may be contributing to burnout,” Jackson added.
Tolbert also discussed health care system factors in place that can lead to burnout. The system is not set up to help people, she noted, and often rewards more care, not necessarily better care, she said. Employers should care about burnout because it affects recruitment and retention. Organizational systems can help promote wellness with clinician autonomy, provide support services/resources and encourage a shared work environment, Tolbert said.
“Retention is key to a health care organization and it affects the productivity of the team. Burned out people don’t do well if they’re not feeling well,” Jackson said. “Patient satisfaction and quality go down when clinicians are burned out, and ultimately, that affects the bottom line.”
Preventing, combating burnout
Physicians tend to focus on treating illness rather than promoting wellness, Jackson said, which is also problematic. To increase physician well-being, evidence supports marriage, spirituality and children, according to Jackson. Clinicians without a partner experienced higher rates of burnout than those with a partner, he said. A survey of wellness practices revealed that self-care, adopting a healthy philosophical outlook, setting limits at work and spending time with family/friends can help physicians “turn down the heat.”
For preventing burnout in nurse practitioners and physician assistants, Tolbert said providing mentorship and reinforcing growth and achievement are important. This is important for clinicians as well, Jackson added.
Depression is common among practicing physicians, Jackson said, and 400 physician suicides occur per year due to greater stress, burnout, social isolation, access to powerful drugs, barriers to getting treatment and stigma. Suicidal ideation is also common, and risk factors include patient demands and complaints, role conflicts and lack of control over working conditions. Mentorship can help clinicians reduce risk for negative outcomes during the intern and early-career periods, Jackson said.
Tolbert also advised the Maslach Burnout Inventory Human Services Survey for Medical Personnel and the WHO-5 Wellness Scale for assessing burnout and resiliency. To avoid burnout, Tolbert said clinicians should identify areas of control, create meaning and purpose in life, stay connected to others, refresh skills and practice self-care. Simple things like arranging schedules to reduce pressure, planning lunch breaks with colleagues, focusing on empathy and emotional connection to patients and having a hobby can help clinicians avoid burnout.
“Actively address burnout, both at the personal and organizational level,” Tolbert said. “The stigma of mental illness; it’s okay to feel ill and reach out and get some help when you feel that way. Burnout doesn’t have a happy ending that we tie with a bow — this is something that we’re going to deal with throughout our whole professional careers, so it’s something that we need to continue assessing and looking at on a regular basis.”
“You have to take care of yourself first before you can be effective at work,” she said. – by Savannah Demko
Jackson WC, Tolbert E. Addressing and overcoming burnout in clinical practice. Presented at: Psych Congress; Oct. 25-28, 2018; Orlando, Fla.
Disclosure: Jackson and Tolbert report no relevant financial disclosures.