What is the remedy to the physician burnout crisis?
In a live event on the web sponsored by the New England Journal of Medicine, many experts called for leaders to look for a remedy to enhance the camaraderie and the joy and to continue practicing medicine in order to avoid the phenomenon of Burnout. The healthcare system is rapidly changing in an effort to deliver more efficient care, improve health at low cost to an aging population with more chronic diseases and more morbidities. New delivery approaches, electronic heath records, patient’s portals etc. have all changed the landscape in delivering care and in documenting data. Re-imbursement has become more difficult.
Navigating the system on a daily basis induce a burden for the physician who struggle with so much changes. They become frustrated and exhausted, resulting in an added pressure on their life style. The phenomenon of burnout brings with it, a sense of depersonalization and exhaustion while the physician exhibits a low sense of accomplishment and a poor self-esteem at work.
The term “Burnout” was coined by a German-American psychologist Hebert Freudenberg who defined it as a physical or mental collapse caused by work or stress. It was identified 30 years ago as a state of fatigue and frustration among health and service workers, arising from excessive demands on their resources. It is a world phenomenon for which each country has their way in approaching the problem. In United States of America, an epidemic of physician burnout is hurting our doctors, costing American healthcare organizations, billions and placing patients at risk. Stephen Swensen MD, a medical director of professionalism and peer support at Intermountain Healthcare, stated in a keynote speech that “if we promote care in a system that does not allow us to choose for ourselves, this creates a moral distress and values dissonance and professional burnout”.
The Mayo Clinic advocates for giving physicians a sense of control over their work and schedules as key tool in reducing burnout. A little more than half of physicians (54%) now show at least one symptom of burnout, up to 10% over three years. Physicians working in their specialties at the front lines of healthcare (medicine, family medicine, general internal medicine, neurology) are among the highest risk for burnout. Emergency medicine physician are the most burnt out with 60% according to the AMA in 2013. More than 7% of nearly 7000 physicians have considered suicide. (Reuters). Severe studies have found that medical students and residents have a high rate in depression compared to others of age similar pursuing other professions. Studies on Nurses, Nurses-Practitioners and Physician-Assistants have demonstrated similar results and the rate of depression may be as high in this group of professionals.
Burnout is twice as prevalent among physicians as US workers in other fields. Between 2011 and 2014, the prevalence of burnout increased by 9% among physicians while remaining stable in other US workers. Medical students and residents in training were found to be affected at a higher prevalence in burnout when compared to age-similar individuals pursuing other careers. More, they were likely to be sleeping on the wheel returning home from duty.
We all will face burnout at a certain time in our practice. Elizabeth Ames MD reported in the Journal of Bone and Joint Surgery that all orthopedic leaders, colleagues, and learners have shown a steady increase in burnout during their medical education. On another side, the incidence in burnout among orthopedic surgeons ranged from 50 to 60% according to Wayne M Sotile PhD at the center for Physician Resilience in Davidson, NC. He believes that the burnout phenomenon can increase the probability of surgical errors, career dissatisfaction and even discord in the home and in the family.
Indeed, researchers at the American College of Surgeons found that when Burnout rise in incidence, there is an 11% increase in chances to make a surgical error. Physicians become more prone to make mistakes because they are more likely to be dissatisfied, and unhappy at work. John Kelly MD, an editorial board member in Orthopedic Today, goes further to argue that physician burnout renders patients as well, less compliant. In anyway, burnout impairs the quality in delivering care.
A direct relation is encountered between Burnout and medical errors bringing malpractice suit to the group of physicians suffering from the syndrome. Inversely, self-perceived medical errors were found also to fuel the burnout phase. Suicidal ideation, Alcohol dependency are often present as well in the picture.
Simply, patients become less happy in their patient/physician relationship. Many institutions have also provided help to the physician in distress, creating dialogues between physician-leaders and non-physicians in order to improve efficiency and effectiveness at the work place. Orthopedists or other physicians who feel “burnt out” may need to re-think their career in discussing issues with their partner or spouse.
Therefore, it is important for physicians to look for help among their co-workers and discuss when it may be time to take a break. Some suggests to practice yoga, mindfulness, relaxation techniques, exercises and fitness. Many believe that Burnout can be prevented in learning how to say no, in protecting family relationships but, in one word, in re-learning how to enjoy life. Orthopedists or other physicians need to accept the concept that there is a problem and they need to be willing to look for help. Consider counseling and participate in wellness programs as well as in stress management programs.
Researchers in 1981, have tried to use the Maslasch/Jacson Burnout Inventory (MBI), as a gold standard tool for measuring “Burnout syndrome”, defining it in three components: an emotional exhaustion, a depersonalization and a low personal accomplishment. This test can be taken in 15 minutes individually or in group but more is needed in the work place and in the environment to complete the study. A recent advertised leadership Retreat is being scheduled in Seattle WA, encouraging physicians to lead the wellness movement in their organization in offering 3-5 days of training (13 CME), Wellness tools for all, and free Resourcing for a support system. I encourage you all to attend in the goal to become an effective Physician Wellness Champion.
Thinking about medical school, may force our students to avoid specialties considered too stressful especially when a recent survey from the AMA showed 42% of the students with signs of being burnt out and 15% admitting clinical signs of depression. My young daughter Carolyn Lara just joined the St George University Medical school, in Grenada. I wish her luck and hope that she will find strength to treat the people of my generation. She appears enthusiastic and ready for the Job.
It is a fact that, too many bureaucratic tasks at work, added to an increase in computerization within the practice and insufficient compensation which may trigger this burnout syndrome.
On the positive side, we have to say that the vast majority of physicians are happy with their career choice and more than half of practitioners still recommend others to pursue medicine. We, physicians are not tired of practicing but only experiencing difficult time to adjust to the daily workload. To all, still in practice, be prepared to manage this problem because the US Department of Health and Human Services predicted that by the year 2025, the nation will face a shortage of nearly 90,000 physicians, many retiring from practice and other suffering from the burnout syndrome. Imagine a little, the cost an employer will have to incur to recruit for more physicians. The healthcare system is in crisis already but a fortune will be spent to replace such professionals.
Be strong daughter Carolyn Lara Coles, we have our eyes over you and know that you will be able to face the challenges while practicing the Art of Medicine. I have learned already that passing less time in the office or in the books has allowed us to perform any sport or activities we keep at heart; This will help us, physicians, to avoid this phenomenon of burnout that many of us are facing. Always be happy, play chess, use your camera to understand mother Nature, study as much as you can the lessons which will help you reach your goals, but find time to enjoy life as well.
Maxime Coles MD
References:
1- Ames SE et al. J. Bone and Joint Surg. Am 20
2- Malasch C; Jackson SE (1981). “The measurement of experienced burnout”. Journal of Occupational Behavior: (2): 99-113
3- Massachusetts Medical Society daily update: “A crisis in Healthcare: A call to action on physician burnout” 1-1-2019
4- Maslasch C: Jackson C ; Leiter, M P.(1996-2016) Malasch Burnout Inventory Manual (4th Edition) Menlo Park, CA: Mind Garden Inc.
5- Schaufeli, W B, Leiter, M P & Kalimo, R. (1995, September). He MalaschBurnout Inventory-General Survey: A self-report questionnaire to assess burnout at the workplavce.-Extending the burnout Construct: Reflecting Charging Career Paths. Symposium.Conference Work,Stress 95: Creating a Healthier Workplace Washington DC.
6- LEE, RT & Ashforth BE (1996): A meta-analytic examination of the correlates of the three dimensions of job burnout. Journal of Applied Psychology, 81: 123-133.
7- Alarcon, GM (2011). “A meta-analysis of burnout with job demands, resources, and attitudes”. Journal of Vocational Behavior. 79 (2): 549-562.
8- Ahola, K, Hakenen, J (2007). “Job strain, burnout and depressive symptoms: A prospective study among dentists” Journal of Affective Disorders. 104 (1-3).
Malasch, C & Jackson, SE (1982) Burnout in health professions: A social psychological analysis. Saunders and Sulis (Eds) Social psychology of health and illness. Hillsdale, NJ: Erlbaum.