Physician burnout: Staying well in a stressful world
It’s a nationally growing problem, affecting at least half of physicians in the US – professional burnout.
Christina Maslach, one of the foremost authorities on the topic and creator of the Maslach Burnout Inventory, describes the syndrome as a state of physical, emotional or mental exhaustion brought on or exacerbated by feelings of self-doubt about the value of one’s professional work.
While some of the key drivers for burnout can differ from one organization or division to another, the most common causes are:
- Loss of autonomy or lack of control
- Insufficient reward (including but not limited to monetary rewards)
- Lack of a sense of teamwork or community
- Unfairness or inequity
- Conflicting values (i.e., when one’s personal values or goals are not aligned with the goals of the organization)
- Work overload
Burnout can happen to anyone, but studies suggest it affects physicians at a higher rate than any other profession.
“Changes in healthcare, such as the implementation of the electronic medical record and the pressure to treat more patients in less time, have put a lot of stress on doctors,” says Derek Wheeler, MD, Chief of Staff, at Cincinnati Children’s. “It’s also a challenge to keep up with new clinical guidelines, research and education requirements.”
Recognizing physician burnout is important because it has been associated with increased medical errors and higher mortality in hospitalized patients. The higher rates of burnout in certain specialties may lead to workforce shortages and adversely impact access to care.
“We need to do a better job of taking care of each other,” says Wheeler. “We need to have each other’s backs.”
Wheeler hopes to collect baseline data regarding physician burnout and its causes at Cincinnati Children’s by including several key questions about it on the biennial provider survey, which will take place soon.
He has already taken steps to foster a sense of community and teamwork among the medical staff by highlighting members’ achievements, e.g., during his State of the Medical Staff presentation in January and via personal congratulatory notes. Most recently, his office partnered with Medical Staff Services and Physician Services to provide breakfast for physicians on Doctor’s Day.
“These are little things,” he says, “but they’re important, and we need to do a better job of making sure physicians know their hard work is appreciated.”
Wheeler is also mindful of the stress generated by regulatory requirements around licensure, continuing education and maintenance of certification. “The reality is, these are things physicians have to do, and we can’t change that. But we can streamline our processes to make it easier.”
Jessica Kahn, MD, MPH, associate chair and director, Office of Academic Affairs and Career Development (OAACD), agrees. Her office has been working on promoting physician/researcher wellness and work-life integration since 2009.
“There is a reluctance among physicians to acknowledge their own vulnerability to stress and to give themselves permission to take care of themselves,” she explains. “We are trained to be caregivers, to put the needs of patients and families before our own, and to manage stressful situations with some degree of detachment and control. Many physicians at the medical center are leaders as well, which may make them reluctant to show vulnerability and admit when they need support, even though these actually enhance leadership effectiveness.”
Kahn and her colleagues – Jamilah Hackworth EdD, associate director of the OAACD; Paul Samuels, MD, chair, Professional Health Committee; Anne Boat, MD, Patient Experience Officer; Rich Ruddy, MD, co-chair, PPEC; and Tom Boat, MD, director, CFWELL – have partnered with Patient Services and the UC Center for Integrative Health and Wellness to develop a faculty wellness initiative that includes:
- Wellness focus for 2017 career development seminars (mindfulness, burnout prevention, personal advocacy, self-care)
- Assessments to identify key drivers of burnout and create strategies to promote wellness within divisions
- Promotion of existing wellness programs offered by Cincinnati Children’s and UC
- Faculty wellness networking group
- A wellness symposium, slated for November
- Tools and resources, e.g., OAACD website, Faculty Flash newsletter articles (Wellness Corner) and wellness champions
While these programs are designed for faculty, they are open to anyone, says Kahn. “If you want to be on our email list or get access to our OAACD website, contact Mallory DePalma at Mallory.DePalma@cchmc.org, or send an email to faculty-affairs@cchmc.org.”
Cincinnati Children’s medical staff also supports the Ohio Physicians Health Program (www.ophp.org), which provides confidential help for physicians and other healthcare professionals who are affected by mental illness or substance-related/addictive disorders.
Paul Samuels, MD, can point physicians to a number of resources, including local psychiatrists with expertise in assisting healthcare providers. Contact him at Paul.Samuels@cchmc.org.
And finally, the Cincinnati Health Collaborative Chief Medical Officers group is working to identify and develop available resources in all of the Tri-State hospitals for providers who are experiencing burnout and other mental, emotional or behavioral issues.
“We recognize the importance of supporting our medical staff members who are on the front line of delivering outstanding patient care every single day,” says Wheeler. “You don’t have to suffer in silence. We are here to help.”
