Physicians

Physician Burnout: It’s Time to Take Care of Our Own

flying cadeuciiDespite highly skilled physicians and advanced technology, the U.S. has not yet figured out how to provide effective affordable health care to everyone. Meanwhile, the health care system is increasingly fractured and stressed—and so are our doctors. Physician burnout impacts nearly half of all seasoned physicians in practice and up to 75% of resident physicians in training1. Over water cooler conversations, as well as in my work as a psychiatrist at the University of North Carolina at Chapel Hill (UNC), I hear more and more physicians report anxiety, stress and emotional exhaustion. Many feel as if they are perpetually swimming upstream; others feel there is no joy or meaning in their work; some want to quit medicine altogether. These good doctors are in crisis in increasingly high numbers — an epidemic that requires immediate attention.

Last year, the UNC School of Medicine launched the Taking Care of Our Own program to address the problem of physician burnout and we have been met with a deluge of physicians asking for help. Burnout, however, is not a diagnosis. It is a constellation of symptoms that include emotional exhaustion, depersonalization and loss of perspective that work is meaningful2. Untreated, burnout syndrome can erode professional behavior at work and healthy relationships at home. This leads to decreased empathy and compassion, poor communication and potentially worse patient outcomes. The personal consequences include disrupted relationships with family and friends, self-medicating with alcohol or other substances, depression and an increased risk of suicide, which is higher among physicians than the general population, in part due to the stigma associated with seeking mental health treatment.

Not a day goes by without my hearing from a physician in distress who has learned about the Taking Care of Our Own program. These conversations have a striking degree of similarity. They typically begin with an apology—a statement about how embarrassing it is to ask for help in dealing with anxiety or depression; or a recent loss; or other emotional stressor that makes it too difficult for the doctor to remain professional and compassionate while managing a demanding workload.

What is Driving Physician Burnout?

The culture of medicine has changed dramatically since I entered medical school more than 20 years ago. Although we worked more hours in the hospital than today’s physicians, there was greater camaraderie and a shared sense of mission and purpose among colleagues. Over the last decade, however, I have observed a growing cynicism and frustration among practicing physicians as they grapple with the complexities and challenges of our struggling healthcare system.

Factors that drive burnout syndrome in today’s environment include overall loss of control and autonomy, along with the ever-growing demands of rigorous computer documentation of all patient care encounters that intensively increase workload and decrease critical face–to-face contact with patients. Other obstacles, such as shortened lengths of stay, increased patient turnover, decreased time for interactions with colleagues and changes in reimbursement also contribute to burnout,. In the younger generation of physicians attitudes have changed, and most resident physicians now expect to have a “balanced life” with idealized ratios of time spent at work versus time with family that may be difficult to reconcile. Despite interventions focused on reducing resident duty hours and sleep deprivation, neither of these factors has been associated with reductions in burnout. New approaches are needed to combat this epidemic and provide appropriate mental health care.

How Do We Take Care of Our Own?

Medicine can be an unforgiving profession. On the one hand, we deal with life and death issues while, on the other, any outward show of distress is often not tolerated and can have grave consequences. Physicians, in general, have good coping skills honed over years of training. They are taught to ignore basic human needs (like hunger and fatigue) and to remain capable, competent and compassionate under highly stressful conditions. As a result of the stigma associated with asking for help for emotional problems, doctors wait too long to seek treatment—often until there is a mental health crisis that may require the psychiatric equivalent of intensive care. Barriers that prevent doctors from seeking mental health treatment include concerns about confidentiality, worries that colleagues will find them inadequate or incompetent or fear that they are failing if they are unable to “handle the stress”. Further compounding the problem is the lack of consistent self-care by many physicians. Resident physicians who consistently work very long hours have trouble finding time for restorative activities that help them emotionally refuel. Peak childbearing years often correlate with residency training, leaving individuals to juggle the demands of residency with the challenge of starting a family.

Taking Care of Our Own offers educational programs about burnout and mental health for resident physicians, and strategies for avoiding and/or addressing it. We work with each clinical department to implement these educational programs and customize material for each clinical specialty, as the demands and stressors vary among the diverse fields of medicine. Residency training directors play an important role when they embrace the need for mental wellness, and give trainees permission to discuss these issues and ask for help. We actively work to remove the stigma associated with seeking care and encourage self-referral. We work with the training directors and other faculty to make necessary changes that greatly increase the odds that the resident physician will be successful. One year into our program, the numbers demonstrate that this has been a winning approach. Rates of referral and demand for services of the program are constantly increasing, now occurring on a daily basis, and have increased 200% in just over 6 months.

The program also provides a mental health evaluation and treatment program for residents and fellows. All physician trainees are eligible to self-refer, although referrals often come from concerned faculty. We have developed a mechanism for triage and referral of resident physicians in need of assessment and treatment to attending faculty throughout our institution. We offer multiple different forms of mental health treatment that include evidence based therapies for burnout, depression and anxiety, and have developed a comprehensive referral base of providers who have experience caring for this patient population.

The Future:

Burnout and physician wellness can no longer be ignored and must be addressed by leadership in academic medicine6. Our initiative is aimed at increasing awareness, providing psychoeducation and offering assessment and treatment in a confidential and supportive setting that is optimized to destigmatize seeking help for emotional distress. The goal is to provide timely, cost effective and efficient care to identify and treat physician mental health issues ensuring improved performance and professionalism. Ultimately, this is good for the doctors, great for the patients and critical for the health care system. We strongly believe that this type of program needs to be offered at all institutions involved in training the next generation of physicians.

Livongo’s Post Ad Banner 728*90

Categories: Physicians, THCB

22
Leave a Reply

19 Comment threads
3 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
19 Comment authors
Nathan BradshawjordynaartiJust another ER DocJon Hager, DO Recent comment authors
newest oldest most voted
Nathan Bradshaw
Member
Nathan Bradshaw

The study took a deep dive into the EHR problems to determine the root cause of burnout. According to the study:

Those reporting poor or marginal time for documentation had 2.8 times the odds of burnout.
Those reporting moderately high or excessive time on EHRs at home had 1.9 times the odds of burnout.
Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout. Read More:

https://blog.curemd.com/physician-burnout/

jordyn
Member
jordyn

Certainly an important issue. The key solution as I see it is that the organizations in which the physician is affiliated with have to take a pro-active empathetic approach in trying to help physicians better adjust to the stress and pressures of today’s health care environment because physicians won’t take action on their own.

Jordyn,
http://anavarforwomen.org/

Just another ER Doc
Guest
Just another ER Doc

Until the state board and malpractice carriers stop asking the question “Have you sought psychiatric treatment?” in the same section as “Have you been convicted of a felony?” and treat a positive answer to either question the same, physicians will continue to avoid seeking help until they’ve reached the breaking point.

Jon Hager, DO
Guest
Jon Hager, DO

Ain’t that the truth! The thing that irritates me most is that we (physicians) seem incapable of coming together and demanding fundamental change in the system. We have the legitimacy and the leverage to do this if we ALL agree to it. Instead, we engage in infighting and petty arguments, such as whether membership in ACEP should be opened to non-EM boarded docs…at a time when we should be all-inclusive and united. There is strength in numbers. We can demand change for our profession and for our patients, or we can continue to piss & moan and burn out by… Read more »

Roger S. Perry, MD, Ph.D, FACEP
Guest
Roger S. Perry, MD, Ph.D, FACEP

After 40 years of full time emergency medicine practice I have just cut back my hours in the pit, now also know as a Toxic Environment. To me the solution to burn out is not, in psycho-therapy, increasing ones recreational activities, increasing more time with family or friends, etc., the solution lies in ridding our emergency departments of the toxic elements that are poisoning us. I would start with dumping the computer charting and physician computer order entry systems as currently being practiced. I am now being trained in my fourth computer charting system and each one has been more… Read more »

Joel Sullivan, MD FACEP
Guest
Joel Sullivan, MD FACEP

Amen to Dr. Bryant’s above post–perhaps p*ssed off is more appropriate than being burned up or being burned out. The volume of patients has gone up and in the meantime we have to document and enter all orders on a computer. In addition to taking care of the patients, one is now doing the job the unit secretary used to do–you can no longer just check orders on a piece of paper and give it to the secretary to order same. And God forbid if you fail to document the entire ROS , family history, or social history, or don’t… Read more »

Ron Peeler MD FACEP
Guest

I would recommend contacting the Center & Society for Professional Well-Being {CPWB} @ http://www.cpwb.org/ or Tel: (919) 489-9167. Founder & President, Dr. John-Henry Pfifferling, Ph.D., has been addressing burnout issues professionally since ~ 1979. Disclosure: I have no financial interests in the CPWB but I am a 1990 ‘graduate’ of some of the Centers programs, which interventions have been efficacious for me for some 24 years.

Dave Bryant D.O., FAEEM
Guest
Dave Bryant D.O., FAEEM

Burnout is different than being burned up. Burnout implies that you are tired of your profession. Many of us are not tired of being doctors. We love our profession. We are tired of having artificial stressors placed on us that have no bearing on the practice of medicine. I love taking care of sick patients and doing so in a chaotic environment. That is why I chose emergency medicine and it energizes me. However, the practice landscape now looks nothing like it did my first years in practice. Our current sitting president stood up at the beginning of his first… Read more »

Joel Hassman, MD
Guest
Joel Hassman, MD

When physicians tolerated if not embraced the for-profit model of health care driven by insurers and big pharma, they screwed themselves. Most who comment here with regularity don’t want a dialogue about doing what is right and responsible, as that doesn’t make money, eh? Which is why I don’t come to this blog much anymore. Misery loves company, and antisocial cretins thrive among the sorrow. You really want to honestly put a dent in burnout? Physicians need to band together and tell the American people almost in so many words: “Get the politicians, profit driven assho–s, and technology obsessed idiots… Read more »

bird
Guest
bird

I agree that workplace stress has always been a part of medicine, for that matter every job has its workplace stress. But for medicine the stressors that are present now are not only affecting the doc but also the patient. I feel it stems from knowing the right thing to do and not being able to do it, that really gets at the doc. We all know that there is usually an underlying issue that is driving most medical complaints, stress, obesity, dysfunctional life and if we had to time to delve into these we could probably make a much… Read more »

Peter1
Guest
Peter1

I can’t remember when (in my 64 years) that docs have not been complaining about their workplace and/or vocation stresses.

Why are our modern workplace stresses any different for docs than any other worker? Did these docs choose the wrong profession?

I have also talked to lawyers who regret going into law. They would just love to argue the law, but the stress of all the other stuff required to perform their training frustrates them.

Welcome to life. It’s a bitch, then you die.

Samantha Meltzer-Brody, MD, MPH
Guest

We need to provide support and care to our young physicians during residency training and we need to do it now!! While indeed there are a multitude of complex challenges facing the U.S. healthcare system (that absolutely require reform), the training of young doctors goes on, and we need to urgently help this next generation of physicians find ways to survive and thrive.

As described in this piece, our new program at UNC is one small attempt to educate and assist our young doctors as they navigate the difficult terrain.

aarti
Member
aarti

Hello Samantha,
Now a days, physical trainers are available every where. Even my commodity hired a physical trainer for all apartment owners.Always keep exercising. This is the only way to keep our 7 hormones active. If they are active, no disease can attack you.. This is the only reason why doctors suggest every individual to keep exercising.. My cousin suffered from Coronary blockage. After doing this diet for 3 months all his arteries were cleared.. I am very thankful to Best hcg drops website for giving us a great source of information.

Carlos Ortiz
Guest
Carlos Ortiz

Reading this is very concerning for us (medical students). I was wondering how can we, as students, prepare for what we are going to face once we enter the working environment? I don’t think medical schools prepare the students mentally for residence, which I think is essential and has to be a must, in order to lesser the effects of physician burnout.

George Dawson
Guest

For any physician defining the toxic environment is easy – this is just a start:

http://real-psychiatry.blogspot.com/2014/07/a-toxic-work-environment-for-physicians.html

Jessica
Guest

What is the nature of the toxin that has infected the workplace? Negativity? Pessimism? Cliques? Until you name the toxin, you can’t do anything about it.

@BobbyGvegas
Guest

Precisely.