Shared responsibility between individual physicians and the organization
Physician burnout is a complex issue and a growing concern across the country. The statistics are alarming. For example, according to a Mayo Clinic study conducted in partnership with the American Medical Association, between 2011 and 2014 there was an almost 10-point increase in physicians who reported feeling burned out (45% in 2011 vs. 54.4% in 2014), with more than half of physicians reporting that they were feeling at least one symptom of burnout.
An October 2016 New England Journal of Medicine survey indicated that 96% of executives, clinical leaders and clinicians overwhelmingly agreed that physician “burnout” is a serious or moderate problem in the healthcare industry. Similarly, in the Advisory Board’s 2016 topic poll, 90% of medical group executives identified burnout across the organization as a high-level priority with more than half indicating that reducing burnout is at the top of the priority list.
Burnout affects physicians across all specialties and is particularly acute in primary care. This has potentially significant consequences for physicians, practice teams, medical groups, healthcare organizations and patients across the continuum of care. It is encouraging to see that organizations are grappling with and seeking meaningful solutions to this multi-faceted issue. What are the potential implications? According to the Mayo Clinic, some potential professional and personal implications of physician burnout include decreased quality of care, increased medical errors, decreased patient satisfaction, reduced productivity, physician turnover, broken professional and personal relationships, alcohol and substance use and mental health issues.
What is burnout?
Burnout is different from day-to-day stress or job dissatisfaction. While stress is characterized by over engagement, burnout is characterized by disengagement. It is often defined as a loss of enthusiasm for work (emotional exhaustion), feeling more callous or cynical (depersonalization), and a low sense of personal accomplishment. Often it’s a feeling of being disconnected from one’s core purpose.
What causes physician burnout?
Many factors can contribute to physician burnout. Some examples include increased workload and productivity expectations, expanding regulatory and documentation requirements and inefficient workflows. Others are feeling undervalued and uninvolved, frustration with referral networks and reimbursement, staffing issues, difficult patients, medicolegal issues and challenges in finding work-life balance. This is not an exhaustive list of the causes of burnout are often unique and variable from individual to individual and between groups.
How can organizations and physicians address burnout?
Despite the increased recognition of the problem and the visibility of the issue in the national media, organizations and physicians struggle with identifying and implementing clear action steps for addressing physician burnout. Organizations are beginning to recognize that burnout and professional satisfaction are not solely the responsibility of individual physicians but rather an area of shared responsibility.
Three-part prescription or framework, focused on actions that individual physicians, the practice/workplace and the organization can take to help better recognize, reduce and address burnout and promote balance.
- Individual Physicians: As a leadership coach to physicians and healthcare executives, I tend to focus first on the individual. How can individual physicians combat burnout and restore balance in their lives? Physicians often have a strong sense of commitment and personal responsibility so it can be difficult to admit feelings of burnout. Individual physicians must take an honest look at themselves. They can help themselves by identifying what being “in balance” means for them, creating a clear mental picture and writing down examples of what it looks/feels likes to be in balance. Through this they should take into consideration the domains of Body (nutrition, exercise, sleep); Heart (personal values, what is important); Mind (self-awareness, presence, emotional regulation, how they interpret things); and Spirit (sense of peace, purpose, gratitude, meditation, positive energy).
The physician can then honestly assess the gap between where he/she is and would like to be and create a simple personal action plan with specific, meaningful actions that he/she will take to help improve personal balance and reduce the potential for burnout.
Other helpful tips are to actively seek out resources to promote resilience and self-care, take a one-minute mini-meditation break at various times during the workday, engage in hobbies or activities that are meaningful and incorporate an end-of-day self-check-in. The self-check-in provides a moment to intentionally reflect on the bright spots in the day—what went well and where he/she made a difference. Physicians who find their work meaningful are less likely to be burned out.
With regard to feeling a lack of control, it is true that physicians have lost some autonomy overall as more physicians have entered into employment or affiliation arrangements and the practice of medicine has become more regulated and standardized. However, there are many meaningful things that physicians can directly control or actively influence.
Physicians may have opportunities to lead or actively influence the design of care delivery systems and processes, for example. A simple tool like Stephen Covey’s Circle of Control can help physicians reconnect with things they can control (the inner circle) and meaningfully influence (the outer circle) and serves as a reminder to focus valuable energy and time on the things inside these circles and not on things which they can neither control nor meaningfully influence.
- Practice or Work Setting: As leaders in the practice/work setting, physicians can help to proactively manage the risk of burnout for themselves, their colleagues and their teams. Examples of meaningful activities in this arena include:
- Acknowledge and assess the risk of burnout
- Recognize signs of burnout and offer support
- Facilitate role clarity and reinforce how roles meaningfully contribute to patient care
- Train team members to optimal performance
- Conduct daily huddles
- Seek input, listen, offer choices, act and close the loop
- Develop adequate administrative support systems
- Build positive relationships, trust and a collaborative team culture “We, Our, Together…”
- Enhance connection to purpose; Ask “What matters to you?” and collaborate to identify and address the unique impediments to joy in the workplace
- Show appreciation for the team and its members; celebrate successes
- Collaborate to improve quality, efficiency and service
- Make meetings meaningful, efficient and accountable
- Implement practices and policies that provide choices, flexibility
- Establish appropriate expectations for patients
- Promote and be a positive role model for work-life integration and well-being
Organizations: Organizations play an important part in understanding and addressing physician burnout. Assessing the risk of burnout, through a survey or other method, and partnering with physicians to better understand and address opportunities for improvement is key. Developing strong physician leaders is also important as their leadership qualities directly impact the well-being and satisfaction of individual physicians, according to results of a Mayo Clinic study.
In addition to the actions listed under the practice/workplace section above for consideration, organization leaders can help build trust by maintaining an open and ongoing two-way dialogue, listening, actively engaging physicians and giving them choices in organizational and operational initiatives. Organizations are using a variety of methods to facilitate meaningful dialog, including one-on-one and small group discussions, forums and rounding. Creating meaningful opportunities for physicians to lead or participate in areas such as care model design, system, process and quality improvement, EMR templates and interfaces, etc. can help align everyone around creating a care experience that is safe, compassionate, coordinated, high-quality and cost-effective. Organization and physician leaders can also collaborate with payers, EMR providers, regulators and others to help encourage continuous improvement, improved usability and reduced clinical burden.
We know physician burnout is a serious and complex issue that won’t be solved overnight. However, there is hope. I believe changes are on the horizon since meaningful conversations are occurring and because there is a great deal of joy in the practice of medicine. It is important to remember that not all providers are burned out and many who experience burnout can and do recover. Incorporating some of the strategies outlined above can help physicians, their practices and organizations move to deliberate, meaningful and sustained action to positively address this important issue.
Shanafelt T, Noseworthy, J. Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout. Mayo Clinic Proceedings. 2017;92(1):129-146. http://www.mayoclinicproceedings.org/article/S00256196(16)30625-5/pdf
Swensen S, Shanafelt T, Mohta, N. Leadership Survey: Why Physician Burnout Is Endemic, and How Health Care Must Respond. NEJM Catalyst Insights Report. Dec. 8, 2016. https://catalyst.nejm.org/physician-burnout-endemic-healthcare-respond/
Advisory Board 2016 Topic Poll. March 31, 2017.
Shanafelt T, Boone S, and Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general population. Arch Intern Med. 2012;172(18):1377-1385. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1351351
Covey, Stephen. The Important Mind (self-awareness, presence, emotional regulation, how they interpret things); and Spirit (sense of peace, purpose, gratitude, meditation, positive energy).