Physician Burnout: Throwing a Lifeline to Overburdened Physicians
The Affordable Care Act triggered a revolution that continues to impact everyone along the healthcare spectrum, from the patient to the provider to the administrator.
The goal of better health outcomes at lower costs has fueled myriad trends. Increased responsibility for copays and premiums has driven the increased expectations of patients-as-consumers. Complex regulations have motivated smaller physician groups to sell their practices to larger healthcare organizations. New reimbursement models like bundled payments have spurred administrators to create innovative ways to mitigate risk among stakeholders.
Physicians are Drowning
Amid this sea change, some physicians feel as though they’re drowning. While physician employment is up, physician engagement is down. A Mayo Clinic study found that the “clerical” work demanded by electronic health records (EHR) and computerized physician order entries is correlated with physician burnout. A literature review in the Lancet noted that physician burnout has topped 50%.
The Startling Consequences of Burnout
Burnout has real consequences. It causes medical errors. It leads to car crashes. And it’s estimated that, each year, more than 400 doctors commit suicide, in part because of the stigma attached to and repercussions of seeking burnout-related mental health treatment. Yet researchers have found that even relatively small decreases in burnout scores – as little as one point – translate into significant decreases in negative outcomes.
Healthcare organizations can take a number of steps – some small, some systemic – to create a working environment that inspires collegiality while still hitting targeted health outcomes and lowered costs.
1. A Gathering Place
In a recent survey of physicians at a small hospital, almost 60 percent yearned for something that was de rigueur in the not-so-distant past: a gathering place for physicians. “We have no place to eat lunch or sit and talk with fellow providers,” noted one respondent. “A physician lounge that is open to all physicians, not just surgeons, would be a welcome addition,” wrote another. A third summed it up this way: “Since so few docs go to the hospital anymore due to hospitalists, there is a loss of camaraderie in our community.”
A literature review published in the Journal of the American Medical Association found that mindfulness programs helped to alleviate burnout among physicians. One study documented an improvement following a program that supplemented weekly mindfulness exercises with presentations about stress-related topics and group discussions. Another relied on weekly sessions that taught mindfulness meditation techniques to physicians and allied health professionals. It’s important to note that both interventions were physician-directed.
3. Communications Training
Burnout increases when physicians talk past each other; ineffectively convey information to residents, nurses, and other care team members; or avoid interacting with other staff members. Intensive communications training, when combined with stress management training, can ramp up physician skills and potentially tamp down burnout.
4. Small Group Discussions
First and foremost, physicians are people. Like all people, they gather comfort and strength from talking to their peers. A study tested a 19-week intervention with facilitated discussion groups that incorporated reflection, shared experience, and small group learning. The result? A substantial decrease in burnout, emotional exhaustion, and depersonalization.
5. Changes to Scheduling
A promising pilot study compared two different types of shift work scheduling for ICU intensivists. The standard staffing model, where one intensivist worked for seven days and was on call at night, was compared to 24/7 intensivist coverage, where one intensivist was scheduled for seven day shifts and two other intensivists alternated working night shifts. The intensivists experienced significantly less burnout. Another study found that two-week inpatient attending physician rotations improved burnout rates when compared to four-week rotations. Taken together, these studies open up the possibility that hospitals should re-examine how they schedule physicians.
6. Treating Physicians as Stakeholders
Physician lounges, mindfulness workshops, and communication trainings are small but important steps in acknowledging doctors as both professionals and people. Another critical measure is recognizing that physicians are stakeholders in the organization and then creating partnerships with them.
A true partnership involves taking the time to explain the “why” behind the “what” and collaborating with doctors in developing short- and long-term strategies to alleviate burnout. Nurturing physician leaders who are then able to communicate with other doctors results in increased buy-in for organizational initiatives.
In this changing healthcare landscape, physicians needn’t be left behind. Ensure that physicians become more engaged partners in meeting today’s challenges and embracing tomorrow’s trends.