The Physician Burnout Series: Part 1 of 4
Sarah: An oncology nurse for 30 years, Sarah has such great bedside manner she’s taught seminars on the subject. But following a recent annual review, statements like “lacking in compassion,” “not listening well,” and “staring blankly when confronted by grief” are bouncing around in her mind. She wanted to argue with her supervisor, to point out the commendations she has received in years past, but truthfully, she knows that the needs of her patients that used to arouse empathy in her now only seem to sap her energy. It’s enough for her to complete the physical work of nursing these days, and she wonders where her passion for people has gone.
Tom: Always the life of the party in medical school and residency, Tom could always be counted on to go clubbing and drink anyone under the table. Even now, after a decade in emergency medicine, colleagues who stopped partying hard to meet the demands of their profession notice that Tom’s energy seems to ramp up rather than diminish with age. Lately he’s not only been energetic, he’s also visibly agitated and unapproachable. Then, following a night shift, he drove his Porsche through a railing and off an embankment on his way home. When he was admitted to the ER, they found methamphetamine in his blood work.
Matt: Matt placed the central line during a code blue and did everything he could to save the 45-year-old man with a vfib cardiac arrest. When the patient died and everyone was clearing the room, it occurred to Matt that the guidewire was left in. He sat at his desk for the next half hour, not sure what to do or say. Did the guidewire have anything to do with the continued PEA arrest? How could he have missed it? How will he face his colleagues when they find out about it? What will he tell the family? Will there be a lawsuit? Is his home and children’s education fund at jeopardy? Head in his hands, Matt wondered for the thousandth time if he really should be practicing medicine.
Though Sarah, Tom and Matt are facing very different circumstances, they all have one thing in common—they are experiencing burnout. According to Dr. Mark Mariani, director of Multicare’s Physician Wellness Program, burnout is a syndrome of depersonalization, emotional exhaustion, and low personal accomplishment that leads to decreased effectiveness at work.
Though not a new phenomenon, the rates of burnout among physicians in the United States have risen dramatically. Ongoing research by Dr. Tait Shanafelt at Mayo Clinic shows the percentage of reported physician burnout in the United States has risen from 30% in 2011 to an alarming 54% in 2014. During the same time, burnout rates in other professional fields in the U.S. held steady in the high 20-percent range.
Specialties at highest risk for burnout include emergency, family and general internal medicine, but large increases were also seen between 2011 and 2014 in orthopedic surgeons, radiologists and rehabilitation.
The trend has many medical professionals understandably worried. In addition, the study shows that 39% of the doctors who took the survey screened positive for depression, the rate of suicidal ideation in the last 12 months jumped from 4 to 7.2%, self-medication and substance abuse is a problem, and burnout is causing many to consider early retirement or reduce their working hours.
“There are costs to the healthcare system as burnout directly affects quality of care, patient satisfaction, nurse turnover and financial performance of the healthcare system,” says Dr. Viral Shah. “There are also personal costs to the physicians that experience burnout—sleep problems, depression, anxiety, substance use, fatigue, and getting into conflicts at work and home.”
The Mayo Clinic will conduct another survey in 2017, but with more than half of the physicians in the United States reporting burnout, it’s past time to do something about this.
According to Dr. Shanafelt, five dimensions that contribute to burnout include excessive workload, inefficiencies in the practice environment, loss of flexibility and control for medical professionals, loss of meaning in work, and a loss of work/life balance (40% of physicians work more than 60 hours per week compared to 7 percent of the general public).
“This is a system-based problem,” says Dr. Shanafelt in a recent radio interview. “U.S. medicine is at a tipping point now, with over half of our physicians experiencing burnout. We need healthcare organizations to address this problem with strategies to focus on improving efficiency in practices … delegating clerical work to support staff, creating an environment that cultivates flexibility and control over work, a greater connection with colleagues, and where addressing the problem is the shared responsibility of both physicians and organizations.
“The current degree of burnout is alarming given the strong links between physician burnout and quality of care, as well as the connection between burnout and medical errors. Physicians who are burnt out are more likely to reduce their professional work effort or cut hours, which could compound the anticipated shortage of physicians in the U.S. during the next decade.”
For those experiencing burnout—a lack of self-efficacy, emotional exhaustion, and depersonalization—there is hope. Thought leaders such at Dr. Shanafelt are taking an academic approach to study the syndrome and come up with solutions; MultiCare’s Physician Wellness Program is in the process of developing an organized approach to addressing burnout; and Physicians Insurance has partnered with Leading Well and Vera University, a division of Vera Whole Health, to offer courses that teach physicians how to prevent and overcome burnout.
But first, the #1 need to be addressed, according to Dr. Mariani, is for physicians to recognize that they are experiencing burnout. They need to know there are solutions available, no matter how complex the situation may be.
“Like with anything cultural, it is not a quick answer or pill that will change this,” says Dr. Mariani. “It’s going to be a long road, but we need to start our journey now.”
Next: Watch for our upcoming blog article Burnout: Stop It before It Stops You (#2 in a 4-part series on burnout).