Strategies to prevent physician burnout

In these days of decreased reimbursement, increased workload, and non user-friendly EMRs, physician burnout rates can be quite high.

Stress, depression, and overwhelming fatigue associated with burn-out can interfere with our ability to care for our patients. If we, as providers, are not emotionally healthy, we are not able to provide the very best of ourselves to our patients. When we allow ourselves to become over extended and over committed without adequate recharge time, we may not be able to respond to a sick patients and their families with much-needed empathy and compassion. Moreover, our cognitive skills and our diagnostic abilities may not be as sharp. This can lead to less than our best care.

Physician burnout may be the cause of medical errors. These errors can then in turn result in worsening of the burnout … a vicious cycle. Family life may suffer as well. Stresses at work are often transported home in the briefcase and can result in negative interactions with spouse and children — further compounding the pressures that lead to burn out. Several studies on physician burnout have been published and two of the most notable articles are found in Annals of Internal Medicine and in JAMA both in 2002.

How can we identify burnout?

Burnout is defined as emotional, physical and mental exhaustion due to overwhelming prolonged periods of stress. It has been said by Dr. Glen Gabbard that physician burnout is the “erosion of the soul.” It is a condition most common in middle age physicians but research has shown that younger MDs are at the greatest risk. Physicians and other health care providers are frequently overloaded with caring for the sickest patients with fewer resources and mounting economic challenges.

As physicians, we are trained to put our own needs aside in the care of our patients, our colleagues and our institutions. From the time we begin our training in Medical School and continue through internship, residency, and fellowship, we are embedded in a culture of selflessness. This makes for great patient care and great partnerships with colleagues but is not a recipe for good care of one’s self. In the medical education culture, overwork and tireless labor is seen as a sign of success or “being a good doctor.” The skewed life-work balance begins early, at the inception of our medical careers. We tend to push aside our own physical and emotional needs in favor of a compulsive need to work and over-work. These maladaptive behaviors (while excellent for making exceptional grades in medical school and receiving superior reviews in training) can have a detrimental effect on ones professional, personal and family lives.

The first step in dealing with unhealthy life-work balance is to perform an honest self-assessment. As physicians, we are taught in training to routinely assess our own clinical performances but rarely are we asked to determine how we balance our personal life with our practice of medicine. Ask a few simple questions: Are you happy and fulfilled? Have your patient satisfaction ratings remained the same? Do you have a shorter fuse than normal? Are there conflicts arising at home? Has the way in which your partners perceive you changed? Do you take time to laugh? Are you overly obsessed with work and work related issues?

Physicians must come to understand the risks for burn out and talk frankly with their spouse and colleagues and practice administrators about achieving balance. Frank discussions with trusted advisors and family can lead to identification of the early signs of burnout. Just as in medical practice, when we identify an issue or risk factor early we can take actions focused at prevention of the burnout and improve outcome.

How can we prevent burnout?

Just as with preventative medicine we can take action to avoid burnout in our own careers. Work to identify things that promote well being on a physical, emotional, psychological and spiritual level. As I reflection my own career thus far, I have employed several of these strategies over the years (sometimes without even realizing it). Strategies below are adapted from JAMA 2002: 288; 12, 1447-1450.

Personal strategies

1. Identify personal and professional values. Do some soul searching. What brings joy to your life both inside and outside of work? Focus on how to find more of these things and weave them into your daily routines.

2.Engage in religious or other spiritual activities

3. Pay attention to your personal life. Find things that give meaning to life outside of work. Strive for a calmness and sense of well-being. Schedule time off.

4. Spend time with family, friends and engage a supportive partner or spouse.

5. Exercise regularly. Make time to care for your own physical health.

Professional strategies

1. Analyse your practice situation and attempt to restructure things in a way that makes you feel empowered and ready for success.

2. Find meaning in your work and set limits.

3. Identify and routinely spend time with a mentor

4. Develop adequate administrative support systems.

In addition to working to identify and prevent burnout in our own lives, we have a responsibility to ensure that our trainees and future MDs do not suffer burnout. Early mentorship programs in medical school and residency are essential. I believe that the concept of burnout should be discussed regularly with trainees so that all can be proactive in prevention.

Always at risk

As physicians, our workloads remain daunting. We will always be at risk for burnout. The key is to strive for the holy grail of the proper life-work balance. This balance is individualized for each person and can change over time. We must constantly re-evaluate and routinely self-assess. Prevention is critical. If I am honest, I have certainly flirted with burnout many times during my career. Luckily, I have a supportive spouse who routinely keeps me in check. February tends to be a tough month for many of us. Its cold, dark and often the weather is quite bad. For me, my strategy is to go somewhere warm, rejuvenate, relax and come back to my practice once again inspired and excited to be at work.

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.

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  • http://empoweredpractice.com/ Trista Koch

    This is great information for all people. I am a business coach for medical professionals, and having been in the healthcare field, I can relate as well to burnout. In fact,  that is exactly what sent me down a different career path in the health care world. The very first key point under personal strategies was my biggest disappointment with my career. I realized that my job was preventing me from following and living my personal values. Once I realized that I conceived a plan to  make positive change in my life. When I work with my clients, whether they be doctors, nurses, or administrators, the first thing we look at is just what you have listed above. I often hear, “I am hiring/paying you for my business, so I won’t list my personal goals,” I have to respond that they all correlate and affect each other, business or professional. It doesn’t take long for them to realize that and we are able to successfully move forward. I don’t know anyone that can’t benefit from your article from time to time. 
    -Trista

  • http://www.threehourmidlifecrisis.com/ Dike Drummond MD

    Hey Kevin … great post here and I want to emphasize two burnout prevention points that have had the most most value for me personally and for many of my clients.

    1) The role of the skills of mindfulness in daily burnout prevention. It is impossible to eliminate all stress from the workplace … and you can learn how to not carry negative thoughts and emotions from patient to patient. Not something we are taught in Med School or Residency … AND this skill of non-attachment is critical to being the eye of the storm at work.

    2) We all have a story. Why we chose medicine. What we love about our medical career – and there is always something we still love about it. This is our source of understanding “Meaning” in our career. Once we hone in on that – a coach is very valuable here – we can rearrange our work schedule and the functions of our work team so we are doing more and more of what we love … what is most connected with the meaning in our personal career.

    Two thoughts for now (two cents?)

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • http://www.threehourmidlifecrisis.com/ Dike Drummond MD

    One more thing …. you don’t have to “search your soul” to figure out your values. There is a much easier way.

    Think back to the times you have been most outraged, insulted, disrespected and hurt … in each case, one or more of your values was being violated. It is often MUCH easier to identify your values from these experiences than thinking you have to understand how you might “search your soul”.

    Then it is a question of reorganizing your environment to automatically honor those values.

    Dike
    Dike Drummond MD
    http://www.thehappymd.com

  • Tom Malinich

    Unfortunately, I think physician “burnout” is largely a creation of the insane medical system we work in.  Patients really are not the customers of physicians in 2012.  Insurance companies, business executives, and the government are now paying the physician with little direct economic impact from the patient.  I started a direct-pay clinic as a part-time venture and still work as an emergency physician.  It has been wonderful and cured my burnout to the point where I enjoy emergency medicine once again as well.  Patients pay me directly and can submit the claim themselves.  Direct-pay medicine may be a new concept in 2012, but is the oldest form of physician payment in history.  It also ensures a strong patient-physician bond… if I don’t satisfy my patients, I’m out of business!

    Tom Malinich, MD
    http://www.medicalsimplicity.com

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