Can an Emphasis on Wellness Prevent Physician Burnout?
April 26, 2019
Physician burnout is more than a buzz phrase; it is a pervasive problem that can negatively impact the lives and careers of physicians, while increasing the likelihood of medical errors and lowering the quality of patient care. Burned out physicians are also more likely to leave their positions, thus compounding the problem of physician turnover and staffing shortages.
So what can be done to prevent these negative consequences?
A new review of physician well-being and wellness programs, published February 7, 2019, in the online edition of Current Treatment Options in Pediatrics, attempted to answer this question and provide some practical suggestions to combat the dangers of physician burnout.
The study’s lead author, Roschanak Mossabeb, MD, who works in the neonatology department at St. Christopher's Hospital for Children, Drexel University College of Medicine and Temple University Hospital, all in Philadelphia, recently spoke to Merritt Hawkins about her research and the key drivers that impact physician wellness.
How pervasive is the problem of physician burnout?
According to the 2018 Survey of America’s Physicians, conducted on behalf of The Physicians Foundation by Merritt Hawkins, 78 percent of physicians sometimes, often or always experience feelings of burnout.
While Dr. Mossabeb loves her job, she acknowledged that practicing medicine has its rough spots. Her research found that the number of physicians that have burnout in the United States is only increasing.
“This is a very tough profession to be in, and it is only getting more difficult,” said Mossabeb. “It is not getting easier for physicians.”
What is causing the rise in burnout cases?
There are a number of driving factors in the increasing physician burnout rate, according to Mossabeb. The very nature of the job and its responsibilities can weigh heavily on a physician. Additionally, physician shortages and the increasing requirements of technology, government regulations and insurance payment systems are taking a toll.
One of the chief culprits? Electronic medical records.
“Physicians are expected to learn new computer systems, new software, and every place you go has a different system,” Mossabeb explained. “I work with three different EMR systems, so I have to know how to navigate those. That is a big stressor. This is easier for the new generation, but for the older attendings, it is really difficult to take this task on and learn to place your notes, navigate your orders, look up results, and it takes a lot of your time. It takes a lot of time away from the patient.”
She added that the information in EMRs relates directly to medical reimbursement by insurance companies, which are tasked with minimizing claims and expenditures. Thus, “physicians are spending a lot of time on the phone, fighting with insurance companies, advocating for their patients, so that again takes a lot of time away from their patients.”
Healthcare administrators are also pushing physicians to work more for less money due to mounting pressures for patient-centered, value-based care. At the same time, some patients are becoming more demanding.
“Now you try to advocate for your patient, but your patient has already consulted ‘Dr. Google,’ so when you tell them something, they question you.” Mossabeb added that having a well-informed patient is wonderful, but this current trend only adds to the stress of a physician’s job.
Shifting the emphasis to physician wellness
While most clinicians acknowledge the problem of burnout, far fewer know how to avoid the problem. That’s why Mossabeb and study co-author, Kevin Sowti, MD, were attempting to change the conversation to that of prevention and wellness. Their recent article, “Importance of Physician Wellness in Battling Burnout,” looks at several strategies.
“Physicians are a very tough group. We are so drilled to be perfect, and be hard working and never admit that we are tired,” said Mossabeb. “At some point it is good to say you are just human. You get tired. You have to learn to say ‘No’ and to set boundaries. You have to protect yourself and you have to work on your own wellness.”
She emphasized that all physicians, residents and medical students need to concentrate on self-care, self-compassion and self-empathy.
“It’s like when you enter a plane, they are telling you that if the air pressure drops, and the oxygen mask drops, you need to put it on yourself first before helping those around you. Physicians need to, at all times, be in a good place physically, emotionally and psychologically. You have to really practice self-care in order to be able to provide appropriate care for anybody else,” said Mossabeb, who includes yoga in her own self-care routine. “You really need to know yourself, you need to eat well, you need to exercise, and you need to sleep.”
Mossabeb also reiterated the need to set boundaries.
“Don’t take your work home, or take it home as little as possible. When you are home, be home with your kids or your loved ones,” she said.
How can physicians approach the subject of burnout with their colleagues?
“The first step is to be open about it on a personal front, and obviously you have to know your colleagues. You have to trust them, and you have to have a good working relationship,” Mossabeb explained.
“For new physicians who start in a group, it is really important to have some sort of mentorship, like a senior attending taking on a more junior attending. The mentor might then share things like: ’These are the things that I did in order to balance my work–life situation,’ or ‘These are the things that I recognize in myself,’” she added, noting that physicians who share from their personal experience can help their colleagues be more willing to open up about their own struggles.
The benefit of physician wellness programs
Physician wellness programs and initiatives are essentially a “win–win,” for clinicians and healthcare employers.
“It works in the hospital’s favor to have happy physicians who are less burned out, in order to provide better care for the patients. It increases patient satisfaction, and results in healthier patients,” noted Mossabeb. She added that cultivating an environment of wellness can cut down on medical errors, physician turnover and the associated costs.
The Mayo Clinic, Duke Health and Stanford Medicine are among the larger healthcare employers that have robust wellness programs for physicians. While Mossabeb found that the industry is moving toward these types of programs, she described that the move “has been a little bit on the slower side.”
As a minimum, she recommends that a hospital or practice should have a point person or a committee that offers wellness resources and a place for physicians to go and unwind, bounce ideas off each other or discuss problems they are having.
The discussion about physician wellness should also start early, with information in a new doctor’s welcome packet. In fact, healthcare employers that recognize the risk for burnout and have proactive physician wellness programs can use this in recruitment.
“When hiring physicians, they should highlight this type of benefit; that would be attractive to physicians. They would see, ‘This is a group that is going to take care of my needs, so that I can take care of patients,’” said Mossabeb.
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