Posted by admin 30.11.18

Physician Burnout and We Can Learn From It

I knew something was serious when a physician-leader and client shared that her days are so hectic that she rarely stops to take a drink of water or gets a snack to re-fuel.  The challenge of this simple act of self-care was undermining her effectiveness and wellbeing.  The high patient load and management responsibilities were relentless, and her pursuit in leading a life lived well, was less than desirable.

In a 2018 study on work and well-being, the American Psychological Association, finds more than one-third (35%) of American workers experience chronic work stress, and more than half say their employer provides sufficient resources to help employees manage stress.

Taken a step further, burn-out is about prolonged or chronic job stress and relates to three dimensions: exhaustion, cynicism, and feelings of reduced effectiveness and professional ability.

Up to 54% of Physicians Experience Burnout-that is Exhaustion, Cynicism, and Reduced Professional Effectiveness

In a study by Fred and Scheid, they found that physicians who suffer from burnout increased from 45% to 54% between 2011 and 2014.  The authors describe burnout by emotional exhaustion, finding work no longer meaningful, feelings of ineffectiveness, and a tendency to view patients as object rather than as human beings.  All red flags.

Comparing the physician stats to the general working population it has remained steady at around 28%.

Physician burnout is reaching crisis proportions in the US and is festered by tasks of documentation and reports that require high administrative attention.  This challenge, along with other system-and-culture oriented issues, like electronic record woes and building high trust and collaborative teams, all contribute to depleted resources and inefficiency.

In my work with healthcare leaders and physician-leaders, in particular, these stats reflect my experience.  Most physicians do not set out for positions of management when they begin their careers.  Most are highly driven and want to do right by the patient.  Some have grown through the ranks within a framework that is more akin to an apprenticeship model and with mentors as guides.  Professional and leader development, team strategy, and culture work is emerging in healthcare settings as ways to address challenges-both for the individual and for the broader organization.

Here are 4-recommendations to get physician-leaders, and more generally leaders at all levels, moving in the right direction:

  1. Stay alert.  Take a brief inventory in areas where you are thriving-and seek to maximize these behaviors.  If you are a good communicator, reinforce messages and expectations to help others succeed.  In areas where you need to improve, such as managing conflict skillfully, pay attention and notice if the issue is more attuned to the individual or system.  Determining the source of the challenge can help direct your attention.
  2. Practice self-care.  Too often our care for others comes at a personal cost.  If your workload is unbearable, what conversation is waiting, if you tend to be a perfectionist or pessimistic about things, what do you need to let go of, or at least modify, to be more effective.  In what ways can you empower and involve others to be a part of the solution.  Exercise, eat well, mediate, invest in your personal and leader effectiveness.  Ask yourself, in what way can you replenish your energy?
  3. Think broad, act from where you are.  Are there steps you can take to anticipate change and plan ahead?  This can include things like expectations about your availability or setting up your team to schedule vacations and time away in advance.  What can you be doing to develop others or equip your staff to be better leaders?  What new skills do they need to be developing and how can you empower them?
  4. Build in reflection and catch up time. If you are all activity and no rest the cycle of burnout continues.  Be sure to pay attention to the culture.  If the individual is improving yet the organizational norms are counter-productive, find ways to bring this up to your leaders or ways you can address them directly.  If the organization tolerates behaviors that undermine morale and effectiveness, what communication and accountability measure need to be put into place?

Just 4 in 10 working Americans say they regularly participate in employee wellness programs

Start with where you are and build out.  Thinking that you cannot do anything about these things contributes to a sense of powerlessness and festers a cynical outlook.  The APA cites that only 4 in 10 employees participate in efforts designed to involve employees in decision-making, problem solving, and goal setting or using flexible work arrangements.

In what ways can you build your hardiness and emotional buffer?  Physicians working with patients is more than expertise and requires social intelligence, hardiness, and flexibility to deal with the barrage of daily challenges. These individual efforts contribute to addressing systemic issues and can shape the overall culture.

Each year about 250,000 patients die in the US because of medical error (Verghese, 2018), which is equivalent to a mid-sized metropolitan area.  Professional development is a key driver to assess, develop, fine-tune, and in some cases, overhaul the system, and in sustainable ways.  To do anything less is to risk failure, and the care of others.