Whether it’s the day-to-day grind or the tireless commitment to success weighing down on a physician, if they are not careful in balancing out caring for the patient with their own self-care, the job can overwhelm a doctor’s capacity to perform their work properly.
As in any occupation, a physician can experience burnout. Due to the job's life-and-death pressures, this condition can be more common among physicians than other professionals. By the same token however, the consequences of burnout among physicians can be far more dire than those in other vocations. For those reasons, it is essential that every physician learns about physician burnout: what it is, how to recognize it, and, most importantly, how to prevent, reduce, and relieve it.
The National Institutes of Health describes burnout in terms of one's metabolism. If you think of your metabolism as an account into which you can deposit energy through recharging activities that rest and rebalance you and from which you can draw energy for your daily activities and work, burnout is essentially a fundamental disorder of that mechanism.
Specifically, the NIH defines burnout as: "the constellation of symptoms that occur when your energy account is in a negative balance."
In particular, when it comes to physician burnout, numerous studies have shown that, while a doctor may continue functioning in this energy-depleted condition, it is at a fraction of the capacity and competence they normally possess when that account is suitably flush.
Three Kinds of Energy
To extend the metaphor of metabolism as an energy account, there are three categories of assets:
- Physical Energy – The energy you use to move your body and engage in the activities of life
- Emotional Energy – The capacity to be compassionate and emotionally available
- Spiritual Energy – Your feelings of connection to the world and purpose in your work
As any physician knows, you first have to identify and acknowledge it in order to treat a problem. While defining and describing physician burnout is typically not difficult, identifying and acknowledging it certainly can be.
Similar to depression, burnout can be tough to diagnose because so many doctors are not even aware of the problem until they are already deep in the end stages.
How Does Burnout Work?
Once you understand that you have not just one energy account but three; physical, emotional, and spiritual, you can begin to grasp how burnout functions in a person. Armed with that information, you can more effectively address and treat the problem.
Each of these three types of energy corresponds with the three symptoms measured in the Maslach Burnout Inventory (MBI):
- The depletion of your physical energy account corresponds with exhaustion. To refill it, get more rest, exercise more, and nourish yourself with nutritious food. Of course, these are all the same things your medical training taught you to sacrifice in order to succeed in your work.
- The depletion of your emotional energy account corresponds with compassion fatigue. To refill it, build and grow healthy relationships with your family and friends. Without an adequate supply of emotional energy, your "bedside manner" could suffer tremendously, as well as your ability to be there emotionally for your staff and loved ones.
- The depletion of your spiritual energy account corresponds with apathy. To refill it, rekindle your sense of connection with a larger force, be it your God, community, or a greater purpose. Recall those moments when an encounter with a patient reminded you of why you chose to become a doctor in the first place. Find ways to connect with your world and your sense of purpose outside of your workplace as well, whether by volunteering your time for a good cause or attending religious services in your community.
How to Cure Physician Burnout
Already, you’ve reviewed some suggestions for how to deal with depletions of your various energy accounts. What follows are some more ways that physicians can implement those strategies practically and effectively.
As Tait Shanafelt, director of the John Hopkins Program on Physician Well-Being and professor of medicine at Mayo Clinic explains: "For physicians to avoid burnout, they need connections with colleagues, a sense of control over their work and schedules, and opportunities to grow and excel."
As important as these goals are, however, physicians are unable to achieve them on their own, he goes on to assert, citing that only 20% of the onus is on the individual, the other 80% on the level of the organization and system where the individual works.
In a study Mayo Clinic published entitled "Effect of Organization-Directed Workplace Interventions on Physician Burnout: A Systemic Review," American Medical Association and IBM Watson Health researchers found that the source of burnout more typically comes from factors on the system and organizational levels.
Thus, they find interventions that focus on alterations to the system rather than the individual physicians potentially more effective at keeping physicians from experiencing burnout.
The Four Ts
In the study cited above, the researchers categorized burnout interventions into one of four categories, each labeled with a word conveniently starting with the letter "T," thereby making them "The Four Ts." While they were devised uniquely for this study's purposes, they have lasting value as a way to evaluate interventions directed at an organizational level to determine their effects on physician burnout.
Twenty of the 50 interventions the researchers examined in the study focused on building better teamwork using techniques like:
- Offering team-based care
- Using scribes to input EHR data
- Improving communication among physicians
In every teamwork subcategory, the researchers noted improvements in physician burnout measures as well as stress levels and job satisfaction. In addition, they found less cynicism and exhaustion, increased practical ability to provide primary care services, and greater chances the physician would recommend the given clinic to other physicians and medical workers as a potential place of employment. Medical practices that offered physicians clerical support full time to enter in orders and other patient information reduced weekly self-reports of physician burnout. The percentage of burned-out doctors dropped from 43% to 14%.
Fourteen of the 50 interventions to resolve physician burnout involved restricting working hours, adjusting work schedules, and incorporating a time-bank system. Of these, eight resulted in positive self-reports of their impact on physicians. Six more of the 50 interventions involved limiting the number of hours worked, but only two found that it relieved any burnout due to the pressure many of the physicians felt to complete the same amount of work in less time. Meanwhile, time banking helped medical school faculty spend more time teaching, mentoring, providing clinical services, and other activities, which, in turn, also improved satisfaction.
Eight of nine studies examined involved workflow changes and transitions, such as separating workflows and targeted projects to improve service quality. These had a significant positive impact on physician burnout and satisfaction. Another study noted vast improvements in physician burnout measures following the implementation of quality-improvement initiatives, particularly in places physicians found most cumbersome, like reconciling medications. As a result, levels of job satisfaction among physicians increased, and stress decreased.
Of ten studies examining the use of technology to solve physician burnout, researchers reported that half successfully improved both physician burnout and job satisfaction. Interventions involving improvements to the EHR system resulted in drastic improvements in physician burnout and satisfaction levels.
There was, however, one study in which implementing EHR in a workflow either increased burnout or had no effect on it. This may have resulted from inadequate training causing inefficiencies in the EHR system. The addition of new features to EHR systems only caused physicians to feel more stressed and burned out. Along the same lines, increased use of computer keyboard due to increased EHR use lowered job satisfaction. If, however, a physician did happen to appreciate the implementation of information technology systems in the workflow, they were also four times as likely to have high job satisfaction.
Concrete Steps to Prevent and Reduce Physician Burnout
Here are some practical tips for preventing and reducing physician burnout:
- Change your schedule: Not that it always works, but sometimes just a schedule change can give you the shift in job satisfaction you need to break out of your burnout. Whether it’s the timing of the shift or the number of hours you’re working, try changing it up, if you can, and seeing what that may do to help.
- Impose limits: If you can delegate certain tasks to others, it may sometimes be useful. If you can’t, then set limits on how much you can do in a set amount of time. Make realistic expectations for yourself so you can meet them with excellence, and ask for assistance when you need it, which may include restructuring workload distribution among colleagues.
- Make time to exercise: Just 30 minutes each day can improve mood and sleep and help you maintain a healthy weight.
- Read non-medical material: You may like reading medical news, but even just 10 minutes of reading an article on an entirely different topic or a short story or chapter in a novel can help clear your mind and emotions and remove your focus from occupational stressors.
- Spend some quality time with your family: The longer the hours you work, in fact, the more important it is to make sure to give your family some of your best energy and not what’s left at the end of a long shift.
- Take a class: Continuing education helps keep your mind sharp and focused, and the process of learning can be immensely enriching. Alternatively, join a book club or take a public speaking class.
- Take on a hobby: Pursue an interest in something completely outside your work field, and you may discover you find more satisfaction in your job when you do work.
- Join a support group or meet with a mentor: Safe and confidential conversation with peers can help relieve stress and provide you with a new chance to review ways others like you have combated their burnout.
- Participate in task forces and committees: Joining groups at your workplace that allow you to influence the culture and policies there in ways that promote beneficial change for everyone in the environment.
Physician burnout is a very real and significant problem that can threaten the efficacy of an entire community's medical system if not adequately addressed.
Fortunately, many proven ways exist to both alleviate the pressures that cause physicians to experience burnout and improve their satisfaction with their practice. While incorporating EHR in practice or system may have mixed effects on these two factors, other organizational efforts could have a pronounced positive impact on them, including those that promote teamwork, better time management and work-life balance, and targeted adjustments to the workplace's workflow.
There are also many steps an individual physician can take to proactively reduce his or her own likelihood of burnout, including those that fuel the individual's physical, emotional, and spiritual energy accounts. By properly addressing and ameliorating burnout, physicians, practices, and hospital systems alike can ensure their abilities to give patients the absolute best medical care they can.