How to diagnose, intervene and succeed in combating physician burnout

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Physician burnout levels hover around 50 percent across most specialties, according to surveys from Medscape, the American Medical Association and the Mayo Clinic. These surveys also indicate burnout is steadily increasing among physicians due to a combination of factors, including long hours, bureaucratic tasks and reduced face time with patients.

With enthusiasm, engagement and decision-making capabilities at risk for roughly half of the nation's physicians, burnout poses a real threat to patient care.

This content is sponsored by TeamHealth.

Here Robert Frantz, MD, a board certified emergency physician and president of TeamHealth Emergency Medicine West, and Jim Tait, TeamHealth's vice president of human resources, share their personal experiences with burnout, how to identify the condition in colleagues and what leaders can do to combat this threat.

Editor's Note: Responses have been edited lightly for length and style.

Question: How prevalent is burnout? Does it hit some specialties harder than others?

Dr. Robert Frantz: It's rampant. If burnout were a disease, there would be a national outcry for resources to deal with it. Nearly half of all providers are burned out at some point in their career, and the other half lie about it. If I were to guess, I'd say about three-fourths of providers experience [burnout] at some point. It's more prevalent in specialties that require direct care with patients. That's not to say radiologists or pathologists couldn't burnout — anybody has the ability to be burned out — but it's a care fatigue problem.

Jim Tait: After [TeamHealth] had two physician suicides within a couple of weeks, I started doing research and talking to physicians. I spoke to roughly 100 and asked why they became a doctor. They basically said three things: I want to help people, better my community and provide a solid lifestyle for my family.

Physicians go through school in an eight- to 10-year sprint. Meanwhile, they look across the road and their contemporaries are becoming attorneys and accountants, living a lifestyle they envision living, while they are a quarter million dollars in debt from student loans. They become entrenched in the workplace and the divide grows until their family believes they love their patients more than them. Conversely, the physician becomes resentful and believes they are doing everything they can to afford that lifestyle.

I see this mostly in the emergency medicine and the hospitalist space. Some face financial challenges. Others face divorce. It's devastating, but they compartmentalize emotions, go on to the next case, and when they are done, go get a sandwich in the cafeteria. Sometimes, they lose the ability to feel love.

Burnout is a hidden problem and the prevalence is understated because the stats are difficult to get a handle on. Out of almost 1 million physicians in the U.S., about 400 will commit suicide each year, and that's probably an understatement.

Q: What are signs of physician burnout? 

JT: Detachment, less rounding on patients, less social interaction. People in this burnout phase fundamentally believe they are on an island by themselves and cannot be rescued, and it manifests itself as isolating behaviors. Beyond that, there are errors like potential coding inaccuracies for billing purposes, lack of attention to detail on EHRs or mistakes during handoffs with patients.      

RF: The most common sign is compassion fatigue. That's why it's so insidious. As a physician, you learn there is an emotional distance required for a therapeutic encounter with a patient. You can't have 100 percent empathy at all times and be effective. But at some point, if you are disassociating from all patients, that's an issue. It can also bleed over into other relationships, and you find yourself disassociating from family members or coworkers.

Q: Have you or a colleague had any personal experiences with burnout and how did you deal with it? 

RF: Yes, I have. I practice one day a week now, which has removed a lot of those calluses.

About 10 years ago, I had a lawsuit, just finished a divorce and was working a clinical shift two days after the lawsuit was resolved. I was so arrogant and blind to the issue; I thought I could work through it. The way I managed patients was completely off. Sitting at my desk and looking at the queue, I realized suddenly — like a lightning bolt — I was overwhelmed, tearful and hopeless. I didn't know how I would get through the shift. Leaving in the middle is not an option, and I was just four hours into a 12-hour shift. I was well beyond the first stages at that point. It was a crisis.

At the time, there was no real awareness of burnout. There was a stigma around asking for help. You were expected to be tough and work through it. But when that fails, you don't have much to fall back on. When our coping mechanisms are breached, you are in real trouble. You revert back. I felt like an intern again. The first person I could think to call was an attending I trained under years ago. I called right in the middle of the shift and he talked me through the acute phase. He helped me understand caregivers also need care, and there is nothing wrong with that. Over time I was able to manage my way out of it. I reduced my clinical shifts, took time to reflect, tried meditation, went to church and focused on relationships and tried to repair them. The crazy thing is I always thought I wasn't the dad or the husband I wanted to be, but that I was the doctor I wanted to be. After the lawsuit, it was like, wow. I'm not even that.

I had to take unflinching ownership and come to terms with my experiences. Especially in emergency medicine, you see emotional crises every day. You think they go right through you and have no effect, but they really go through you like radiation. You're not aware of it, but you start finding out you have physical problems and it's the radiation — it's been doing damage all along.

JT: I went through burnout as an executive climbing the corporate ladder too quickly for my own good, but I didn't know it then. For me, making a contribution to society used to mean doing good work, being available and driving significant outputs in professional arenas. Now making a contribution means doing good work in the community, being a better father and a better husband. It's a reprioritization.    

With physicians, we are trying to get them to a place where they can say, 'I'm dealing with some stuff and I need help.' There are a number of things you can do to create this culture. One of the things we offer is an enhanced employee assistance program—LiveWell WorkLife Services. This program offers unlimited telephonic consultation, support and educational resources, providing our clinical and non-clinical teams with 24/7/365 access to speak one-on-one with a TeamHealth-specific, master's-level counselor. If personal therapy sessions are needed, our associates and their spouses or children can attend up to three in-person therapy sessions per year per issue, and it's 100 percent covered if referred through our program. The program also includes concierge services to help with time management. If a physician needs to order flowers, make dinner reservations, do dry cleaning or call a handyman, we provide that. We also help physicians find assisted living for elderly parents and manage emotions around that too.

We also have a number of internal processes to allow dialogues to become more open, natural and frequent. We've taught multiple courses on burnout and burnout prevention during our National Medical Leadership Conferences and in other leadership training sessions. Just as physicians round on patients, our facility medical directors round on clinicians. Physicians have performance reviews, which is fairly unique in the healthcare industry. The reviews are behavioral, not clinical. This has helped open those lines.

Q: What should leaders do when they suspect a provider is burned out?

RF: There needs to be recognition that [burnout is] real. We need to remove the stigma associated with talking about it and getting help. Physicians have to admit they have a problem when the signs come. The treatment is much more effective early on.

JT: They should confront physicians appropriately, with coaching prior to that discussion. Leaders need to tell physicians convincingly — and back it up with facts —they do not have to lose their jobs. We had a couple of situations where we found out through drug screening that someone had a problem. We have been able, with physician participation, to get them back to work with credentials and full privileges at the facility they used to work at. They may have to write prescriptions under supervision, but they are back working and their career is not lost.  

Q: What can physicians and other leaders do today to address burnout?

JT: First, recognize burnout is an issue. It is not a sign of weakness to ask for help.

RF: First, physicians can do an honest self assessment. Then, become sensitive to this in your partners. How can it be that we as physicians are so sensitive we can smell a GI bleed from the doorway, or the whiff of ketones on someone's breath, but we can't recognize burnout in someone we work with for 12 hours a day? We aren't sensitive to it. Physicians want to take a test, intervene and fix the problem. This is not one of those things. You can't vacation your way out of it. Talking about it and owning the problem will fix it. If we don't start taking care of ourselves, our patients are going to suffer.

 

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