Why Mayo Clinic is picking up the check for physicians to dine together

Although an exceptional healthcare institution, Mayo Clinic struggles with an all too familiar and uncomfortable problem: "We have an epidemic of burnout in our ranks," President and CEO John Noseworthy, MD, said at the Becker's Hospital Review 7th Annual Meeting in Chicago.

Burnout's emotional exhaustion, loss of meaning in work and feelings of ineffectiveness affect caregivers, their families, patients and the medical profession as a whole. "These doctors are impaired," said Dr. Noseworthy. "They're at risk for increased medical errors, turnover and suicide. They are at risk for decreased professionalism, patient satisfaction and productivity." 

At Rochester, Minn.-based Mayo Clinic, hematologist Tait Shanafelt, MD, and his colleagues have studied physician burnout for 15 years. In a national survey, Dr. Shanafelt and team found the number of physicians reporting at least one symptom of burnout grew 10 percent from 2011 to 2014. That's 54 percent of physicians experiencing burnout, with those in general internal medicine, family medicine and emergency medicine hit hardest.

"We at Mayo are not immune," Dr. Noseworthy told attendees in Chicago. "Our physicians struggle as well." With a lengthy list of medical breakthroughs in its 150-year history, Mayo Clinic decided to approach burnout with research, resources and ingenuity — much like it did with diseases that came before it. In 2007, it founded a systemwide program on physician well-being, which Dr. Shanafelt heads as director. The multidisciplinary program touches on the expertise of various medical specialties, including internal medicine, psychiatry and psychology, health sciences research and experts in quality of life research. The system only applies the burnout interventions that, through research, have been proven to work for individuals and the organization.

"Make no mistake about it," said Dr. Noseworthy. "There's no hope of achieving a sustainable, high-value healthcare system for our patients if we're dealing with a workforce that's not sustainable — personally and professionally."

A problem at Mayo Clinic, too
A 2015 survey of 3,896 of Mayo Clinic physicians found 40 percent reported at least one symptom of burnout. To shine a light on one of the faces in those numbers, Dr. Noseworthy read comments received from a Mayo Clinic physician. Among the statements made in the physician's letter:

I'm defined by my work. There are always more patients to see, and the time it takes is always longer than I planned. I was angrier and angrier at the patients who were more needy. Department leadership was responsible for half of this; the other half was mine. I wasn't taking care of myself. Though others hadn't mentioned it, I was drinking more. I walked around angry, angry at myself for failing my own standards, afraid I'd make a mistake.

The physician also questioned how to talk about these feelings. "I'd rather tell you I'm a felon than tell you how painful burning out is," he wrote. Dr. Noseworthy said he found the letter deeply concerning.

Studying their own ranks, Dr. Shanafelt and his team dug deeper to find other correlations between burnt-out physicians and their environment. Interestingly, burnout rates were higher among physicians who held unfavorable views of their leader. Specific leadership qualities of certain department chairs accounted for 50 percent of the variation in staff's overall satisfaction. "Leadership matters," said Dr. Noseworthy. "Leaders who show humble interest in the well-being of staff make a huge difference."

Showing humble interest involves asking simple, straightforward questions: Are you happy? How's your career? How's your family? Or, as Dr. Noseworthy put it, "What are the pebbles in your shoe we can help with?"

More formally, Dr. Noseworthy said the system is working with department chairs to help them understand their role in mitigating the drivers of burnout. Now, physicians annually assess their chairs on nine dimensions of leadership. Mayo Clinic administrators collect this information and provide feedback and resources to help chairs learn and grow in their leadership capabilities.

Breaking bread
But as the physician said in his letter, leadership is only responsible for a portion of a physician's burnout. Another portion rests with the physicians themselves. Those affected by burnout need to take ownership of their wellness and strengthen the sense of balance and resiliency in their lives, said Dr. Noseworthy. He wants to give them the resources to do just that.

Mayo Clinic offers a myriad of physical and mental health resources for physicians, including a two-day resiliency program, follow-up coaching, mindfulness-based stress reduction programs, and an on-campus healthy living center with fitness classes, yoga, cooking programs, nutritious food and massage therapy.

More recently, based on the idea that social connections at work are a powerful contributor to wellness, Mayo Clinic tested a culinary cure for burnout. Mayo Clinic researchers conducted two randomized trials that showed eating a meal together enhances physicians' sense of meaning, reduces burnout and helps create a sense of community in the workplace. Armed with this finding, Mayo Clinic kicked off a systemwide program in which physicians venture off the medical campus and dine together. All 4,100 physicians and scientists can participate, and Mayo Clinic picks up the check.

"Our doctors have said, 'If you're dumb enough to pay me to have lunch with my friends, I'll certainly go,'" said Dr. Noseworthy. "But it actually works to build collegiality, connection and meaning in work."

Groups consisting of five or six physicians on average meet at a restaurant every two weeks. The first 15 minutes of each gathering are devoted to discussion about the physician experience, and then physicians can talk about any other topics they like. Since the collegial program was implemented less than a year ago, 950 of Mayo Clinic's physicians and scientists have formed dining groups across all system sites. Dr. Noseworthy said the dining buddy system has helped Mayo Clinic "turn the tide," as it recently saw a double-digit difference in its burnout trends compared to national rates.

"Physicians find more meaning in work if they are part of a highly functioning team," he said. This relates to what he considers Mayo Clinic's greatest contribution to medicine: the integrated group practice model. "Mayo's founders believed the combined wisdom of peers is greater than that of any individual physician."

While the dining project has seen promising results so far, Dr. Noseworthy said it's not a perfect solution. It won't work for everybody. That's why he wants more input.

"We need new ideas; your ideas," said Dr. Noseworthy. "We need continued research showing us what actually works so that we can steer our resources to what is most effective and help people recover."

After all, the combined wisdom of physicians is greater than that of any one.

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