Fixing Physician Burnout Starts with Believing in the Abstract

By Joseph Patruno, MD, Lehigh Valley Health Network

Considerable attention has been circulating around the topic of physician burnout, for good reason. Like a bank account that contains energy instead of money, burnout is when your energy account is depleted, but you keep spending. Almost half of the physicians in the United States have reported feeling burned out, defined by three key symptoms: exhaustion, depersonalization, and lack of efficacy. Hospitals and health systems have just started to see the adverse effects this can have on patient care and satisfaction, from reductions in quality and productivity to a decline in overall morale of the organization.

Data indicates that, to a great extent, the problem is operational and organizational as opposed to originating from personal issues. As expectations and demands become too high and caregivers’ sense of control is diminished, burnout is inevitable. Plus, requirements relating to financial challenges, meaningful use, quality expectations, maintenance of certification, and other administrative activities are intensifying. The responsibility to manage the problem falls, therefore, both on organizations and individuals.

Taking a leap of faith

The substance of the solution to health care burnout is to create an environment where doctors and other caregivers are professionally fulfilled. This becomes a complex undertaking in many health systems since they are increasingly under pressure to operate like businesses with financial constraints and revenue goals. Supporting physician wellness is difficult to truly quantify. That’s why solutions need to begin off paper: Leaders have to believe that the well-being of caregivers really matters and makes a difference in the quality of the health care being delivered. They must recognize there is a return on investment, and believe if they can optimize their staff well-being, it will have a positive effect on the environment and the overall culture, as well as the bottom line.

Several large, academic health centers, such as Stanford Health Care and Mayo Clinic, were able to take this view of the problem and have invested in caregiver wellness. Consequently, they are farther along in solving it and have been able to create an approach that comes at the problem from numerous angles that are now being implemented at many health systems. It’s about optimizing efficiency in practice with a focus on workplace systems, processes, and practices. It is finding and implementing those ideas that promote quality, effectiveness, and positive patient and colleague experiences with a goal of bettering work-life balance. The essence of the goal is to allow caregivers the most time actually communicating with, and caring for, patients. When they are not doing this it is about finding time to be professionally or personally satisfied and achieve balance in life.

How health systems are getting started

Since burnout has emerged, many hospitals are unaware of how extensive the problem is within their own organization. Some have followed the Mayo Clinic’s lead and incorporated a survey, (Mayo’s is called the Well-Being Index) to monitor the wellness of doctors and other caregivers. By having physicians answer key questions and recording the results, leaders and others can identify departments, specialties, and population groups who may be, or are, at risk for burnout. This makes leadership aware and accountable in exploring cohorts with high burnout or “distress’ scores. Without data and measuring distress it becomes difficult to create strategies and solutions to optimize wellness. The data also makes it possible to determine and measure the financial effects of burnout on the organization based on its influence on attrition, lost productivity, and reimbursable elements of quality and patient experience, among others.

Once health systems have access to data, they are strategizing paths forward:

• Appointing a chief wellness officer to champion physicians and advocate for efforts under consideration
• Reassessing physical spaces and processes in offices and units are structured for patient care and also caregiver efficiency
• Making electronic medical records systems more usable, by offering training programs and offering point of care assistance.
• Experimenting with, and using, scribes to assist with record keeping; this might include virtual scribes, which entails a medical professional listening to the physician-patient conversation and then interpreting and transcribing notes
• Assuring that all caregivers and administrative staff are working efficiently and at the top of their licenses to promote satisfaction and team-based care (this can involve creating systems that let team members take on roles that alleviate the physician’s administrative load)
• Offering caregivers some latitude in how they manage their offices by balancing standardization with a level of independent contributions to the practice

Finding balance in a complex world

As the friction between keeping a business afloat and what caregivers value most is brought to the fore and addressed, the issue of physician burnout starts to become manageable. It’s a matter of organizations prioritizing the health of their caregivers in a similar way they do the patients they care for. This mindset has started to take hold, with some innovative organizations even changing their mission statements and focusing on network goals that revolve around the concept of the Quadruple Aim: A model where caregiver wellness is prioritized in the same way as quality, experience, and cost.

With a national focus on burnout, caregivers themselves are becoming more engaged, taking the opportunity to share their workplace needs and wants, and also considering their own work-life balance. Locally, some hospitals have seen their high distress rate drop by bringing the problem into the light, empowering caregivers to share their needs, and by supporting meaningful changes. While it’s a huge undertaking to begin the seismic shift that ensures the systems in place are serving the wellness purpose, with every conversation and each small step taken, we’re chipping away at the problem. Whether health system or physician, it’s important to remember that cultural change takes time and wellness is a journey.

“The many drivers of both burnout and high professional fulfillment fall into three major domains: efficiency of practice, a culture of wellness, and personal resilience. Efficiency of practice and a culture of wellness are primarily organizational responsibilities, whereas maintaining personal resilience is primarily the obligation of the individual physician. Each domain reciprocally influences the others; thus, a balanced approach is necessary to build a stable platform that will drive sustained improvements in physician well-being and the performance of our health care systems.”

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Physician Well-Being: The Reciprocity of Practice Efficiency, Culture of Wellness, and Personal Resilience, NJEM Catalyst; https://catalyst.nejm.org/physician-well-being-efficiency-wellness-resilience/