Robert Lancey, MD, MBA, Medical Director, Heart and Vascular Institute
Bon Secours Hampton Roads | Portsmouth, VA
STS News, Fall 2016 -- The health care industry has undergone historic changes at a precipitous pace over the past two decades. The changes—which include a complete redesign of how we are reimbursed (volume vs. value), how we are employed (private practice vs. hospital-employed), and to whom we are beholden (patients vs. regulators)—have impacted physicians at all levels. This shifting environment has been accompanied by the erosion of many key drivers of physician satisfaction, including the maintenance of clinical autonomy, the sense of personal and professional accomplishment, and feeling aligned with one’s institution in delivering patient-focused care.
The steady decline in professional satisfaction has been accompanied by an increase in occupational burnout. Physicians experience the highest rate of burnout in the US workforce, with the frequency of those reporting at least one symptom rising from 45% in 2011 to 54% in 2014, according to a 2015 article in Mayo Clinic Proceedings by Tait D. Shanafelt, MD and colleagues. This syndrome, characterized by emotional exhaustion, depersonalization, cynicism, and a low sense of personal accomplishment, likewise has been exhibited in up to one-half of medical students and is associated in this population with a higher likelihood of engaging in unprofessional behaviors.
Its prevalence in the physician workforce should come as no surprise when considering the six facets of work life in which a decoupling between the organization and the individual contribute to burnout: workload, control, reward, fairness, values, and the sense of community or collegiality. As cardiothoracic surgeons, we are challenged to varying degrees in each of these areas, whether it be too much (or for some, too little) work, declining reimbursement, lack of alignment with organizational values, and loss of autonomy and control over clinical workflow.
Recognizing the Signs
There are well-described warning signs of burnout to watch for in ourselves and our colleagues: deteriorating interpersonal work relationships, difficulties at home or in personal life, absenteeism, or falling behind with record keeping. There may be signs of chronic fatigue, exhaustion of emotional energy, the onset of patient biases, and losing a sense of purpose in one’s professional life.
Physician leaders play critical roles in reducing the frequency of burnout. Shanafelt also demonstrated a strong inverse correlation between physician burnout rates and the strength of leadership exhibited by direct physician supervisors. The most effective physician leaders help their colleagues connect with what is most meaningful in their work and provide the opportunity to reflect on gratifying professional experiences, rather than focusing on the “last worst case.” They share ways that they worked through personally difficult clinical situations and emphasize the value of introspection and resiliency—the latter being the ability to respond to stress in a healthy way with minimal psychological and personal costs, while attaining personal and professional goals.
Physician leaders play critical roles in reducing the frequency of burnout.
How to Reduce Your Risk
Faced with the growing problem of physician burnout, it is time not only to acknowledge the problem, but also to devise strategies that remove the stigma, provide means of early identification for those at risk, and deal effectively with colleagues already exhibiting signs of burnout that are impacting them, their families, and their patients.
It is important to disseminate information and engage in conversations within our societies and professional working environments about ways to minimize the factors that contribute to burnout. These may take the form of self-regulation (getting regular sleep, keeping nutritionally and physically fit, and setting aside protected time for family or for purely personal, enjoyable activities and hobbies) or developing self-awareness through guided meditation. This latter strategy, which may focus on mindful stress-reduction techniques, is the cornerstone of programs that are available for physicians, such as the Cleveland Clinic’s Stress Free Now program.
Developing wellness programs for employees is recognized by most health care organizations as not only providing intrinsic value for the employees themselves, but also carrying high value for the organization by improving productivity and reducing absences and attrition, while also increasing the quality of care and patient satisfaction and compliance. As physicians, we need to support similar efforts for our colleagues.
Patient Safety Symposium to Tackle Burnout Issues
For more on this important topic, attend the Patient Safety Symposium at the STS 53rd Annual Meeting in January. The 2017 Symposium is titled “Resilience or Burnout: Do We Have a Choice?” and speakers will discuss how physicians can develop resilience, what institutions can do about physician burnout, and the use of mindfulness to reduce work-related stress. The Symposium will be held on Tuesday, January 24, from 1:00 p.m. to 5:30 p.m., and is included with Annual Meeting registration. Register for the meeting today at www.sts.org/annualmeeting.
