Physician Wellness: Understanding and Preventing Burnout

By Melissa Moore
Monday, January 9, 2017
Specialty: 

The health and well-being of physicians rely on understanding the true causes of burnout and what health systems can do to help.

After an individual has dedicated years to the study and training of medicine, it can be devastating to reach the point of burnout — a state of career exhaustion that can drastically affect a physician’s productivity and his or her patients’ care. In 2015, 46 percent of all physicians participating in the Medscape Physician Lifestyle Report survey reported burnout, an increase from 40 percent in 2013. The highest levels were found in critical care — 53 percent — and emergency medicine — 52 percent.

The team at MMIC, the largest policyholder-owned medical professional liability company in the Midwest, knows that physician burnout can pose significant risks not only to the individual physicians, but also to the people they serve. Battling burnout and promoting resiliency has become a significant part of MMIC’s organizational mission, which is to help physicians and all those who devote their lives to health care attain their dream — to help, to heal and to serve. They work with their clients and many national, state and community partners to promote programs that improve physicians’ well-being. Additionally, they serve in an advisory capacity for health systems throughout the region, in the hope that this work will help more physicians regain their spirits and improve the quality of care they provide to the people and communities they serve.

High stress levels can lead to less effective communication, more medical errors, poor morale and low patient satisfaction. Losing team members to burnout also has a monetary cost to the health system and to the community — replacing a single primary care physician can cost between $500,000 and $1 million after accounting for lost annual revenue for the hospital. Expenditures are even higher to replace specialists. Burnout is also expected to worsen the predicated shortage of physicians, which is expected to reach a deficit close to 100,000 in the coming years according to the American Medical Association.


Laurie Drill-Mellum, MD, MPH,
Chief Medical Offficer, MMIC

Laurie Drill-Mellum, MD, MPH, Chief Medical Officer at MMIC, identifies three main symptoms of burnout in physicians:

  • Depersonalization. “When providers start seeing people seeking health care as just body parts or a collection of diseases, they are burned out,” Dr. Drill-Mellum says. “We stop thinking of them as people, and start seeing them as an inconvenience or just another burden.”
  • Emotional exhaustion. “This is when it feels like providers cannot handle one more concern or question,” Dr. Drill-Mellum says. “I practiced emergency medicine full-time for 25 years, and I said multiple times that the day I stopped being impacted by the people seeking help in the emergency room was the day I should leave medicine. I never reached that point, although I certainly had shifts and days where I reached the end of my rope.”
  • Low sense of personal accomplishment. “Doctors themselves feel depersonalized, like they are just another cog in the wheel,” Dr. Drill-Mellum says. “They begin to feel that what they do does not really matter, which is especially devastating. When you survey physicians, you find that the reason they wanted to go into medicine was to take care of people and make a difference. When someone’s day-to-day work has strayed far from his or her mission or purpose in choosing medicine, which is a common problem in the practice of medicine today, it feeds into the doubt and self-guilt of career exhaustion.”

Institutional Changes Causing Individual Issues

According to Dr. Drill-Mellum, one of the biggest misconceptions is that burnout is an individual problem. In reality, she says, it is a symptom of systemic problems in the practice of medicine that have resulted in an overwhelming impact at the individual level.

Burnout may stem from the loss of meaningful interaction with patients. Increased usage of electronic health records can distract from face-to-face conversations with patients, and overscheduling places unrealistic demands on physicians’ time during appointments. Rather than centering on the relationship between physician and patient, all too often modern medicine often falls back on a production-line approach to treatment simply to meet demand.

“The opportunity to care for patients and build relationships is what draws individuals to the field of medicine in the first place,” Dr. Drill-Mellum says. “The physician-patient relationship, when it is good, is rewarding and promotes engagement. When the relationship is not properly nourished or supported, either by increased emphasis on electronic interactions or lack of time for building meaningful connections, then the connection is not as healthy or strong. This impacts both patients and physicians, and can result in negative downstream effects like lack of trust.”

The system, Dr. Drill-Mellum explains, presents physicians with an imbalanced reward system. Patients, and physicians themselves, expect, and may even take for granted, a perfect level of care. There may be little acknowledgement when good care is delivered, but when there is an unexpected or adverse outcome, the subsequent displeasure from patients and families and lack of support from colleagues and institutions can be devastating. For physicians, who have devoted their lives to many years of training and experience, the pressure to achieve perfection can result in exceedingly high levels of stress that overwhelm even the most resilient practitioners.

“Loss of control and autonomy in medicine are also driving forces of disengagement and burnout,” Dr. Drill-Mellum says. “Physicians are self-driven and internally motivated. A sense of purpose, mastery and control is vital to their happiness and well-being. When this is lost, they become more susceptible to dissatisfaction and disillusion about their careers.”

Organizational Influence and Impact

Because much of physician burnout is attributable to institutional changes, systemic improvements and initiatives are going to provide the most help for physician wellness. Dr. Drill-Mellum highlights that preventing and addressing on-the-job stress starts at the highest levels of a health system, hospital or practice. Administrators need to identify the problem, and then take steps to measure and study specific organizational needs. Experts at MMIC can provide high-level guidance and institutional support, as well as data analytics, for groups looking to understand their physicians’ needs.

Once problem areas are identified, they can be addressed within the organization. Dr. Drill-Mellum notes that changes can often be as simple as re-evaluating and optimizing workflow, including:

  • Scheduling flexibility for maximum time with patients, taking into account the diagnosis and condition. For example, if clinicians agree to have more than the standard 20-minute appointment to fully address the needs of a certain subset of patients, such as those with diabetes, then making it a policy to extend the appointment times for these individuals can help improve the quality of the office visit, for patients and physicians alike.
  • Prioritizing work/life balance and meeting the needs of providers with families. “The traditional model of a physician family, where one spouse was a doctor and the other managed things at home, is not holding true in the new generation — often in medical marriages, both partners work for pay,” Dr. Drill-Mellum says. “To better facilitate a balance in these providers’ lives, administrators should ask themselves, what kind of flexibility and forethought is built into the schedule? It may be that high-need patients should not be on the schedule at the beginning of the day, because it can start the whole day off on the wrong foot. Similarly, avoid scheduling complex patients at the end of the day for improved patient experience as well as provider well-being — patients can get the time and attention they need and physicians will not have to feel the time pressure and constraints that arise at the end of the day.”
  • Outsourcing time-consuming tasks. “Many times, medical doctors are responsible for tasks that would be more appropriately performed by support staff,” Dr. Drill-Mellum says. “Whether it is documenting in the EHR or answering prescription refill lines, effective workflow management and task assignment can make a difference in how physicians feel about their daily work.”
  • Recognizing accomplishments of providers regularly. Taking the time to provide positive feedback can counter-balance the asymmetric rewards faced by physicians, whether it occurs one-on-one or in staff meetings
  • Establishing a mechanism for ongoing feedback. Measuring and evaluating well-being should not be a one-time effort. Dedicated time at staff meetings to share concerns, scheduled office hours with a healthcare administrator, and a comment box in a central location are all strategies that practices can utilize to ensure problems are identified in a timely fashion and on an ongoing basis.

Personal Steps to Better Health

“There are steps people on the front lines of care can take to promote their own well-being and prevent burnout,” Dr. Drill-Mellum says. “Individuals can and should promote their own resiliency. This includes getting enough sleep and eating healthy foods which, sadly, are not always highlighted in the practice and training of medicine.”

Dr. Drill-Mellum and her colleagues at MMIC are doing their part to promote physician wellness and combat the issue of physician burnout. MMIC recently awarded a grant to the Hennepin County Medical Center to help build a wellness center for medical providers, including physicians, physician assistants and nurse practitioners. The center includes an exercise area and shower. As a training facility, HCMC’s investment in provider well-being will hopefully help set a new standard for how organizational leadership can support the physical and emotional well-being of their healthcare providers to promote greater well-being in the industry. The overriding concept is that we only get so far in providing great health care if those who deliver it are not at their best

To further promote provider health, Dr. Drill-Mellum recommends mindfulness techniques. In addition to helping physicians manage the day-to-day stress of practice, mindfulness has been shown to improve the communication between patients and providers. Clinicians who rate themselves as more mindful engage in patient-centered communications more frequently than those who do not. As a result, these providers also have more satisfied patients. Although taking the time to learn mindfulness techniques — such as meditation and deep breathing — may appear difficult to coordinate with physicians’ already busy schedules, small research studies have shown that participating in just one weekend class as well as two follow-up lessons about mindfulness was enough to make an impact on physician burnout.

The practice of preventing burnout extends outside of the workplace. Strong personal support networks are another important tool for ensuring individual well-being. This includes emotional support from spouses, family members and close friends. Dr. Drill-Mellum notes that taking time to socialize with other physicians can also lead to improved emotional health.

“I tell people that choosing to be a physician comes with a heavy burden,” Dr. Drill-Mellum says. “Whenever I give a talk about burnout and resiliency to a group, it is common for individuals to come to me afterward who want to tell me their stories — either about difficulties they have experienced or are experiencing, or stories of colleagues who had left medicine due to depression or disillusion with the practice of medicine. What I sense is that there is a great untapped need for physicians to commune, communicate and share.”

Is Money Enough?

In a survey from Medscape, insufficient income increased from fifth most-cited cause of physician burnout in 2013 to third in 2015. As the regulations around health care change and reimbursement becomes entangled in regulatory bureaucracy, medical providers clearly find economics to be a major driver of job exhaustion.

However, Laurie Drill-Mellum, MD, MPH, Chief Medical Officer at MMIC, notes that money alone cannot solve the issue.

“Past a certain level of income, money is not what motivates people,” Dr. Drill-Mellum says. “What motivates people is mastery, purpose and control. Money is not enough for people working in an environment where they are making mistakes because they do not have enough help or they are too exhausted. You cannot pay physicians enough to make up for sacrificing their mission, mastery or control.”

 

To learn more about how MMIC invests in the well-being of physicians, visit MMICgroup.com.