Dike Drummond, MD, offers an adage of how medical school nearly molds physicians for burnout: It is common in surgery residency programs that when a chief resident leaves the hospital after the day shift, he tells the intern on duty, “You can call tonight if you need me, but remember that calling me is a sign of weakness.” When Dr Drummond recalls this common story, he chuckles, even though he is not really joking.
Med students absorb several flavors of conditioning as they become doctors. They become Lone Ranger, superhero, workaholics, following the prime directives of “the patient comes first” and “never show weakness,” said Dr Drummond, the CEO and founder of TheHappyMD.com, a physician coaching and training company focused on burnout prevention. Not only do doctors deal with sick people all day in a high-stress atmosphere, but they feel they cannot reach out for assistance when they need it, said Dr Drummond, a family doctor who has helped hundreds of physicians recover from burnout. It is no wonder that the prevalence of burnout among US physicians in a recent study1 was over 50%, he said.
What burnout looks like
Want to recognize burnout in yourself or your staff? You will begin to feel (or see in others) exhaustion, low energy, and significant drops in productivity. You may become cynical or sarcastic and venting more frequently about patients and their problems. Another sign is increased absenteeism. But when you are dealing with burnout vacation is not a cure, Dr Drummond said. Taking a day or week will give you a break from the stress, but if you do not start taking new actions when you return from your vacation, the downward spiral of burnout will simply resume when you return.
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If burnout becomes really bad, you may start doubting the quality of your work or fear you will make mistakes if something does not change.
You know you are burned out and in survival mode when “you dread going to work and you get everything done as quickly as possible so you can drag your exhausted butt home,” Dr Drummond said.
Causes of Physician Burnout
According to Dr Drummond, these are the top 5 categories of stress that cause physician burnout:
1. The inherently stressful nature of working with sick and dying people and their family members.
2. The daily job-specific stresses associated with doctors’ practices, such as call rotations, electronic medical records, and dealing with staff, only add to the challenges for physicians.
3. Bad leadership. Nothing burns out a good doctor faster than a bad leader. This is true in all professions. “We are only now learning it applies in medicine too as large employed physician groups from around the country.”
4. Problems at home that compromise physicians’ ability to recharge their energy. This could be problems in their relationship with their significant other, children, finances, and personal health. And it is true that a doctor can burn out spectacularly, and this has nothing to do with work.
5. The “deny your own humanity” conditioning drilled into doctors in medical school coupled with the underlying workaholic, superhero personalities of many physicians.
“Docs will show up to work sick and know they are a danger to patients because they don’t want to be perceived as weak or not pulling their weight,” Dr Drummond said. “No other profession has this attitude about self-care and wellness. Even in the military they have a saying, ‘Rest is a weapon’ because they know fatigue is dangerous and the most rested group of soldiers will win the battle.”
Fixing it
Dr Drummond cautions not to think of burnout as a “problem” that can be fixed with a single solution. Instead, burnout is a classic dilemma, a perpetual balancing act that you will always have to manage.
Individual physicians must build their personal burnout prevention strategy. A common word for this is resilience. This is 3 to 5 steps you take weekly to:
a) Manage stress at work, such as templating your chart notes and holding BID team huddles.
b) Increase your ability to recharge, such as meditation, yoga, or journaling.
If your problems are home-based, work to solve those so they do not spill over into your job.
If you are the leader of an organization, however, there are a couple of key things practice managers can do to reduce the likelihood of burnout among staff. For starters, it is important to be collaborative, according to Jessica Sweeney-Platt, executive director of physician performance research at Watertown, Massachusetts-based athenahealth, which provides cloud-based services for healthcare and point-of-care mobile apps. Managers should ask physicians what they do during the day that stresses them out and refine those pieces of the system.
“You need an environment that allows the physician to focus on what he or she does best,” Sweeney-Platt said. “Where they can focus almost exclusively on patient needs and a lot less on everything else that distracts them from those needs.”
Physicians did not go into the medical profession to do administrative tasks like dealing with regulations, information technology, and documentation. Muddling through this all day, or taking it home after a long day, takes away from their sense of control, she said.
To reduce the burden, she recommends giving as much of this work as possible to the front desk, medical assistants and others. For instance, if a patient needs immunizations or a test performed, have the assistant do the chart prep work and tee up the orders. That way the doctor can just confirm the orders and move on. Even before the visit, plan as much as possible and have it ready so doctors are not doing as much chart work after.
A second major component to burnout is isolation, which Dr Drummond said could be handled by making structural changes within an organization. “You can build social networks, regular social gatherings and re-build the person to person connections physicians had back in the days of the smaller, physician controlled provider groups. These human connections can reinforce the message that you aren’t in this alone,” he said. “There are other people who are experiencing the same things you are and all of us struggle from time to time. If we know each other well enough, this shared experience can result in asking for and offering support much more quickly and easily”
Practices can create forums for physicians to come together, connect more as humans than physicians and share their stories. Practice leaders can do this outside of work by scheduling dinners where physicians and their families meet and get to now each other. This way, doctors can ask for and provide support much more easily than they would otherwise, Dr Drummond said.
Reference
1. Shanafelt TD et al. Changes in burnout and satisfaction with work-life balance in physicians and general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-1613.
