Physician Burnout: A National Epidemic

Authors: Clark Schmutz, Chithra R. Perumalswami, MD

INTRODUCTION:

Burnout is a pathological syndrome characterized by emotional exhaustion, depersonalization, and a lack of self-efficacy. Burnout is a serious and prevalent problem among medical professionals throughout the U.S. health care system (1). It is experienced by physicians in nearly every medical specialty (1–5).

Interventions to treat burnout are one potential solution to reducing the rates of burnout in physicians. Intervention methods vary, but several methods have shown potential usefulness.

OBJECTIVE OF BLOG:

Review the current literature that is available on interventions to prevent and to treat physician burnout. Use this narrative review to identify any gaps in the scientific literature and to help inform my analysis of our study results during the winter semester.

METHODS:

A literature review was conducted in PubMed using the following search terms: (“physicians”[MeSH Terms] OR “physicians”[All Fields] OR “physician”[All Fields]) AND burnout[All Fields] AND (“Intervention (Amstelveen)”[Journal] OR “intervention”[All Fields] OR “Interv Sch Clin”[Journal] OR “intervention”[All Fields]) and repeated in Web of Science, Jstor, and Google Scholar(currently in process). A total of fourteen articles (1–14) were retrieved as they pertain to interventions to reduce or treat burnout and their contents analyzed to contribute to this review. In addition, gray literature sources such as popular news outlets were searched. These include but are not limited to: the Wall Street Journal, the New York Times, Kevin MD, The Atlantic, and MedScape. A total of four articles (15–18) were retrieved as they pertain to interventions to reduce or to treat burnout in physicians.

RESULTS:

Interventions discussed in these articles include mindfulness workshops and meditation as stress reduction tools. The effectiveness of these interventions was measured utilizing the following methods: longitudinal evaluations with pre-post surveys (3–7, 12, 13, 14), meta- analyses (10), and systematic review (9). The interventions were grouped into two general types:

Workplace Interventions: Shifting culture away from values of perfectionism, denial of personal vulnerability, and delayed gratification

Mindfulness Interventions: The most effective type of intervention. Used measures of personal health among physicians such as stress, anxiety, and affect among others.

Coaching Interventions: Derived from the field of positive psychology, mindfulness, and self-determination theory. This intervention increases one sense of accomplishment, purpose, and engagement.

IMPORTANT QUOTES:

“Fulfillment in medicine, as with any endeavor, is about managing hopes. Probably the group best equipped to deal with the changes wracking the profession today is medical students, who are not so weighed down by great expectations.” –Sandeep Jauhar, MD

“For many doctors, it’s not the lack of interest that prevents them from incorporating mindfulness into their clinical practices; it’s the time required to complete a standard training course. The courses require a significant commitment, ranging from a full week, to a full day once a week for eight months.” –Pauline Chen, MD

“If people work in an environment where they believe there is meaning, they will put up with a lot,” Dr. Shanafelt observed. “It goes beyond the significant personal consequences for an individual physician. It affects whom patients can see when they are sick, the quality of care they receive and their safety.” –Tait Shanafelt, MD

DISCUSSION:

An analysis of the current literature on this subject reveals medical student and physician training in burnout awareness and self-care to be at risk for deficiency. A career in medicine, at its core, draws compassionate, empathetic, and highly motivated individuals with a desire to help others. Understanding the well-being of physicians and medical students is important as associations between burnout in providers and potential impacts on patients and families is currently not known and may warrant further investigation. Systemic integration of interventions to prevent and to treat burnout will be a key challenge in reducing the epidemic of physician burnout.1 Policy changes to address burnout in medical education as well as maintenance of certification programs for physicians already in practice may be important in the future.

Bibliography/References

  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613. doi:10.1016/j.mayocp.2015.08.023.
  2. Schneider S, Kingsolver K, Rosdahl J. Physician Coaching to Enhance Well- being: A Qualitative Analysis of a Pilot Intervention. Explor J Sci Heal. 2014;10(6):372-379. doi:10.1016/j.explore.2014.08.007.
  3. Milstein JM, Raingruber BJ, Bennett SH, Kon AA, Winn CA, Paterniti DA. Burnout assessment in house officers: Evaluation of an intervention to reduce stress. Med Teach. 2009;31(4):338-341. doi:10.1080/01421590802208552.
  1. Goodman MJ, Schorling JB. A Mindfulness Course Decreases Burnout and Improves Well-Being among Healthcare Providers. Int J Psychiatry Med. 2012;43(2):119-128. doi:10.2190/PM.43.2.b.
  2. West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: A randomized clinical trial. JAMA Intern Med. 2014;174(4):527-533. doi:10.1001/jamainternmed.2013.14387.
  3. Edgoose JYC, Regner CJ, Zakletskaia LI. BREATHE OUT: A Randomized Controlled Trial of a Structured Intervention to Improve Clinician Satisfaction With “Difficult” Visits. J Am Board Fam Med. 2015;28(1):13-20. doi:10.3122/jabfm.2015.01.130323.
  4. Goldhagen BE, Kingsolver K, Stinnett SS, Rosdahl JA. Stress and burnout in residents: impact of mindfulness-based resilience training. Adv Med Educ Pract. 2015;6:525-532. doi:10.2147/AMEP.S88580.
  5. Linzer M, Poplau S, Grossman E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015;30(8):1105-1111. doi:10.1007/s11606-015-3235-4.
  6. Williams D, Tricomi G, Gupta J, Janise A. Efficacy of Burnout Interventions in the Medical Education Pipeline. Acad Psychiatry. 2015;39(1):47-54. doi:10.1007/s40596-014-0197-5.
  7. Regehr C, Glancy D, Pitts A, LeBlanc VR. Interventions to Reduce the Consequences of Stress in Physicians. J Nerv Ment Dis. 2014;202(5):353-359. doi:10.1097/NMD.0000000000000130.
  8. Shanafelt TD, Kaups KL, Nelson H, et al. An interactive individualized intervention to promote behavioral change to increase personal well-being in US surgeons. Ann Surg. 2014;259(1):82-88. doi:10.1097/SLA.0b013e3182a58fa4.
  9. Sood A, Sharma V, Schroeder DR, Gorman B. Stress Management and Resiliency Training (SMART) Program among Department of Radiology Faculty: A Pilot Randomized Clinical Trial. Explor J Sci Heal. 2014;10(6):358-363. doi:10.1016/j.explore.2014.08.002.
  10. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians. JAMA. 2009;302(12):1284-1293. doi:10.1001/jama.2009.1384.
  11. Oman D, Hedberg J, Thoresen CE. Passage meditation reduces perceived stress in health professionals: A randomized, controlled trial. J Consult Clin Psychol. 2006;74(4):714-719. doi:10.1037/0022-006X.74.4.714.
  1. Chen P. How Mindfulness Can Make for Better Doctors. 2009:10-13.
  2. Chen P. Easing Doctor Burnout With Mindfulness. New York Times. 2013:26- 28. well.blogs.nytimes.com/2013/09/26/easing-doctor-burnout-with- mindfulness/?pagewanted=print.
  3. Miller M. A Burnout Fix : Occupational Health. 2015:1-6.
  4. Maccormick H, Comments N. Stanford’s “ time banking ” program helps emergency room physicians avoid burnout. 2015:1-2.
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