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Tuesday Jan 13, 2015

Beating Burnout: Get Involved, Call for Change

During AAFP Assembly last fall in Washington, keynote speaker Dike Drummond, M.D.(www.thehappymd.com), asked family physicians in a packed ballroom to raise their hands if they had experienced symptoms of burnout. Hundreds of hands -- far too many -- went up.

Although disheartening, the response certainly wasn't surprising. According to a 2013 Medscape survey(www.medscape.com), more than 40 percent of U.S. physicians reported experiencing at least one symptom of burnout (loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment). A 2012 study in JAMA Internal Medicine(archinte.jamanetwork.com) found that more than one-third of physicians were burned out.

More than 40 percent of U.S. physicians experience at least one symptom of burnout.

Some of the reasons for this crisis -- such as administrative burden, difficulty finding work-life balance, feeling undervalued, frustrations with referral networks, government regulations, and (of course) reimbursement issues -- are shared across different types of family medicine practices. Other factors may vary from practice to practice. For example, employed physicians like me may be struggling with the loss of control over our day-to-day practice. Meanwhile, some small and solo independent practice physicians may be having difficulty figuring out how to meet the latest regulatory requirements with limited staff resources.

In addition to these challenges, physicians face more and more pressure to meet or exceed patient expectations. Patients want to be heard and family physicians want to listen, but in our stressed work environments, we often don't have enough time -- more than the typical 15 minutes – or adequate resources to meet the needs of our complex patients. I've had patients thank me for listening and for being thorough, but how often do we hear that? Based on the current environment, I would say not nearly enough.

A growing number of my colleagues seem discouraged, and it saddens me to hear family physicians say things like, "I don't know if I can do this anymore." Many physicians are responding to burnout by limiting their scope of practice, reducing their work hours, or leaving the practice of medicine altogether. According to a 2012 Urban Institute data analysis(jpc.sagepub.com) 30 percent of primary care physicians ages 35-49 planned to leave their practices within five years. The rate was more than 50 percent among physicians 50 and older. Those numbers should alarm anyone aware of the already glaring shortage of primary care physicians.

Clearly, this is becoming a crucial public health issue. The drivers of burnout are different for each individual physician, but the impact of physician burnout is affecting health and health care delivery for every consumer in the country. If we don't address these drivers and take care of the physicians we have, there will not be enough of us left to care for the health of our nation.

An article published in the November/December issue of Annals of Family Medicine suggested that the triple aim framework -- which calls for better care, an enhanced patient experience and lower health care costs -- needs the additional aim of improving the work life of physicians and our staff members.

So what do we do about it? Individual physicians may be able to help themselves(www.helpguide.org) by better managing their stress or by seeking support. But what about change on a broader scale?

I've had my own experience with burnout. When I felt that I needed to get off the hamster wheel, one of the things that helped me refocus was getting involved and advocating for change. I've been involved with the Academy for years through the Congress of Delegates, commission work and the National Conference of Special Constituencies. But the No. 1 issue that prompted me to run for the Academy's Board of Directors last year was burnout. I don't know all the answers to solving burnout, but I know it must be addressed.

The Academy adopted a position paper on the issue last year. And it's worth noting that the AAFP last year created 10 member interest groups to provide a forum for members with shared professional interests. The MIGs provide new outlets for members to make their voices heard.

The AAFP also is working to address many of the drivers that lead to burnout, including payment reform and administrative burdens related to electronic health records.

Finally, we need to remove the stigma from burnout. Physician who need help shouldn't be afraid to ask for it. If you feel burned out, know that this is not a weakness or a character flaw, and you are not alone.

You can help yourself with resources(www.thehappymd.com) that support personal resilience and time management skills, but you also can tackle the problem on a broader scale by working within your organization to address the drivers of burnout in your practice. And know that the AAFP will continue to work to alleviate regulatory burdens and other factors that contribute to burnout.

Lynne Lillie, M.D., is a member of the AAFP Board of Directors.

Posted at 08:43AM Jan 13, 2015 by Lynne Lillie, M.D.

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