Practical Ways to Address Physician Burnout and Restore Joy in Practice
It starts with one simple principle: “Get rid of stupid stuff” in your practice. Here's how.
Fam Pract Manag. 2019 Nov-Dec;26(6):7-10.
Author disclosure: no relevant financial affiliations disclosed.
Everyone is talking about burnout these days, with reports that almost half of all physicians are experiencing some symptom of burnout.1 But patient care and other responsibilities can keep physicians so busy that they do not have time to reflect on whether they are personally experiencing burnout symptoms. Aren't stress and exhaustion just part of the job?
Thoughts that may reflect symptoms of burnout include the following:2
Depersonalization: “The diabetic train wreck in Room 2 will put me way behind schedule,”
Loss of pride in work: “All I did today was click on the electronic health record (EHR) and document to meet billing rules.”
Emotional exhaustion: “I don't have it in me to figure out the cause of her headache. I'll just refer to neuro.”
Physicians who are experiencing burn-out may feel that they are drowning — that no matter how hard they try, they cannot accomplish everything required to give quality care to their patients. They might begin to believe that something is wrong with them and that working harder will fix it. It won't.
Physicians facing burnout need to know three things:
You are not alone. Knowing that others are experiencing the same emotions can be reassuring.
You are not to blame. The system is to blame.3
You are not powerless. You can take practical steps to bring some relief, as this article will discuss.
Although burnout is largely a system problem, physicians can take simple steps that will lighten their burden.
Electronic health record changes such as minimizing notifications and logins can save time and reduce distractions.
Workflow changes such as ordering pre-visit labs, extending prescriptions, or rerouting portal messages can also free up time and mental energy for more meaningful tasks.
WHAT'S CAUSING BURNOUT?
Many experts attribute about 80 percent of burnout to the chaotic environment in which physicians work and only 20 percent to personal factors.4 However, when organizations first address burnout, they often suggest interventions such as meditation classes, exercise, and eating right, all of which suggest that the problem is you. These suggestions may make you feel better for the moment, but they add to your busy day and don't address the real problem: the chaos in the delivery of care.
The causes of burnout are myriad. The knowledge explosion has led to the development of thousands of clinical guidelines. Many clerical tasks previously performed by nonphysician staff have been shifted to the physician within the EHR. Compliance, information technology (IT), and regulatory departments often overinterpret regulations out of fear (e.g., “If we just have the doctor do it, we won't get into trouble”). EHR demands leave less face-to-face time for direct patient care, which is necessary to build trusting relationships and is the source of
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2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among U.S. physicians relative to the general U.S. population. Arch Intern Med. 2012;172(18):1377–1385. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1351351. Accessed Oct. 3, 2019.
3. Winner J, Knight C. Beyond burnout: addressing system-induced distress. Fam Pract Manag. 2019;26(5):4–7. https://www.aafp.org/fpm/2019/0900/p4.html. Accessed Oct. 3, 2019.
4. Kleeman ML. What's driving physician burnout? Clinical Practice Today. Oct. 9, 2018. https://physicians.dukehealth.org/articles/whats-driving-physician-burnout. Accessed Oct. 3, 2019.
5. Ashton M. Getting rid of stupid stuff. N Engl J Med. 2018;3791789–1791. https://www.nejm.org/doi/full/10.1056/NEJMp1809698. Accessed Oct. 3, 2019.
6. Sinsky TA, Sinsky CA. A streamlined approach to prescription management. Fam Pract Manag. 2012;19(6):11–15. https://www.aafp.org/fpm/2012/1100/p11.html. Accessed Oct. 3, 2019.
7. Sinsky CA, Sinsky TA, Rajcevich E. Putting pre-visit planning into practice. Fam Pract Manag. 2015;22(6):30–38. https://www.aafp.org/fpm/2015/1100/p34.html. Accessed Oct. 3, 2019.
8. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being. Mayo Clin Proc. 2017;92(1):129–146. https://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/abstract. Accessed Oct. 3, 2019.
9. Sinsky CA, Bodenheimer T. Powering-up primary care teams: advanced team care with in-room support. Ann Fam Med. 2019;17(4):367–371. http://www.annfammed.org/content/17/4/367.full. Accessed Oct. 3, 2019.
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