Wednesday Jun 03, 2015
Give Residents Tools to Turn Tide on Physician Burnout
It wasn't that long ago, during my college days, that I thought burnout referred to a certain lifestyle rather than a severe form of career (and life) dysfunction. Today, however, tales of physician burnout are hard to miss.
In fact, the Academy developed a position paper on the topic last year. And this year, the AAFP posted a blog about burnout, as well as an even more sobering editorial about physician suicide. Burnout also was addressed by Dike Drummond, M.D.(www.thehappymd.com), in his keynote speech last year during the AAFP's annual meeting, and a closely related topic -- managing stress -- will be the general session topic presented by author Kelly McGonigal, Ph.D.(bit.ly), Oct. 1 during the Family Medicine Experience (formerly AAFP Assembly) in Denver. It’s safe to say we all know this is a huge problem.
I think perhaps one of the most fascinating concepts related to burnout is prevention. Many researchers have highlighted the idea that devoting a time to something you are passionate about (research, teaching, etc.) -- really anything that is outside of the daily grind -- can be enough to help prevent burnout. One of the reasons it has taken us so long to come to terms with the fact that we, as physicians, can (and do) get burned out is that most of us went into medicine because it was something we were passionate about. We think of medicine as a calling; therefore, how could we get burned out?
The reality, unfortunately, is that we do. During Drummond's Assembly session last year, he asked each of us in the audience to raise our hand if we, or someone we knew, had experienced symptoms of burnout (loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment). Nearly everyone in the ballroom -- hundreds of family physicians -- raised a hand.
You could argue that was a rather unscientific survey and a relatively small sample size. But there is plenty of evidence that suggests burnout is rampant in our profession. A study presented recently(www.medscape.com) (free registration required) at the American Psychiatric Association's annual meeting found that 70 percent of medical residents met criteria for burnout. The numbers were lower, but still significant for family medicine, with 50 percent of our residents experiencing burnout.
I feel fortunate to work at a community-based academic residency program because we spend more time addressing this topic than the average practice would. Our program has been proactive in teaching residents and students to recognize burnout. Of course, we have the traditional Maslach Burnout Inventory that we discuss with residents, but we also have invited thought leaders on the subject to speak at our residency and to other programs within our health system. Most recently, we heard from Tait Shanafelt, M.D.(archinte.jamanetwork.com) director of the Mayo Clinic's Department of Medicine Program on Physician Well-being, and colleagues.
We provide residents with resources to not only recognize burnout, but to treat it when they do recognize it. Even more importantly, we try to prevent it.
Physicians have always been pressed for time, and demands in the current health care system may be worse than ever. Therefore, we try to capitalize on 15- to 20-minute segments of time by, for example, utilizing a short reading followed by a period of reflective writing or discussion. We also ask questions that orient residents' attention to challenging or rewarding encounters, such as asking them to recount a time in the past week where they felt particularly helpful (or helpless) or to describe a situation that reminded them why they became a physician. We have found that Balint groups are particularly helpful in setting the stage for these other brief, “on-the-fly” activities.
These exercises in mindfulness about the topic really seem to help accomplish our goals. We have implemented this program during the past few years, and although we have not officially published any findings, we have noted a significant shift in the recognition, and, we believe, prevention of burnout.
I’m fortunate to have variety in my job and also to be involved in research. I think these aspects of my role have buffered me from the burnout epidemic. Still, I keep the issue in the forefront of my mind and remember to enjoy my time away from work, whether it's simply reading a book quietly at home, spending time with family or on a needed vacation.
The millennials have some of this figured out. It’s really about balance, self-awareness and introspection, and as you can see, the resources and tools are not anything groundbreaking. I think we are beginning to recognize just how far-reaching this problem can be, and by empowering our youngest physicians (and really all physicians), we’ll all get there eventually.
Joshua Tessier, D.O., is a faculty physician and coordinator for research and scholarly activity at the Iowa Lutheran Family Medicine Residency and serves as regional assistant dean for Des Moines University at UnityPoint Health – Des Moines. His professional interests include research, medical student education and evidence-based medicine. He enjoys time with his family, cruises, and drum and bugle corps -- all great buffers to burnout.
Posted at 02:18PM Jun 03, 2015 by Joshua Tessier, D.O.