________________________________________________________________________ Burnout in Physicians
Support groups can also focus on a theme. For example, resi- dents rotating through a medical intensive care unit developed “grief rounds” as a way to discuss their feelings and other issues related to the deaths of patients they cared for [111]. When asked to assess the program, 77% of respondents agreed or strongly agreed that the rounds enhanced their intensive care unit experience. Further study is planned to determine if the grief rounds are associated with a decrease in burnout. Pursue Professional Passions Administrative burden and heavy patient loads often reduce the amount of time physicians have to pursue their professional passions, but time to participate in specific clinical or research interests is essential to having meaningful work, which in turn is paramount to physicians’ satisfaction [20; 92; 112]. In the 2015 Medscape survey, lack of professional fulfillment was a leading cause of burnout [31]. Surgeons who focus on find- ing greater meaning in work have been less likely to become burned out, and other physicians have noted that maintaining passion for one’s work is helpful in avoiding burnout [94; 96]. Encourage Organizational Change Physicians should work with leaders to effect organizational change that addresses issues associated with job dissatisfaction and burnout, such as excessive hours or workload, inefficiency, electronic burden, lack of physician autonomy, and inadequate resources for high-quality care and patient safety [20; 112; 113; 114]. Physicians can become advocates for making these changes as well as other strategies, such as promoting part-time careers for physicians, providing protected time for physicians to pursue meaningful professional activities, offering programs that enhance physicians’ resiliency (such as mindfulness pro- grams) and provide opportunities for physicians to interact with their colleagues, making physician satisfaction and well- being quality indicators, and emphasizing the importance of self-care [20; 114; 115]. It is vital that physicians are true partners with leaders in collaborating for such changes [112]. Physicians can become champions of a healthy work environ- ment by developing or participating in a wellness committee. This committee should be composed of physicians, other healthcare professionals, and staff and should collaborate with the organization’s leaders [108]. Some potential initiatives are opportunities for physicians to openly and honestly discuss medical errors, how to achieve well-being, and how to avoid stress [65]. A wellness committee can also work to ensure that tools are available to assess physician well-being and burnout and that the results generate resources to address physicians’ needs. CALLS FOR ACTION The substantial effect of stress, dissatisfaction, and burnout has led some professional organizations to publish position papers or calls for action. For example, the American Academy of Family Physicians published a position paper to note its commitment to helping find personal and system-wide solu- tions to physician burnout [116]. The Critical Care Societies
Collaborative issued a call for action to enhance awareness of burnout in the critical care specialty and to encourage members of the specialty to work to create a healthy work environment [19]. The American Academy of Pediatrics issued a call to prevent burnout by promoting physician health and wellness, and the American Medical Association developed the program STEPS Forward as a resource to help physicians address practice-related issues that have been associated with burnout [85; 117]. In a collaborative report by the Massachu- setts Medical Society, the Massachusetts Health and Hospital Association, the Harvard T.H. Chan School of Public Health, and the Harvard Global Health Institute, physician burnout is declared to be a public health crisis, seriously impacting “the health and well-being of the American public” [120]. The call to action lays out a plan of intervention to help reduce physician burnout. CONCLUSION Burnout is a syndrome of emotional exhaustion, deperson- alization, and reduced personal accomplishment. Levels of burnout are high among physicians, ranging from 27% to 60%, with even higher rates among physicians in training. At the root of burnout is job dissatisfaction. If left unaddressed, this dissatisfaction can lead to prolonged stress and subse- quent burnout. Several causes of burnout among physicians have been identified, including work overload; long hours; inadequate work-life balance; excessive time for administrative tasks, especially electronic documentation; loss of autonomy; and evolving health policy. These sources of dissatisfaction can be correlated with mismatches identified by Maslach, the foremost authority on burnout. High degrees of job dissatisfaction and stress precede burnout, making it incumbent on physicians to recognize stress early to help prevent burnout before it occurs. Preventing burnout is vital not only for the well-being and professional preservation of physicians but also for ensuring optimal patient outcomes. Several personal and professional lifestyle strategies can help physicians cope with stress, achieve better work-life balance, and become more engaged in their work. Practices and institu- tions should focus on creating a healthy work environment in which physicians feel supported by their peers, have control over their schedules as well as decision-making regarding their patients, and are offered resources to help them develop resiliency and enhance their well-being.
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