Physician Burnout During the past month…. Steven Gabbe, MD Have you felt burned out from your work? Professor Emeritus CEO Department of Obstetrics & Gynecology Division of Maternal-Fetal Medicine The Ohio State University Wexner Medical Center During the past month…. During the past month…. Have you worried that your work is hardening Have you often been bothered by feeling down, you emotionally? depressed, or hopeless? 1 During the past month… During the past month… Have you fallen asleep while stopped in traffic or Have you felt that all the things you had to do driving? were piling up so high that you could not overcome them? During the past month…. During the past month…. Have you been bothered by emotional problems Has your physical health interfered with your (such as feeling anxious, depressed, or ability to do your daily work at home and/or irritable)? away from home? 2 Burnout in this Learning Objectives At the conclusion of this presentation, New Era of Healthcare the participants will be able to: • Describe the characteristics of the environment that contribute to burnout in this new era of healthcare. • Identify the important elements of burnout including emotional exhaustion, depersonalization, Steven Gabbe, MD and low personal accomplishment. Professor Emeritus CEO • Recognize the contributions of increased demand, Department of Obstetrics & Gynecology lack of control, and decreased support in the Division of Maternal-Fetal Medicine burnout process. The Ohio State University Wexner Medical Center • Develop individualized approaches and understand the role physicians play in institutional strategies to reduce and prevent burnout. “The young doctor should look about early for an avocation, a pastime, that will take him away from patients, pills and potions.” “These are the duties of a physician: First…to heal his mind and to give Sir William Osler, 1909 help to himself before giving it to anyone else” Epitaph of an Athenian Doctor, 2 AD Author: The British Museum CC BY-NC-SA 4.0 Author: U.S. National Library of Medicine Original Repository: Osler Library of the History of Medicine, McGill University. 3 Physician Wellness: A Missing Quality Indicator 50% “When physicians are unwell, the performance of healthcare systems can be BURNOUT suboptimum. Physicians wellness might not only Medical Students benefit the individual physician, it could also be vital Residents to the delivery of high-quality Practicing Physicians health care.” Source: Wallace JE, Lemaire JB, Ghali WA. Lancet 2009; 374: 1714-21. Burnout Burnout Demands “What started out as important, meaningful and Lack of Resources challenging work becomes unpleasant, unfulfilling and Work Overload Personal Conflict meaningless. Energy turns into exhaustion, involvement Burnout turns into cynicism, and efficacy turns into ineffectiveness.” Diminished: Exhaustion • Emotional exhaustion Control Coping Cynicism/Depersonalization • Depersonalization in relationships Social Support Diminished Accomplishments and with co-workers Efficacy • A sense of inadequacy or reduced Autonomy Costs personal accomplishment Decision Involvement Diminished Organizational Commitment Turnover and Absenteeism Maslach et al. Annu Rev Psychol 2001; 52: 387-422. Physical Illness Maslach, Jackson, Leiter 1996. Source: Maslach, Jackson, Leiter 1996 4 Burnout and Medical Errors Among American Surgeons The Resilient Physician 18.00% P<0.0001 16.00% 14.00% “High demand/low control 12.00% is bad enough; 10.00% High demand/low control/ 8.00% low support can be Last 3 Last Mo. 6.00% deadly.” 4.00% % % Major Medical Errors in 2.00% 0.00% Low EE Low DP Int EE Int DP High EE High DP Source: Sotile W, Sotile M, 2002. Shanafelt, TD., et al. Ann Surg., June 2010. Vol 251 (6). 995-1000. Changes in Burnout and Satisfaction With Work-Life Balance (WLB) in Burnout Physicians “Burnout is a pervasive problem among physicians that appears to be getting worse. Our findings suggest a 10% increase in the prevalence of burnout among U.S. physicians over the last 3 years. More than half of the U.S. physicians in our survey had symptoms of burnout when assessed using the full MBI, with increased rates of burnout observed across all specialties. A substantial erosion in satisfaction with WLB has also been observed among U.S. physicians over the past 3 years, despite no increase in the median number of hours worked per week.” % Reporting burnout Shanafelt, T. et al. Mayo Clin Proc. 2015; 90(12):1600-1613 5 Medscape Physician Lifestyle Report 2017 Satisfaction with Work-Life Balance % Satisfied that work leaves enough time for personal and/or family life 22 A Longitudinal Timeline of Burnout in Medicine: Who Thought Sitting in a Chair From Start to Practice Would Be so Hard? 70 60% 60 53% 51% 50 43% “As unprecedented reforms 40 37% 40% pull our complex 30 27% organizations in new Burnout -Burnout MBI directions, the department 20 chair is arguably the linchpin 10 bearing the most stress.” 0 Pre-Med 12 3 4 Residency Early Career Medical School Dyrbye LN, et al. Burnout Among U.S. Medical Students. Academic Medicine, Vol 89, No. 3 / March 2014 Dyrbye LN, et. al. Personal Life Events and Medical Student Burnout: A Multicenter Study. Academic Medicine. April 2006;80(4)374-84. Brazeau C, et al. Distress Among Matriculating Medical Students Relative to the General Population. Acad. Med. Vol. 89, No. 11 / 23 November 2014 Source: Cohen J. Academic Medicine 1998; 73: No. 3. 6 Emotional Exhaustion “There is tremendous satisfaction in this job, but every day there are tremendous frustrations. Bureaucracy, endless paperwork, audits, OIG, JCAHO, lawyers, etc. take away much of the enjoyment of being chair.” ≤ 18 19-26 ≥ 27 Source: Gabbe et al. Am J Obstet Gynecol 2002; 186: 601-12. Source: Gabbe et al. Am J Obstet Gynecol 2002; 186: 601-12. “I believe the world we live in is not emotionally healthy. Unless an individual can figure out how to have some quiet time on a daily basis, they will have difficulty dealing with other people’s problems.” “My partner is my greatest support – I couldn’t do what I do without her help.” Source: Gabbe et al. Am J Obstet Gynecol 2002; 186: 601-12. 7 Stress Management Drivers of Burnout and Engagement Workload Number and job demands • Time with family and friends 93 Efficiency Control and and • Positive approach to life 65 Resources flexibility • Hobbies 55 Meaning in work • Exercise 51 Organizati • Religion 5 onal Work-life culture integration and values Social • Alcohol 3 support and community at work Source: Gabbe et al. Am J Obstet Gynecol 2002; 186: 601-12. Shanafelt, TD, Noseworthy, JH, Mayo Clin Proc. 2016 Nov 18. pii: S0025-6196 (16)30625-5 Who’s to Blame for Burnout? Changes in Burnout and Satisfaction With Work-Life “Either – or” vs. “Both – and” Balance (WLB) in Physicians “There is an urgent need for systematic “Both the person and the organization have a application of evidence-based interventions role to play in improving the work place and addressing the drivers of burnout among people’s performance within it.” physicians. These interventions must address contributing factors in the practice environment rather than focusing exclusively on helping physicians care for themselves and training them to be more resilient.” Maslach, C., Leiter, M. P., Medical Teacher 2016: 12:1-8. Shanafelt, T. et al. Mayo Clin Proc. 2015; 90(12):1600-1613 8 Solutions for Physician Burnout: Solutions for Physician Burnout: Organization or System Level: Organization or System Level: 4. Cultivate meaning in work: 1. Focus on efficiency and support in the - Create an environment that nurtures practice environment. community, flexibility, and control. 2. Select and develop leaders with the skills to foster physician engagement. 5. Establish principles that facilitate work-life integration 3. Help physicians optimize “career fit” Shanafelt, T. et al. Mayo Clin Proc. 2015; 90(12):1600-1613 Shanafelt, T. et al. Mayo Clin Proc. 2015; 90(12):1600-1613 Mayo Clinic Physician Solutions for Physician Well-Being Index Burnout During the past month . Individual Level: • have you felt burned out from your work? • have you worried that your work is hardening you 1. Identify personal and professional values emotionally? • have you often been bothered by feeling down, and how to prioritize them. depressed, or hopeless? 2. Train in mindfulness-based stress • have you fallen asleep while stopped in traffic or driving? • have you felt that all the things you had to do were piling reduction up so high that you could not overcome them? • have you been bothered by emotional problems (such as 3. Pay attention to self-care, developing feeling anxious, depressed, or irritable)? personal interests, protecting and • has your physical health interfered with your ability to do your daily work at home and/or away from home? nurturing relationships Dyrbe LN, Satele D, Sloan J, et al. Utility of a brief screening tool to identify physicians in Shanafelt, T. et al. Mayo Clin Proc. 2015; 90(12):1600-1613 distress. J Gen Intern Med. 2013;28:421-427. 9 Individual Approaches to Reducing Burnout in Medicine: and Preventing Burnout Is There a Happy Ending? • Protecting Relationships 1. Burnout must be acknowledged • The “Thank You” Folder 2. The risks for burnout increase • The Quiet Drive to Work as control in the work environment decreases • Small Uplifts: 3. The risks for burnout increase as support in the work environment decreases • Music • Pats on the Back – Gratitude 4. Burnout is characterized by high emotional exhaustion, high depersonalization, and low • Walking and Breathing personal accomplishment • How Do You Come Home? Burnout in Medicine: Burnout in Medicine: Is There a Happy Ending? Is There a Happy Ending? 5. The symptoms of burnout include fatigue, 8. The medical practice consequences of insomnia, headaches, and deterioration in burnout include reduced quality of care, relationships with family and friends patient satisfaction and safety; increased 6.