Solving The Epidemic Of Physician Burnout and Its Effects On Patient Care.

This is the 2^nd article in the series about THDC’s pioneering approach to prevent burnout and their support of the American Medical Association’s initiatives to do the same.[1]

More than 50% of U.S. physicians report symptoms of burnout, a nearly 10% increase in less than three years. Experiences of severe physical and mental exhaustion are causing doctors to leave the profession in droves. The statistics are jarring. Physicians dying by suicide are increasing and many of the individual stories are truly tragic.[2] In addition there are attempts at suicide – which can incapacitate a doctor or resident for long periods of time, and even just considering taking one’s life is a painful experience.

Along with physicians, others reporting high levels of burnout are residents, nurses and other healthcare professionals, resulting in poorer health outcomes for patients, increased risk of medical mistakes, and overall higher healthcare costs for our nation.

One thing is for sure, our doctors, nurses, and resident, who have dedicated their life to saving ours, need a heap more compassion and understanding, especially that they are human just like we are, from an increasingly demanding, law suit oriented public.

To address this issue, experts say the problems require solutions that offer a systemic approach. Multiple organizations from the Mayo Clinic to the American Medical Association (AMA) have joined the effort, working towards solutions for the epidemic of physician burnout affecting not only healthcare providers, but patients as well. Read more here.[3]

Physicians consistently encounter patients and families who are in distress, fearful, and understandably, often impatient, due to their unrealistic expectations that physicians can and should perform miracles. At the same time, doctors are bombarded with constant demands from the healthcare system itself – spending hours documenting patient encounters into electronic health record systems, fighting with insurance companies for authorization of necessary treatments and so on. In December of 2016, a joint study published between the AMA and Dartmouth found that every hour of face-to-face patient time equaled two hours of EMR (electronic medical record) documentation.[4]

Compounding this problem is the fact that much of medical training focuses singly on technical capabilities, and instills the “Iron Man” culture, discouraging physicians to have empathy and compassion for themselves. Lacking are coping skills and supportive environments to help deal with the ever mounting stressors and pressures. This makes it doubly difficult for having the close relationship and trust necessary for optimum patient-provider care.

The result? Physicians are highly vulnerable to stress and burnout.

People in healthcare professions hold themselves to high standards of selflessness and excellence, often aiming for perfectionism in patient care. Unrealistic expectations, like being “error free” result in physicians’ self-care falling to the bottom of their priority list or being non-existent. Self-neglecting behaviors, such as skipping meals, not hydrating adequately, and not getting sufficient sleep become the norm. This norm becomes unconscious and continuously sabotages physicians’ self-care behaviors, increasing the deleterious effects of stress and overwhelming their meager coping mechanism.

The first installment of our series was on the important breakthrough The Human Development Company (THDC) believes has been accomplished doing the Danbury Hospital clinical trials, helping physicians and other professionals overcome stress and burnout. The last two years were spent developing a multidisciplinary, holistic approach that can help everyone, especially doctors, residents, and nurses, mediate stress and prevent burnout. You can read the first in this series of four articles here. [5]

After doing an analysis of the clinical trial’s preliminary data of a small yet significant sample, THDC was pleased by the positive results. Despite physicians, residents and nurses facing all types of obstacles to attend the workshops and webinars on a regular basis, the biomarkers and self-assessments were surprisingly encouraging. Additionally, the constant verbal reports received regarding improvement in participants’ mental and physical states, strongly indicated their experiencing less stress and emotional exhaustion, as well as improved professional satisfaction. (Results will be detailed in the 3rd article in this series.)

After reading about multiple organizations seeking a solution to the burnout epidemic[6], THDC reached out to Dr. James Madara, CEO of the AMA regarding the ongoing clinical trial at Danbury Hospital, CT, a Yale affiliate.

Within days, Michael Tutty, PhD, Group VP of Professional Satisfaction and Practice Sustainability called us. After hearing our novel approach to burnout prevention he expressed the AMA’s interest. It sparked a strategic meeting to discuss what the AMA has been doing to address the issues and what steps they felt The Human Development Company should be taking to bring their original methodology and results into public view.

The AMA has fully committed to addressing physician burnout as one of its top priorities and challenges facing our healthcare system today. In order to solve the burnout epidemic, AMA views the ‘external environment’ as the primary driver of physician dissatisfaction. By creating healthy and supportive systems, physicians can truly thrive through autonomy to practice quality care, by optimizing efficient clinical workflows, and building strong relationships with colleagues and patients.

For the past year, AMA has focused intently on ramping up efforts in the form of convening top healthcare leaders, researchers and stakeholders to develop targeted strategies for change. These conferences, led by VP of Professional Satisfaction and leading burnout expert, Dr. Christine Sinsky, have resulted in actionable steps and powerful calls to action from the nation’s top CEO’s.[7] They have also committed to identifying data-driven solutions by helping organizations measure burnout and identify opportunities for improvement, led by Senior Practice Advisor, Allison Winkler, MPH. Lastly, AMA’s free practice transformation platform STEPSForward ™[8] continues to help physicians and practices develop skills to manage their daily “environmental” challenges, such as work flow optimization, leveraging team-model of care, improving the administrative burden, enhancing team and patient culture.

While the AMA’s efforts have focused on the ‘external environment’, THDC’s model focuses on the individual physician’s (residents and nurses) inner challenges to self-care and stress perception, a pioneering concept in the field of stress and burnout prevention.

THDC’s approach addresses a serious question that has yet to be addressed, much less solved. Why does the population at large, physicians included, have such a difficult time taking better care of their health and well-being?

THDC’s answer: society teaches people to focus on others’ welfare before their own, which results in placing themselves last when it comes to taking care of their basic health needs. The “tough and selfless” or “Iron Man” mentality taught physicians requires coping mechanisms like depersonalization and cynicism, which are hostile to the more effective qualities of empathy and compassion toward self and patients.

Such inner conflict creates both resentment and frustration in physicians and similar groups of front line professionals under stress, exacerbating conditions causing burnout. Sustaining compassion and empathy towards others, requires practicing self-caring behaviors in order to establish a positive internal relationship with oneself, the foundation for behaving positively with patients and colleagues.

First and foremost THDC wants to bring the issue of self-care to light and into the mainstream conversation. Making physicians aware of their propensity for ignoring their own health, and clarifying the need to give themselves permission in changing this self-destructive behavior, are the primary steps for supporting physicians to make lifestyle changes necessary to prevent burnout. This falls under the realm of emotional and psychological training.

Often doctors are in denial of their burnout symptoms or feel wary of seeking help for fear of losing their jobs. This fear necessitates; 1. That they are given the emotional and psychological tools they can use privately to prevent and ameliorate symptoms of burnout through self-care, and 2. That they participate in workshops that teach those tools and how to process stressful issues. Being in large groups also has the ability to inspire self-examination and imbue people with the courage to seek help.

THDC’s groundbreaking approach to stress management has universal applications to all corporations and organizations and has captured the interest of HR professionals everywhere. Given nationwide employee burnout in so many fields, we’re inviting you to join our campaign to solve this crisis.

THDC focus on the internal solutions and the AMA focus on the external solutions are complimentary and holistic. We invite you to join and support our respective organizations as we move forward to finding the most effective answers to the physician and healthcare burnout epidemic.

THDC submitted this article to the AMA for their input and to ascertain the correctness of the information regarding the AMA’s efforts visa vie the current burnout epidemic effecting physicians.

If interested in learning more about the AMA resources please contact Allison Winkler, [email protected].

If interested in learning more about the THDC HR initiatives and clinical trial; email Stefan Deutsch at [email protected].