Work & Life
Physician burnout and well-being are hot topics among medical professionals throughout the health care delivery and educational continuum — for good reason. Current estimates of the impact of physician burnout approach or exceed 50%, and most experts suggest that the percentage is growing. In response, national, regional, and specialty healthcare organizations are beginning to focus on this crisis. Efforts include the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience., with more than 50 partnered organizations, including the Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME), working to better understand the problem and identify evidenced-based solutions to mitigate its impact. Although the causes of and potential solutions for burnout are complex and varied, most researchers agree that a multipronged approach (including individual, workplace, system, and national-level interventions) is needed. Finally, the medical community seems to agree that the answer to the burnout problem requires more than building individual resiliency.
In view of the growing recognition of this challenge, NEJM Resident 360 hosted a discussion on burnout focused on the resident and fellow experience and system-level interventions. Included in the discussion were experts representing healthcare administrators, program directors, faculty, residents, and recent graduates. The discussion addressed the definition and recognition of professional burnout in oneself and peers; the personal and system-level factors that impact the environment to mitigate, or conversely, to promote burnout; the concept of meaningful work and efficacy in practice to improve the working environment; the impact an individual can have on the culture change that is needed; and how to improve the learning and working environment to maximize connectedness and the personal sense of meaning in the work we do as physicians.
In this post, I highlight and expand on the following ways for those in training to influence system-level change to improve their own and their colleagues’ environment:
Connecting to combat burnout
Recognizing struggle in yourself and others (and getting help when needed)
Engaging with leadership to implement innovation
Focusing on developing opportunities for meaningful and purposeful work
As social beings, humans are not at our best when isolated; connections are the key to resilience. Participants in the discussion described feeling energized after leaving a patient care encounter and finding solace in connecting with peers over shared experiences in the clinical learning environment. One participant started a physician discussion group and described the power of narrative to build connection and develop relationships across the healthcare hierarchy. Such real-life anecdotes remind us of the need to foster connectivity with our colleagues. Although the days of sitting across from one another in a traditional doctor’s lounge are no longer the norm, there are still ways to cultivate connectedness. System-level interventions to facilitate physician-peer connectedness cultivate resilience and must be developed to promote physician wellbeing. Developing these opportunities on the institutional and program level are vital to recreating the culture of connectedness, and thereby building resilience against burnout. The resident’s voice can be a powerful catalyst. Look for opportunities that you can champion to build connectedness and community. You will likely find unique opportunities to break down barriers with your fellow clinicians. Once you identify opportunities, think about how you might implement them and start looking for support.
Another important means of enhancing connection is to empower residents and fellows to look out for one another. Peer recognition of struggle, combined with the proper intervention tools, offers the most potent conduit to physician connection and potentially life-saving intervention. Two video-based resources on the MedEdPortal (Make the Difference: Preventing Medical Trainee Suicide and Time to Talk About It: Physician Depression and Suicide) help you recognize when a colleague is struggling, start the conversation, and intervene. Both videos demonstrate ways to discuss the challenges inherent in the training environment and start a critical dialogue about suicide risk and awareness in the graduate medical education setting. My recommendation is that every program view these or similar videos at least annually and provide time and support to address struggles that fellow residents are encountering. To be effective, this effort requires asking difficult questions and being ready to listen to and connect with the person giving the response. Having structured time to build strong peer support within the residency is critical and requires program leadership support.
Several participants shared their personal stories of losing colleagues to suicide and the devastating effect on those left behind. If you or someone you know is struggling, call the National Suicide Prevention Lifeline at 1.800.273.TALK (8255) or contact the Crisis Text Line by texting TALK to 741741. No one is alone in their struggles and asking for help is not weakness —in fact, it is very brave.
Addressing institutional and systemic issues related to burnout involves partnering with your healthcare administration. Often termed “the C-suite” (Chief Executive Officers, CEOs; Chief Financial Officers, CFOs; Chief Operating Officers, COOs; Chief Medical Officers, CMOs), institution leaders may be physicians or professionals from a myriad of other backgrounds. Residents and fellows often do not feel empowered to engage leadership, but many participants agreed that such engagement provides an opportunity for effective solutions in an area of shared interest. Research shows a dose-dependent correlation between empathetic leadership and reduced likelihood of staff burnout. Furthermore, preventing burnout has been shown to save money — with estimated savings of $500,000–$1,000,000 for every physician that must be replaced. Addressing burnout as a team is win-win for all parties involved: practicing physicians, residents in training, the healthcare delivery team, and the C-suite. Communication is key. If efficiently articulated, it should become evident to leaders that physician wellbeing is a C-suite imperative. Team up with your faculty and develop a plan. Some strategies for communication with the C-suite include:
engage leadership as partners with shared outcome goals
measure burnout at the institutional level
use financial calculations to determine appropriate budgeting for well-being programs
create specialty and occupation-based interventions based on a needs assessment
look for win-win solutions that improve physician well-being and patient care quality
With a little support and preparation, an innovative solution to address burnout or build connection in your working environment may be exactly what leadership is looking for to solve a problem that they are also wrestling with.
Another concept that is supported by data is to focus on finding meaning in your work. For many physicians, that means spending more time with patients and less time with the computer. For others, it involves developing innovative solutions to patient problems, conducting research, or teaching. Studies show that physicians who spend at least 20% of their professional time focused on the work they find most meaningful reduce their risk of burnout by half. Although this may be difficult to do in training, you can start thinking about the areas of training or work that you find most meaningful.
In an effort to support residents in developing local projects designed to increase the amount of meaningful time devoted to patient care, the ACGME Council of Review Committee Residents (CRCR) recently established the Back to Bedside initiative to empower residents and fellows to develop innovative ideas to improve their work environment, increase efficacy, and increase opportunities for meaningful interaction with patients. During the next 12 to 18 months, the hope is that the first 30 projects will serve as proof of concepts to inspire other residents and fellows to start their own interventions. By engaging local institutions, leveraging the interest of the C-suite, and finding innovative solutions to their own workspace sources of burnout, residents in the front lines will benefit both from the interventions they implement and the satisfaction of knowing they lead their institution through a shared challenge.
As leaders of the next generation of clinicians, you will be charged with the culture change that is required to stem the burnout epidemic. With knowledge of focus areas and tips and tools discussed in this post, there is no reason you cannot start now.