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Physician engagement and the prevention of burnout

Written by Jen Volland, DHA, RN, MBB, CPHQ, NEA-BC, FACHE, Vice President Program Development, NRC Health

What Is Physician Burnout?

According to The Agency for Healthcare Research and Quality, physician burnout is defined as a “long-term stress reaction marked by emotional exhaustion, depersonalization, and a lack of personal accomplishment.”

Physician burnout is a critical dilemma in the healthcare industry and it’s on the rise. 1 in 3 physicians is experiencing burnout at any given time.1

Not only is this an issue for providers, but it’s also an issue that your patients will increasingly be faced with in managing their health. Almost one in four Americans has multiple chronic conditions.2 On average, older adults with multiple chronic conditions see 14 different physicians per year.3

So let’s do some math. That means your patients who need the highest levels of medical management for complex chronic conditions have, on average, at least 4 of their physicians going through burnout at a time.

What Causes Physician Burnout

Unfortunately, research into the matter is limited but the most common culprit is a poor work-life balance with today’s medical professionals. Long hours at the clinics, increased pressures from fear of lawsuits, and even desensitization to death all contribute to burnout.

Additional sources of burnout could be:

→ Too much bureaucracy
→ Financial issues
→ Shifts into computerization
→ Impact of the Affordable Care Act
→ Lack of professional fulfillment
→ Difficult patients
→ Too many appointments in a day
→ Unable to provide patients with the quality they feel they deserve
→ Difficult coworkers
→ Unable to keep up with current research
→ Compassion fatigue from overexposure to death

Causes of Physician Burnout

What Are The Symptoms of Physician Burnout?

Burnout is characterized by the same symptoms as other chronic stress and depression disorders. This includes:

→ Constant fatigue and feeling drained despite adequate sleep
→ Increased sickness due to weakened immune system
→ Chronic headaches and pain, especially in the back and muscles
→ Unusually increased or decreased sleep and/or appetite
→ Low libido or impotence
→ Feelings of self-doubt, helplessness, feeling trapped or a sense of failure
→ Emotional detachment and feelings of isolation
→ Lack of motivation
→ Decreased satisfaction in once pleasurable activities
→ Withdrawal from social obligations and personal responsibilities
→ Negative attitude and increased frustration
→ Using food, drugs or alcohol to cope

Unfortunately, it doesn’t stop there. Burnout has been directly linked4 to:

→ Lower patient satisfaction and care quality
→ Higher medical-error rates and malpractice risk
→ Higher physician and staff turnover
→ Alcohol/drug abuse and addiction
→ Physician suicide

In short, burnout is not a topic that can be ignored nor expected to take care of itself. Those experiencing symptoms of burnout should seek treatment.

How Improved Physician Engagement Can Help Prevent Burnout

One of the ways that healthcare leaders can help facilitate the avoidance of physician burnout is to foster physician engagement. Rather than have physicians feeling like they’re giving up their practices for inclusion in a hierarchy structure, organizations must create inroads for collaboration, a sense of purpose and meaningful occupation, and shared engagement agreements.

It’s essential that physicians don’t feel like they’re working alone on an island, and that they recognize there’s an entire team behind them.

The Ottawa Hospital (TOH) is located in Ottawa, Canada. They’re a top performer on the Access to Care dimension, in which patients rate the availability of their doctors and nurses and their ability to get all of the services they need while in the hospital. To achieve initial success the organization focused on three important themes for driving performance levels: patient experience, performance management, and physician engagement. In their relentless pursuit to deliver world-class care, TOH partners with their physicians to engage them in meaningful ways and improve workflows. Recently the hospital Board adopted healthcare’s quadruple aim as its strategy – including staff and physician wellness as a cornerstone for success.

All healthcare leaders should be asking themselves: Within my organization, what’s the promise I deliver to my physicians?

Every year, the administration at TOH renews a promise to its physicians that care delivery is and will remain a team effort. Within the hospital’s academic environment, care is provided according to patient- and family-centered principles; in line with clear, effective, and transparent leadership; and following an organizational commitment to its physicians. Their Hospital/Physician Engagement Agreement is aligned to TOH’s core values of:

→  Commitment to quality
→  Compassion
→  Working together
→  Respect for the individual

In addition to its Hospital/Physician Engagement Agreement, the organization has established multiple processes to support their providers, including the development of dyad teams and skill-building programs and the addition of clinical care leaders to help alleviate some of the factors that can lead to physician burnout when patients feel like their needs aren’t being met during a hospital stay. Clinical leaders are charged with the mission of focusing on key areas such as patient flow, patient experience, and clinical tactics.

To learn more about the processes that have been put into action at TOH, check out the linked case study which provides a deeper level of information about this high performer in the industry. Finding ways of working together and helping physicians feel that they are an influential part of the team can be the first step to not only correcting a growing problem but also helping your patients get everything they need.

1. Shanafelt, T.D. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient-centered care. JAMA. 2009; 302(12):1338–1340.
2. Partnership for Solutions, Johns Hopkins University. Chronic conditions: making the case for ongoing care. https://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf
3. Medscape Physician Lifestyle Survey 2015. https://www.medscape.com/features/slideshow/lifestyle/2015/public/overview#2.
4. Physician Burnout: Its origin, symptoms, and five main causes. Family Practice management. 2015:22(5) 42-47. https://www.aafp.org/fpm/2015/0900/p42.html#fpm20150900p42-b1.