Physicians fight burnout

Burnout has become as much a part of medicine as the stethoscope, with too many doctors feeling overworked, over-regulated, and underappreciated. The result is physicians retiring early, changing careers, or losing their love of medicine at a time when there is already a shortage of primary care physicians.

In the Medical Economics 2019 Physician Burnout Survey, 92 percent of respondents indicated they have felt burned out from practicing medicine at some point in their career, 68 percent said they are burned out right now, and 73 percent said they have thought about quitting medicine. Despite the prevalence and scope of the problem, only 13 percent plan to seek or have sought professional counseling.  

Solutions are elusive, because the causes can vary by specialty, location, or practice, and doctors rarely have any control over contributing factors like regulations or EHR design. But that doesn’t mean all doctors have given up or are willing to tolerate the status quo. In fact, as burnout has become increasingly common among physicians, so, too, has the fight against it.

Here are the stories of seven health professionals and what they are doing to battle burnout in the profession.

"We can do better"

Gabe Charbonneau, MDFamily Medicine, Stevensville, Montana

Gabe Charbonneau, MD, experienced burnout in 2009 when the demands of practice limited the time he and his wife, also a practicing physician, were able to spend with their new son. When the family grew to three kids, something had to change. His solution was to share a practice with his wife, so that one of them would always be at the practice while the other was with the kids.

“It was super scary, but the best decision we ever made,” says Charbonneau. “We gave up a massive amount of income and had to throw some material things overboard, but our quality of life went way up.”

From there, he began to think about how he could help other doctors fight burnout. “I met so many people who were intelligent, smart, and good doctors, but they were stuck with issues that were insurmountable,” says Charbonneau. “I had an idea that I needed to come up with something symbolic that would give hope to these smart people that they could get to a better place than where we were stuck.”

The result was an image of the Rod of Asclepius being lifted out of the ashes by a phoenix that he printed on a shirt and displayed on his website, fightburnout.org. The American Medical Association wrote an article about his efforts, interest in the shirts and the cause grew, and now he describes himself as “an accidental person who became an expert on burnout.”

He hopes that his efforts lead to greater awareness of the problem, and that employers will take a hard look at physician workloads and start indexing their burnout so they can measure progress-or lack thereof.

“Leaders often talk about well-being and burnout, but it doesn’t make it onto their financial spreadsheets,” he says. “They offer wellness classes and nice things that are supposed to be helpful, but there is no accountability for physician well-being. They can make a decision in the boardroom that can destroy their doctors, because they are chasing after every dollar.”

One proven solution for reducing burnout is to have physicians meet in a social setting outside of work to share experiences, where they can see they are not alone in their feelings and can share coping advice, he says. There is also a doctor-to-doctor peer support group on Facebook if no local group is available.

“I throw down the challenge that all of us need to start to help unravel this problem before we lose more good physicians and drive them out of medicine,” he says. “I know we can do better. As a society, we have to own this problem.”
Ending the unwritten rule

Tyree Winters, DO P
Pediatrician, Morristown, NJ

Tyree Winters, DO, wanted to be a physician since he was five, with a great desire to help others. “But then you get out there and realize it can be a thankless job,” says Winters. “Even though you want to help people, sometimes as much as you do, it’s never enough.”

His loss of interest created an internal conflict: What do you do when you’ve wanted to be a physician your entire life only to achieve your goal and realize that maybe it wasn’t the best choice?

The breaking point came about five years ago. His mother had just passed away, and the next day, while trying to be both an administrator and filling in as a pediatrician, he diagnosed a child with a cold and offered the mother advice on basic care measures that would help. The mother was furious, telling him, “You don’t care about my child. You physicians don’t care about anything.”

“It was the perfect storm,” he says. “I was thinking to myself that I don’t want to do this anymore.” Winters accepted the fact that he was burned out and needed help, not only by seeking counsel, but also in identifying what his passion was. He found a different way to reach his dream of helping people.

“Even if I’m not seeing patients, I’m doing things like teaching and attending community events, using my medical degree to educate people to make an impact in their lives,” says Winters, who is medical director of the Healthstart Pediatric Clinic and associate program director of pediatric residency for Atlantic Health System. “That’s what motivated me to get over the feeling of burnout. I’m not immune to burnout, but I want to get up in the morning.”

Winters says medical students need to be educated on the challenges of being a physician and the risks of burnout. “They need to be able to seek help-not even professional counseling, but just surrounding themselves with individuals who are going through the same thing. There’s an unwritten rule where doctors are taught to believe if you are not able to handle things, then that’s a weakness. So people keep it to themselves and we need to get over that stigma.”

Winters says doctors don’t always recognize signs of burnout in themselves, such as apathy, or coping through alcohol or food. “They write it off as just having a bad day or just needing some sleep,” he says.

Physicians need to focus on what brings joy in their lives and find a way to escape from the rigors of their day. He recommends finding a couple of hours to do something that isn’t work-related, whether it’s exercising, binge-watching Netflix, or in his case, dancing.

“Doctors have to be able to step away and just live their life,” he says. “And don’t be afraid to be open and direct with your supervisor or department chair to tell them you are starting to feel burned out and that you are looking for advice. You might be surprised how a lot of institutions respond.”

Recognizing the signs

Daisy Smith, MD, FACP 
ACP vice president for clinical education, Philadelphia

Smith leads the ACP’s efforts to demystify and build awareness about burnout, including how physicians can identify warning signs in themselves. “We need to fix the water clinicians are swimming in,” says Smith. “We know medical students are more resilient when they start medical school, but their risks increase as they complete their training.”

She says it’s important for doctors to recognize burnout in colleagues, because it can be contagious, spreading through an entire staff. “It is part of your responsibility to not only identify and address it when you see colleagues suffering, but to also help intervene and fix the overall culture.

“The overall causes of burnout are a workload where people keep adding more and more things to front-line clinicians, but nothing gets taken away,” says Smith.

Physicians should look for sudden changes in behavior in their colleagues as a warning sign that all is not well. “If someone who was outgoing and is now withdrawn, that can be an indicator,” says Smith. Missing meetings or conferences, or even not answering pages can also be a sign of potential burnout. Physical pain, difficulty sleeping, changing appetite or a crisis of confidence are other warning signs.

“They may have a lack of confidence in their work that comes from a sense of powerlessness because they can’t change things or make things better,” she says. “They may become more cynical, be quick to anger or have relationship problems or trouble getting along with family or friends.”

The ACP has resources on its website for physicians who feel burned out and has trained a cadre of 160 members around the country to fight burnout. “Our message is, don’t worry, you are not alone in this,” says Smith. “This is a common issue and a problem that everyone needs help with sometimes. We encourage them to reach out to a friend, a colleague or call their employee assistance line-whatever they feel comfortable with.”

In addition, the ACP is looking to patients as allies in fighting burnout. “The same things that bother doctors are bothering patients,” says Smith. “They want more time together. We think if we join forces with patients and patient advocacy groups to reform healthcare delivery, we might be successful.”

The things you can control

Marie Brown, MD
Internist and AMA practice transformation officer, Oak Park, Ill.

Brown says that many organizations are well intentioned when they set up mindfulness training or yoga classes for physicians, but that while such programs may be helpful in some regards, they can also contribute to burnout.

“Offering classes without fixing the working environment just sends the doctor home an hour later and exacerbates their time away from their family, and takes away time that could be used for exercise or sleep,” says Brown. “We also know burned out physicians write more prescriptions, send out more referrals, make more errors, order more tests, and have higher readmission rates. In every other profession, the higher the education level, the more control the person has over their day and the work they do, with the exception of physicians.”

Brown focuses much of her efforts on helping doctors find small solutions to free up more time. “They often say, ‘What can I do, I can’t fix the whole system?’” says Brown. “What I suggest is to begin by looking at their practice and the things they control.”

For example, Brown changed how she prescribes medication for chronically ill patients. It’s common to write a prescription for three months with one refill, so physicians are refilling the same prescription every six months. She suggests changing that to three months plus four refills, so that doctors are writing the prescription once per year. “If you do that, six months from now, the number of refills decreases by half,” says Brown. “With that extra hour, you can stop drowning long enough to see what else you can do.”

Another area to examine is the EHR.  Brown says doctors need to look at all the notifications they are receiving. She turned off discharge summaries and notifications about tests that did not include results.

“I decreased my inbox by about 50 percent,” she says. “It doesn’t take any resources and doesn’t cost a lot of time. When you are at your wits end, this is something you can do tomorrow.” She also encourages physicians to seek peer-to-peer training on using their EHR more efficiently.
Whenever possible, make sure patients who require lab work have their labs completed before the visit. “That way when you see them, you’ll have everything you need to have a discussion,” says Brown.

“The greatest driver in preventing burnout is being able to deliver quality care, but there are so many obstacles that stop us from delivering it,” says Brown.

The power of listening

Adam S. Holzberg, DO, FACOG
Urogynecologist, director of physician engagement, Rowan University School of Osteopathic Medicine, Stratford, NJ.

“If you do not have engaged physicians who have a vested interest in being there five years from now, you are not going to be able to provide a good patient experience,” says Adam S. Holzberg, DO, adding that healthcare organizations that want to improve their patient experience must tackle physician burnout. “Every study has shown that if you have engaged providers, the patient has a better experience and that results in better outcomes.”

Healthcare administrators must start by measuring burnout in their organization. They should do this by enlisting an outside company to survey the doctors, says Holzberg. “You have to be willing to then act on it and create an action plan,” he says.

Progress is possible when leaders take the time to listen. In a prior position, Holzberg helped move the physician engagement scores from the 24th percentile compared to the national average to the 73rd percentile in less than five years. “It wasn’t because we gave them so much more, we just listened to them,” says Holzberg. “We had good methods of communication.”

The organization created a blog to keep physicians up to date on changes. It included a way for doctors to make suggestions on how to improve working conditions. Doctors always got a response to their suggestions, even if they weren’t feasible. “You can say no with a good explanation-you would be surprised at how much they appreciate that compared to no response at all,” Holzberg says.

Listening is a great way to reduce burnout. “There’s not a lot that providers want,” says Holzberg. “They want to take care of patients, have a say in the plan for the organization, and have some recognition for what they do. They want to have the supplies and tools they need to do their jobs and do it without a lot of obstacles. If you pay attention to a lot of that, you will be surprised at how much difference it can make.”

Ending the stigmaLakshman Swamy, MD, MBA
Pulmonary/critical care fellow at Boston Medical Center

Swamy was a third-year medical resident working nights with two small children at home when burnout hit him. “I became very cynical and laughed about a lot of things-beyond the gallows humor physicians typically use to get by,” he says. “I was falling apart, getting less sleep, and I felt like I was failing with my patients and at home.” He says his work was becoming shoddy and he was being selfish and passing patients off to the next shift.

“It was unprofessional and a really bad spot for me,” he adds. “The big takeaway is, at the time, I could not have told you it was because I was burned out. I couldn’t recognize it in myself, and if I had done so, there were innumerable supports that could have helped.” When he rotated off that shift, his situation improved. Now, he advocates for doctors to look for signs of burnout in each other and to take action when they do.

He advises doctors who suspect a colleague might be heading for burnout to meet with them outside of work to discuss it. “Say, ‘Hey, is everything OK?’ or use other open-ended questions,” says Swamy. “You don’t have to say burnout, because people are often sensitive to that. They might be defensive in the moment, but it lays the groundwork to actually talk to them.”

Speak with them alone, he adds, and not from a position that implies they are unable to do their job. If there is no personal relationship, talk with someone who knows them better and tell them about your concerns. For residents, Swamy advises speaking to the chief resident, but choose your words carefully.

“There’s a big stigma speaking about mental health in medical culture, and burnout relates to that” says Swamy. “If you are in a world where you cannot show weakness and someone is very clearly suffering, the answer is not to go to their seniors and effectively say you think they are weak.

You never want to throw people under the bus.”

While he appreciates employers providing yoga or massages for physicians, those do not address the root causes of the problem. “I personally find a lot of wellness in running and doing yoga, but that doesn’t address the root cause of sitting in front of a computer going mad trying to click all the boxes.

“Burnout is a symptom of an incredibly broken healthcare system,” says Swamy. “It needs addressing, but the root causes are deep and pervasive."