Practice-level changes that can alleviate physician burnout

Physician burnout is a problem that requires system-wide changes, but there are some individual and practice-level changes that can help clinicians regain a sense of fulfillment and pleasure in their work.

There is a lot of be said for taking time out in your clinical day for meditation or refocusing and improving work-life balance, but oftentimes clinicians struggle with a feeling that they have little control over their environment.

“Many physicians feel stuck in complicated work environments over which they have little individual control. For example, specific decisions about the type, volume and roles of support staff, so critical to the efficiency and safety of day-to-day work, may not be under the control of the physicians closest to the patients,” said Christine A. Sinsky, MD, a board-certified internist, vice president of professional satisfaction at the American Medical Association, director of the American Board of Internal Medicine (ABIM) and chair of the Board of Trustees for ABIM.

“Physicians may feel responsible for the outcomes to which they are held accountable, and yet have limited control over the resources required to achieve those outcomes. Responsibility without control is a set-up for burnout,” Sinsky added.

Practice-level changes require system-wide support, she said, but there are programs available that can guide these efforts.

AMA’s STEPS Forward modules and case reports illustrate concepts in action to fight burnout at various institutions. Some of the concepts addressed include team documentation-the most powerful change to reduce burnout, pre-visit planning, pre-visit lab, team huddles, team meetings, and streamlining the process for handling incoming patient requests.

Making these changes can be difficult without system-level support, she said, and practices should identify a leader to champion these efforts on a larger scale.

“Two of the most powerful means of reducing burnout are improving workflows and improving leadership. In fact, almost half the variation in physician satisfaction within an organization can be explained by the leadership score of a physician’s immediate supervisor,” Sinsky said. “The most important point is that while efforts to improve professional well-being can include initiatives targeted to the individual, such as mindfulness training and self-care, an organization should not start here, nor put the majority of their effort here. Doing so would send clinicians the message that burnout is their fault. Organizations are better served by directing their initial efforts and the majority of their efforts toward fixing the environmental factors that contribute to burnout.”

It can be difficult to imagine a new way of doing things, Sinsky said, so learning from pioneers who have helps transform other institutions is instrumental.

“The good news is that there are many interventions a health system can implement to reduce burnout and to improve the conditions where joy, purpose and meaning in work are possible,” Sinsky said.

The inaugural Joy in Medicine CEO Consortium identified 11 steps that they committed to at their organizations and encouraged others to consider, Sinsky said. In addition to measuring and tracking burnout, estimating the costs, tracking physician turnover and reductions in clinical effort, this group also committed to leadership skills development for their physicians and managers, addressing clerical burden for physicians, working with regulators to reduce regulatory burden and waste, and supporting national efforts to address well-being.

Perhaps most important, though, is recognition of the fact that burnout is a problem that doesn’t rest solely on an individual’s shoulders, and that clinicians aren’t the only ones to face the fallout.

“Approximately half of physicians experience burnout. Each one-point increase in burnout on a 7-point scale is associated with a 43 percent greater odds of reducing clinical effort within 24 months,” Sinsky said. “Studies have demonstrated that burned-out physicians retire early, reduce the time they devote to clinical work, or leave medicine entirely. As a result, patients have longer wait periods to see their doctor or, worse yet, lose their trusted physician altogether.”