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Administrative burdens and long hours contribute to rising levels of physician burnout, so too do the emotional repercussions of being involved in an adverse event.
Nearly half (46%) of doctors report they felt burnout, up from 40% in 2013, Medscape’s Physician Lifestyle Report, shows. Physicians who specialize in critical care emergency medicine, and family medicine reported feeling burnout the most.
Other studies back up Medscape’s findings. Physician burnout is on the rise, and the reasons are familiar: administrative burdens, EMRs (and other technology-related office tasks), and too many hours spent at work.
Medscape’s study may be new, but for many physicians, the findings aren’t news. Robert Wah, MD, president of the AMA, says that one of the biggest concerns physicians have is the complexity of upcoming regulations and the reporting requirements. “We’re in an environment where a lot of those things are on the rise instead of on the decline”.
The news this week that Medicare will transition more of its reimbursement to be based on valuerather than volume by 2016 may reverse the level of physician burnout, says Don Crane, president and CEO of CAPG, one of the largest associations of multi-specialty and independent physician groups in 20 states.
“Physicians are burdened with an enormous amount of administrative work,” says Crane. “But, now physician leaders are trying to become leaders of an enterprise that will rise or fall based on medical management, not nickels and dimes. Physician leaders’ stock will rise and their sense of reward and gratification of the profession will improve.”
Burnout Impacts Patient Care
For hospitals and health systems, burnout should be taken seriously because of the effect it can have on patient care.
“The stakes are very high,” says Samantha Meltzer-Brody, MD, assistant professor and director of the UNC Perinatal Psychiatry Program in the department of psychiatry. “You’re dealing with peoples’ lives in high-stress, difficult moments.”
Meltzer-Brody developed a program for the University of North Carolina School of Medicine called “Taking Care of Our Own,” which aims to de-stigmatize the problem of physician burnout. She says she recognized the need because she was seeing an increasing number of physicians and resident physicians in her practice.
“I was seeing … physicians [who were] just exhausted,” says Meltzer-Brody. “That led me to having a sizable number of physicians with burnout, and I started hearing from other doctors, too. I realized it was a big problem.”
The program is voluntary, and physicians and residents are either referred to Meltzer-Brody by a supervisor or peer, or they can self-refer. Meltzer-Brody says she can tell the program is catching interest because initially she’d get referrals when she gave a lecture or talk about the program. Now, she has a steady stream of referrals.
In the two years since the program launched, about 200 physicians and resident physicians have sought help for managing stress. “Sometimes, I’ll get a call and the person will ask, ‘Are you that person?'” she says.
Meltzer-Brody says that physician burnout is not just an apt description for older physicians. She says stress to the point of burnout looks different depending on the age and specialty of the physician.
“Residents, for example, are working horrible hours, and they have fewer resources than faculty. For other physicians, a stressor may be that they are not as facile with an EMR.”
Operationalizing Help for Physicians
The program has grown beyond the medical school. UNC Health Care, the nonprofit integrated health system owned by the state, has partnered with Meltzer-Brody to help physicians affected by sentinel events.
Celeste Mayer, RN, PhD, patient safety officer for UNC Health Care, says physicians who are involved in serious adverse patient events are profoundly impacted by the experience and need help coping. “We move on as an organization, but individuals are bearing a huge weight for some time after, she says.
Mayer and Meltzer-Brody started working together last year to come up with a model that provided emotional support for these physicians, often called second victims. They pitched the idea as a pilot project and received one of three grants from UNC School of Medicine last year. Mayer says it’s an indication that the organization is taking physicians’ need for emotional support seriously.
Meltzer-Brody is equally encouraged because she believes physician wellness needs to be given priority and operationalized across systems. “It’s taken me a couple of years to beat the drum loudly,” she says. “Now, I am hearing people say, ‘this is a problem, what can we do?’ ”
The adverse patient event program hinges on peer support. Physicians who are involved in an adverse event have the option of being paired with a peer, either within their specialty or outside of it, who is available to talk with them about what happened in a non-judgmental, empathetic way.
Mayer says there is wide support for the program. When she and Meltzer-Brody were preparing to put out a call for volunteers to be supportive peers, the CMO of UNC Health Care sent a message to each department promoting the program.
“Every department nominated at least one person,” says Mayer.
Thirty people are now volunteers for the program. They are trained on empathetic listening techniques and to know when a mental health professional needs to intervene.
“It’s devastating for well-meaning medical staff,” says Meltzer-Brody. “At its worst, it [an adverse event] can cause post-traumatic stress disorder, and it can cause people to leave the profession.”
The volunteers are from all halls of medicine: physicians, nurses, pharmacy techs, etc. Once a physician requesting support is matched with a peer, that peer contacts the physician as soon as possible and they meet in person. There is a follow up meeting two weeks later, then another one in two months.
“We have offered it to 32 different people since August, but that doesn’t mean we’ve had 32 adverse events, rather there are 6–12 people who may [have been] affected by an event,” says Mayer. “Nine have participated in peer support, 15 did a depression screening survey, and some have declined or not followed up.”
Each conversation is confidential, and Mayer says the feedback from the volunteers bears out that this program is needed.
“We’re finding a lot of volunteers have personal experience,” says Mayer. “They say, ‘Thank you for giving me this opportunity; I wish this program could have been there for me.”
The pilot program is still in its first year, but Meltzer-Brody hopes this is a training ground for rolling out more programs that support physicians. “One of my goals is de-stigmatizing that burnout only happens to other doctors,” she says.