If you are a practicing physiatrist, you are familiar with burnout – either you have experienced it yourself or have a colleague who has struggled with it. We know this because 63 percent of physiatrists had experienced burnout as of 2014, and the problem seems poised to continue. In other words, burnout is the rule, not the exception.
This situation is not just bad for the physicians who find themselves in the grip of burnout – it’s bad for healthcare overall. During a session at the 2019 AAPM&R Annual Conference, other startling statistics highlighted the problem. Presenters Allison Bean MD, PhD of the University of Pittsburgh Medical Center and Monica Verduzco-Gutierrez, MD of the University of Texas Health Science Center of Houston, explained that we lose one physician per day to suicide. A physician experiencing burnout is two times as likely to leave their organization within two years, costing the organization more than $250,000 to replace them. Physician burnout is a specialty problem, a healthcare problem, and a societal problem.
In the Annals of Family Medicine, Bodenheimer and Sinsky proposed expanding the Triple Aim of enhancing patient experience, improving population health, and reducing cost. They suggest that this widely accepted paradigm for optimizing health system performance should become the Quadruple Aim, which adds the goal of improving the work life of healthcare providers.
Unfortunately, many solutions for this additional aim have been offered and failed, with undue emphasis on resilience – exactly who is resilient if not a physician who has made it through training? An intervention with professional coaching actually did improve resilience among physicians, along with emotional exhaustion and overall quality of life, but there was no change in depersonalization, personal accomplishment, or job satisfaction. Another intervention with facilitated discussion groups had similar outcomes.
On the contrary, evidence demonstrates that individual and system-based interventions have similar benefits, except overall burnout improved more with the system-based interventions. Bean and Verduzco-Gutierrez presented an overview of two programs that are seeking to incorporate both individual and system-based approaches.
The Mayo Clinic has a nine-step strategy for promoting professional well-being. Their strategy is built on the idea that it is a shared responsibility between the healthcare organization and the physician to address the issue, concluding, “Leadership and attention from the highest level of the organization are the keys to making progress.”
The AMA Steps Forward modules on physician well-being, recognizing that both organizational and individual factors are at play, offer “strategies on how to engage health system leadership, [in]understanding physician burnout and how to address it, as well as developing a culture that supports physician well-being.”
In their talk, Bean and Verduzco-Gutierrez concluded that efforts should be non-stigmatizing, evidence-based, and multifaceted, including changes at both the organizational and individual level. Further, they emphasize that these efforts be individualized and continually reassessed. If you choose to advocate for burnout interventions at your institution, these principles can serve as a roadmap for guiding change. With the problem so rampant among physiatrists, this is everyone’s battle to fight.