Issue link: https://beckershealthcare.uberflip.com/i/717576
73 Executive Briefing How to Diagnose, Intervene and Succeed in Combating Physician Burnout P hysician burnout levels hover around 50 percent across most specialties, according to surveys from Medscape, the American Medical Association and Mayo Clinic. These surveys also indicate burnout is steadily increasing among phy- sicians due to a combination of factors, including long hours, bureaucratic tasks and reduced face time with patients. With enthusiasm, engagement and decision-making capabili- ties at risk for roughly half of the nation's physicians, burnout poses a real threat to patient care. Here Robert Frantz, MD, a board certified emergency physi- cian and president of TeamHealth Emergency Medicine West, and Jim Tait, TeamHealth's vice president of human resources, share their personal experiences with burnout, how to identify the condition in colleagues and what leaders can do to combat this threat. Editor's Note: Responses have been edited lightly for length and style. Question: How prevalent is burnout? Does it hit some spe- cialties harder than others? Dr. Robert Frantz: It's rampant. If burnout were a disease, there would be a national outcry for resources to deal with it. Nearly half of all providers are burned out at some point in their career, and the other half lie about it. If I were to guess, I'd say about three-fourths of providers experience [burnout] at some point. It's more prevalent in specialties that require direct care with patients. That's not to say radiologists or pathologists couldn't burnout — anybody has the ability to be burned out — but it's a care fatigue problem. Jim Tait: After [TeamHealth] had two physician suicides within a couple of weeks, I started doing research and talking to phy- sicians. I spoke to roughly 100 and asked why they became a doctor. They basically said three things: I want to help people, better my community and provide a solid lifestyle for my family. Physicians go through school in an eight- to 10-year sprint. Meanwhile, they look across the road and their contemporaries are becoming attorneys and accountants, living a lifestyle they envision living, while they are a quarter million dollars in debt from student loans. They become entrenched in the workplace and the divide grows until their family believes they love their patients more than them. Conversely, the physician becomes resentful and believes they are doing everything they can to afford that lifestyle. I see this mostly in the emergency medicine and the hospitalist space. Some face financial challenges. Others face divorce. It's devastating, but they compartmentalize emotions, go on to the next case, and when they are done, go get a sandwich in the cafeteria. Sometimes, they lose the ability to feel love. Burnout is a hidden problem and the prevalence is understated because the stats are difficult to get a handle on. Out of almost 1 million physicians in the U.S., about 400 will commit suicide each year, and that's probably an understatement. Q: What are signs of physician burnout? JT: Detachment, less rounding on patients, less social interac- tion. People in this burnout phase fundamentally believe they are on an island by themselves and cannot be rescued, and it manifests itself as isolating behaviors. Beyond that, there are errors like potential coding inaccuracies for billing purposes, lack of attention to detail on EHRs or mistakes during handoffs with patients. RF: The most common sign is compassion fatigue. That's why it's so insidious. As a physician, you learn there is an emotional dis- tance required for a therapeutic encounter with a patient. You can't have 100 percent empathy at all times and be effective. But at some point, if you are disassociating from all patients, that's an issue. It can also bleed over into other relationships, and you find yourself disassociating from family members or coworkers. Q: Have you or a colleague had any personal experiences with burnout and how did you deal with it? RF: Yes, I have. I practice one day a week now, which has re- moved a lot of those calluses. About 10 years ago, I had a lawsuit, just finished a divorce and was working a clinical shift two days after the lawsuit was resolved. I was so arrogant and blind to the issue; I thought I could work through it. The way I managed patients was com- pletely off. Sitting at my desk and looking at the queue, I re- alized suddenly — like a lightning bolt — I was overwhelmed, tearful and hopeless. I didn't know how I would get through the shift. Leaving in the middle is not an option, and I was just four hours into a 12-hour shift. I was well beyond the first stages at that point. It was a crisis. At the time, there was no real awareness of burnout. There was a stigma around asking for help. You were expected to be tough and work through it. But when that fails, you don't have much to fall back on. When our coping mechanisms are breached, you are in real trouble. You revert back. I felt like an intern again. The first person I could think to call was an attending I trained under years ago. I called right in the middle of the shift and he talked me through the acute phase. He helped me understand caregivers also need care, and there is nothing wrong with that. Over time I was able to manage my way out of it. I reduced my clinical shifts, took time to reflect, tried meditation, went to church and focused on relationships and tried to repair them. Sponsored by: