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Physician Burnout

Dike Drummond, MD and Rob Orman, MD
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Most of us will face some degree of burnout during our careers. The trick is to recognize it and grow from there.

  • Pearls:

    • The vast majority of physicians will experience burnout at some point in their career.

    • Awareness of what one’s “ideal job” looks like and efforts to align current practice with the ideal one will reduce burnout.

 

  • Burnout keeps people from productively engaging in their work. The gold standard for measuring burnout is the Maslach Burnout Inventory.  It has three symptoms:  

    • Emotional exhaustion

    • Cynicism and sarcasm

      • Venting about patients is a dysfunctional coping mechanism and is never healthy.  

    • Lack of efficacy

      • This is the feeling that your work has no meaning or purpose.  One may be concerned that things have gotten to the point where a mistake will be made.

  • Burnout is different than stress.  When stress occurs, energy reserves drop, but the individual is able to recover before returning to work.  Burnout is a downward spiral with no bottom.

  • On average, ⅓ of physicians are burned out at the present moment, and all physicians in their mid-40s have been burned out at least once.  This applies to all specialties and countries.

  • Doctors forget that they have free-will.  They are accustomed to the lack of free-will during the many years of medical school and residency.  When finished with residency, they do not take advantage of the fact that they now can make choices and do anything they want with their board certification.  Dr. Drummond teaches the importance of regularly asking oneself the following question:  “What is my ideal practice?  What is the practice that I dreamed about before I entered residency?  What kind of patients am I seeing?  What setting and location am I working in?  What are my ideal hours and pay?”  He suggests the answers to these questions be written down.  Physicians should continuously try to align their current practice more with their ideal practice.

  • Many people stay in their current work scenario explicitly for the money .  They are surrounded by a wall of guilt, and there’s a little voice in their head that says, “You’re a rich doctor.  Why would you give this up?  This is the dream job.  What are you thinking?”  It’s only a matter of time before they experience burnout.

  • Burnout can kill you.  Male or female, physicians commit suicide at double the rate of other professionals.  The foundation in the vast majority of these cases is burnout.

  • There are four root causes of burnout:

    • The practice of medicine is stressful.  We are responsible for caring for people who are sick, dying, traumatized, hurting, or broken.  

    • There are additional job-specific stresses that are put around the practice of medicine which have nothing to do with caring for patients.  Examples are electronic medical records, call schedule, compensation formulas, and personality conflicts with partners.

    • Trying to have a life outside of medicine causes stress.  The birth of a child, personal illness, and becoming an empty-nester are just a few of the thousands of stressful events that can occur at home.  These events can interfere with your ability to recharge your energy accounts at home and can manifest as burnout at work.

    • The final cause of burnout is the conditioning of medical education.  During the seven-plus years of medical training, doctors are conditioned to be workaholics, superheroes, lone-rangers, perfectionists, and emotion-free.   We are taught the two prime directives:  the patient comes first and never show weakness.  This sets us up to: 1) not be aware of our physical needs; and 2) continue working even when our energetic bank accounts are in a negative balance.  We are trained to see it as a sign of weakness to ask for help when we need it.  And we don’t reach out to our colleagues to support them.  

  • Physicians should ask themselves to rate their practice on a satisfaction scale from zero to 10.  Zero is when “It couldn’t get any worse” and 10 is when “It couldn’t get any better.”  Anyone whose number is below five is in trouble.  

  • The first step to reversing burnout is to acknowledge that a change needs to happen.  The second step is to determine what needs to change in order for you to create your ideal practice.  Dr. Drummond asks physicians to create a Venn diagram, where one circle is the current job and the other circle is the ideal job.  He assesses the percent of overlap between the two jobs and asks physicians to speculate what it would take to push the two circles together and increase the overlap, without changing jobs.  Most physicians are able to quickly come up with a list of changes that would improve their current job satisfaction.  This creates a project list, and the only decision that has to be made is where to start.  He has found that for physicians who start with only 15-25% overlap, by correcting sources of dissatisfaction from the project list, the amount of overlap with their ideal job can increase to 75-80% within 6 months.  

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  • Electronic medical records (EMR):  a dilemma, not a problem.

    • EMR is a balancing act between the amount of work that you do to put the documentation in the chart and the quality of the documentation itself.

    • Dr. Drummond recommends a strategy to help physicians who are overwhelmed by and truly detest EMR.  He teaches a one-breath mindfulness technique to let go of negative feelings in the workplace

      • First, check your attitude.  If you have a bad attitude, your charting will be reflect that.

      • Second, ensure that you’re always documenting a minimal data set.  There are only three reasons to add a note in the chart:  to justify the billing code, to cover yourself medicolegally, and for continuity of care.  He warns against wasting time on proper punctuation, spelling, or complete sentences.  

      • Third, utilize templates.

      • Fourth, enlist the help of your team for assistance with documentation.  Share the load with others who are likely eager to help you.

Finally, hire a scribe.  Pay for it in a pilot project and show that scribes allow you to see more patients and, therefore, make more money.  Prove to administration that it is financially wise for them to take over payment from you to continue your increased productivity.

Sean M. -

What an amazing lecture that comes at a great time for me as a physician- Thank you!

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Strep Throat burns out the Gout! Full episode audio for MD edition 190:58 min - 90 MB - M4AHippo Primary Care RAP March 2015 Summary 430 KB - PDF

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