physicians: individual and systemic strategies to …...physicians: individual and systemic...

Physicians: Individual and Systemic Strategies to

Prevent Burnout

Florida Chapter of the American College of PhysiciansDecember 9, 2017

Kathleen Gibney, PhD, ABPP, LMHC, DirectorThe Center for Physician Wellbeing, Florida Hospital

Financial Disclosures

• No relevant financial relationships with any commercial interests.

Kathy Gibney, PhD, ABPP, LMHC

615 E Princeton St. Suite 410Orlando, FL 32803

thecenterforphysicianwellbeing.org

Dimensions:‐ Emotional exhaustion‐ Impersonal attitude toward patients & coworkers (depersonalization)

‐ Perceived lack of accomplishment

Can lead to:‐ Anxiety‐ Depression‐ Substance abuse‐ Addiction‐ Suicide

© 2014 Canadian Medical Association or its licensorsSource: Fralick, M. and Flegel, K. Physician burnout: Who will protect us from ourselves? CMAJ 2014; June 2 (Epub ahead of print).

Physician Burnout



1. 54.4% reported at least one symptom of burnout in 2014 as compared to 45.5% in 2011.

2. Satisfaction with work‐life balance declined from 48.5% to 40.9%

3. In comparison to the general population an increasing disparity exists in burnout and satisfaction with work‐life balance in physicians.

Shanafelt (2015) Changes in burnout and satisfaction with work‐life balance in physicians and US Working population between 2011 and 2014. Mayo Clinic Proceedings, Dec 90:12, 1600‐1613.

Out of 6,880 physicians surveyed using Maslach Burnout Inventory:

A look at the numbers


thecenterforphysicianwellbeing.orgCarol Peckham | January 13, 2016. Medscape Lifestyle Report 2016: Bias and Burnout.

15,500 physicians participated


thecenterforphysicianwellbeing.orgCarol Peckham | January 13, 2016. Medscape Lifestyle Report 2016: Bias and Burnout.



Consequences of Physician Burnout

‐ Medical errors1‐3

‐ Impaired professionalism5,6

‐ Reduced patient satisfaction7

‐ Staff turnover and reduced hours7

‐ Depression and suicidal ideation9,10

‐ Motor vehicle crashes and near‐misses11

1. JAMA 296:1071 2. JAMA 304:1173 3. JAMA 302:1294 4. Annals IM 136:358 5. Annals Surg 251:995 6. JAMA 306:952 7. Health Psych 12:93 8. JACS 212:421 9. Annals IM 149:334 10. Arch Surg 146:54 11. Mayo Clin Proc 2012



Essential skills are lost when burnout is present:

‐ Compassion‐ Patience‐ Empathy‐ Ability to listen

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.

Richard Gunderson

•Excessive Work Load• Inefficiency and Clerical Overload•Loss of Control and Flexibility•Loss of Work & Life Integration•Loss of Meaning

Tait Shanafelt ~ Mayo Clinic

Bottom Line and Common Sense

• LET DOCTORS DO WHAT THEY DO provide support & improve EHR• WORK LOAD SHOULD REFLECT WHAT IT TAKES TO CARE FOR PATIENTS• MEASURE, TRACK AND BENCHMARK PHSYCIAN WELLBEING• LEADERS NEED TO INFORM, ENGAGE, DEVELOP, EMPOWER AND ACKNWOLDEGE THAT BURNOUT EXISTS

• TRUST PHYSICIANS eliminate intrusive regulations that do not improve care.

http://catalyst.nejm.org/videos/physician‐burnout‐stop‐blaming‐the‐individual/

National Academy of Medicine: A call to explore and address Burnout as an underrecognized threat to safe,

high‐quality careResearch is needed in Organizational, Practice, Financial, Regulatory and liability environments

Research on implications of professional distress and well‐being for health care outcomes

Intervention research to improve work‐lives and well‐being of health care professionals

NAM.edu/perspectives July 5, 2017Dyrbe, Shanafelt, Sinsky, et.al.

TRAIN ADMINISTRATORS

Manager and Physician Cultures Area Administrators Physicians

Basic Assumptions

Central Logic Rationalization, efficiency Collegial control, expertise

Values View of WorkPrimary loyaltyResponsibilityTolerance for ambiguityPatient focusTimeframe of actionView of resources

Make a livingTo the organizationSharedHighBroadMiddle‐longLimited

Work is livingTo the patientPersonalLowNarrowShortUnlimited

Artifacts Basis of KnowledgeExposure to “others” while trainingRelationshipsCareer DevelopmentVocabulary

Social/management sciencesLittleHierarchicalHierarchical advancementCost, benefit, revenue, patient satisfaction

Biomedical sciencesGreatCollegialAchievementQuality, patient outcomes

Change requires an understanding and appreciation of the differences on both sides Kaissi, 2014

There is no one/perfect plan

AMA: Steps Forward Program

• Seven steps to prevent burnout involving administrative functions

• Mini Z burnout survey to assess personal level of symptoms• Examples of positive practice changes including

• Workflow• Communication• Quality improvement

• chronic health management programs• synchronized prescription renewal

https://www.stepsforward.org/

A Thin White Line

Physician Training

90 hours/weeksleep deprived Survival mode – split off from

own emotions and needs

Evaluated 24/7

Profession’s Expectations

• High Degree of Integration(personal/psychosocial/spiritual)

• Highly Developed Interpersonal Skills

• Able to Maintain Balance

Profession’s Reality

• Trained to Split

• Cut off from Meaningful Interactions

• Pulled Toward Imbalance/Postponement

Behaviors and Living in the Present

• Slow Down ~ Radical!• Play• Be Aware• Be Intentional• Deliberately Feel• Notice Details• Share Experiences• Turn off Technology

Cease Not till death…

The real challenge isn’t what we are able to do with our eyes closed. It is to be more self‐aware in the crucible of our everyday lives, and to behave better as a result. That’s

mindfulness in action.

Tony Schwartz is the chief executive of the Energy Project

And…An Irish Blessing

physicians: individual and systemic strategies to …...physicians: individual and systemic...

Documents