And the time to act is now
by Martina Schulte, MD, Chair, CMS Committee on Physician Wellbeing
Featured in the July-August 2019 Colorado Medicine Colorado Medicine.
Welcome to a special issue of Colorado Medicine that puts the focus on you – Colorado’s physicians – and your wellbeing. The writers, contributors, CMS staff and members of the CMS Committee on Physician Wellbeing are excited to share stories, ideas and expertise with you on this topic. The wellbeing of our Colorado physicians is vital to each of us personally and professionally, and is essential for the wellbeing of our patients and our health care system. So let’s jump in.
Whether you’ve heard the terms burnout, moral distress, satisfaction, wellness or professional joy, or whether you have a different preferred way of talking about the professional situations of yourself and your colleagues, we physicians are hearing a lot these days about it all. Each label or description elicits emotions, associations and, sometimes, reactions in our minds.
Many leaders and frontline doctors want to move away from the term burnout because they see it as blaming or shaming the individual for his or her situation. And some organizations have attempted to address burnout simply by encouraging individual resilience. To move from the idea of individual blame and individual responsibility, the conversation has changed to working toward joy in practice, wellness and professional fulfillment. Certainly those are the goals, and this issue will touch on many ideas for moving in that direction.
Regardless of the vernacular, something serious and concerning is happening to health care professionals in the workplace and we must understand it so we can make meaningful and effective interventions. The work environment is rife with cultural and systems challenges that are leaving many feeling emotionally exhausted, detached from the very patients and colleagues we choose to serve, and wondering if we are accomplishing what we intend or want. These are the symptoms of burnout,1 and medical data suggests that nearly 50 percent of us are experiencing some or all of these.2,3,4
It is easy to identify issues that impact our workday: productivity requirements, billing and regulatory requirements, hours of electronic health record documentation, diminished say in scheduling, challenges with referrals and medication choices, less time to connect and share with colleagues, systems inefficiencies for which physicians often try to compensate, and so much more. While it is the individual who experiences the symptoms, burnout is caused by the work environment.1
Here is a quick lesson on what we know about drivers of burnout in the workplace.1
From the work of Christina Maslach, an American social psychologist and professor emerita of psychology at the University of California, Berkeley, the six aspects of the work environment that drive burnout are workload, autonomy (or lack of it), values and meaning, fairness, community, and reward.
All six of these directly relate to what many of us experience in our clinical practices or other health care workplaces. Addressing these driving concepts underlies many of the interventions currently being tried and recommended. In this issue, you will read stories of reclaiming control and autonomy, building community, and changing practice situations to align with personal values.
Nationally, as the focus moves from individual-level interventions to combat burnout to organizational responsibility, the conversations are about changing the work environment to prevent burnout and to facilitate meaningful engagement.5 The main organizational focuses are on measuring wellness, burnout and satisfaction, and then enhancing workplace culture and addressing workplace inefficiencies.
Having had my own experience of burnout in primary care, and now having worked as a coach with many physicians navigating their work and careers to create sustainable experiences, I hear repeatedly how dismissed or unvalued physicians feel in the workplace. We all need and want to feel valued, and when our ideas are ignored and our concerns about systems and safety appear to be disregarded, it is disheartening and devaluing. Addressing workplace culture is vital to reclaiming engagement and fulfillment. Workplace culture includes leadership, voice, authentic and ongoing acknowledgement and appreciation, and building a truly supportive workplace community.
When I ask people I work with to tell me of their best work experience, they nearly always credit working with a great team; having time to do some work they truly loved such as teach, write curriculum, try new workplace interventions, etc.; or having a terrific boss. It seldom includes statements like seeing fewer patients, receiving high payment or compensation, or having a sabbatical.
In other words, when we reflect on our best work experiences, they are usually great because the workplace environment created a space to do good work, feel that our work is truly noticed and valued, have support from colleagues and boss, and have some freedom and say in our workday and tasks.
Culture matters – and so influences the efficiency and effectiveness of workplace. Continually improving workplace systems and workflow are crucial to physicians spending more time doing face-to-face care and less time on administrative care tasks. The section of this issue starting on page 19 contains stories on efforts to enhance care delivery systems.
While I have so far stressed workplace interventions including culture and efficiency, we each remain responsible for taking care of ourselves in ways that mean we arrive at work in a state that allows us to be present, contribute and cope well with the challenges inherent in our work. That means our attention to self-care matters. Investing in our own care, our relationships and our growth are essential. Sometimes, caring for ourselves means asking for help or reaching out for professional assistance. Historically, we physicians have not been good about recognizing when we need help or asking for it. We too often hold ourselves to unrealistic expectations and see our humanity as a weakness. Reaching out for help, in informal or formal ways, is crucial to our wellbeing, and I invite you to read the stories starting on page 9 and explore the resources within, as well.
But a word of reality first. There is no clear, easy or simple quick fix to burnout and creating professional fulfillment. Or, as our CMS President Debra Parsons, MD, says, no “secret sauce.” The leading organizations around the country working on this employ multi-pronged approaches, and research is still ongoing to learn best practices for desired results. With that word of caution, this issue aims to share stories and ideas that may give you realistic and doable options as you pivot to creating your own professional fulfillment.
You will read some colleagues’ stories of personal journeys, ideas for workplace and individual interventions, and some organizational actions that are already in the works around our state. I extend a special thank you to all our colleagues who have shared their stories and expertise in this issue. Your willingness to share in order to serve us all is essential to making true progress in combating isolation and creating community as we move forward. There are ideas for big groups and for individual practices, ideas for employed physicians, academics, specialists and primary care doctors. I welcome you to read ahead, and I am confident you will find connection in the stories, lots of ideas, and maybe even some new thoughts worth more exploration. Please enjoy and let us know your thoughts and suggestions by emailing firstname.lastname@example.org.
- Maslach, C., & Leiter, M.P.(1997). The truth about burnout: How organizations cause personal stress and what to do about it. SanFrancisco, Calif: Jossey-Bass.
- Rotenstein LS, Torre M, Ramos MA, et al. Prevalence of Physician Burnout: A systemic review. JAMA. 2018;320(11):1131-1150. doi:10.1001/jama.2018.12777.
- Shanafelt TD, Hsan O, Dyrbye LN, et al. Changes in Burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90(12):1600-1613.
- Shanafelt TD, West, CP, Sinsky C, et al. Changes in Burnout and Satisfaction With Work-Life Integration in Physicians and the General US Working Population Between 2011 and 2017. Mayo Clin Proc. n XXX 2019;nn(n):1-14 n https://doi.org/10.1016/j.mayocp.2018.10.023.
- Noseworthy J, Madara J, Cosgrove D, et al. Physician Burnout is a Public Health Crisis: A message to our fellow healthcare CEOs. Health Affairs Blog. March, 2017: 10.1377/hblog20170328.059397.