Posts Tagged burnout

Reducing Physician Burnout Focus of New Study at UAB

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Reducing Physician Burnout Focus of New Study at UAB

BIRMINGHAM – A program to study and reduce physician burnout amongst residents will be introduced at the University of Alabama at Birmingham, along with three other hospitals around the nation. The five-year, $1.8 million grant is funded by the American Medical Association.

UAB’s Tinsley Harrison Internal Medicine Residency Program shares the grant with Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center and Stanford University School of Medicine. The award supports the study of key factors that contribute to the well-being and clinical skills of internal medicine residents across different training programs.

“We are excited to be a part of this important study,” said Lisa Willett, M.D., professor of medicine at UAB and program director of the Tinsley Harrison Internal Medicine Residency Program. “The learning environment is critical to the professional development of physicians in training. With this study, we hope to identify the key elements of the learning environment that shape the professional development of residents, while ensuring they are able to spend meaningful time at the bedside caring for patients.”

Information gathered from the early years of the study will help educators better understand that training environment. Once factors that affect the residency training environment are identified, new techniques to reduce physician burnout and improve clinical skills will be tested. The final years of the study aim to improve resident wellness and clinical skills.

Working with the residency program to implement the AMA “Reimagining Residency” grant will be Stephen W. Russell, M.D., associate professor of internal medicine and pediatrics, and KeAndrea Titer, M.D., assistant professor of internal medicine.

“The Tinsley Harrison residency program is already taking steps to enhance the clinical skills of residents by offering formative skills assessments with real-time feedback,” Dr. Russell said. “The hope is that by collaborating with other leading universities, UAB will continue to investigate and implement the best practices of resident education and that knowledge can be generalized to other programs.”

Dr. Russell will represent UAB on the grant’s executive committee as well as oversee the outpatient formative assessments of clinical skills. As a recent chief medical resident at UAB and new faculty in the Division of General Internal Medicine, Dr. Titer will oversee the bedside rounding initiative at UAB as well as lead local resident engagement.

“This grant, along with graduate medical education leadership, will not only serve to increase wellness in our trainees,” Dr. Titer said, “but also continually improve upon the delivery of excellence in patient care that they provide each day.”

The Tinsley Harrison Internal Medicine Residency Program serves as one of more than 20 residency programs within UAB graduate medical education. The residency program comprises 116 categorical residents and 16 combined Medicine-Pediatrics residents, providing care at UAB Hospital and the Veteran’s Administration Medical Center (BVAMC). During training, residents acquire clinical acumen for the diagnosis and management of common acute and chronic medical illnesses as well as rare diseases that involve complex clinical reasoning. This grant will aid in the continual development of physicians who demonstrate excellence in clinical skills and compassion in patient care.

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Could Employee Engagement be a Cultural Decision?

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Could Employee Engagement be a Cultural Decision?

As the Baby Boomers retire and Millennials join the workforce, managers find themselves with a new challenge in engaging the staff. The baby boomers did not mind following strict rules, nor did they require a daily pat on the back. Most employees need more than just a task list. They need to feel valued, informed and engaged. Physician leaders and administrators can engage the staff more effectively if they are modeling a positive culture based on a mission statement, values and communicating goals. Behavior modeling creates a sense of trust and engagement in the staff that improves morale and retention. High turnover in a medical practice is stressful for everyone; the remaining staff must take on more work and re-train staff over, and over again. High staff turnover is costly – the time to interview, onboard staff and train staff reduces productivity, and it is a definite sign there is something wrong at the leadership level.

Most physicians are experiencing “burnout” due to challenges in health care and increasing patient volume. In past years, a group practice was led by a physician who was interested in the business of medicine; the others in the group simply supported the ideals of the lead physician. Physician and administrator relationships are the basis for building a positive culture. The physicians and the administrator should meet often. All physicians should be involved in business decisions and develop leadership styles to enhance a positive culture. New physicians have skills in technical aspects of practice management and can serve as a champion to guide new projects. An administrator skilled in communication and empowerment can engage staff and grow leaders. Practice administrators learn what motivates each employee, and they can influence the entire team by assuring conflict is avoided or resolved. An effective administrator assures the office is running smoothly and leads by example. The administrator is a coach in every sense; he or she impacts the physician leaders, the staff and the patients. An effective administrator seeks opportunities to build morale by celebrating work milestones, birthdays, or even organizing a company picnic.

Engaged employees contribute to the organization’s effectiveness. An engaged employee feels passionate about the job and is loyal to the practice. If an employee is emotionally committed to the practice, he or she is more committed to the goals of the practice. A workplace that encourages idea sharing and personal value will give leaders and employees a sense of purpose and belonging, which leads to empowerment. An engaged employee will be an advocate for the practice, they speak positively about their work and encourage others to be a part of the organization. As we invest in our employees and overall culture, we raise the level of expertise and strength. As the team grows stronger, the projects are successful and seamless because the administrator and the physicians can work at a higher level.

A positive culture shows in every aspect of the practice; the efficiency and cheerfulness of the staff and the overall experience of the patient. I spoke recently during a group staff meeting on patient satisfaction. We discussed body language, a patient can detect when a staff member does not care or is not happy with their job. The patient experience relies upon an engaged staff member. We discussed companies who have an exceptionally positive culture that is ‘’caught” not “taught.” A positive culture starts at the top and trickles down to everyone!

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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How Can Physicians Effectively Address Burnout?

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How Can Physicians Effectively Address Burnout?

How many of your colleagues are complaining that they are doing more work and getting less for it? How many of them are experiencing ever-increasing levels of frustration brought on by outside influences: governmental regulation, insurance regulation, increased concern about medical malpractice, increasingly negative attitude by society towards physicians, and weakened physician-patient relationships?

Most individuals considering medical school know up front that a medical career inherently makes certain demands – they will be called upon to place their personal lives on hold financially as they study and train in the field of medicine. Competition is expected, as is delayed gratification, personal sacrifice, limited sleep, lack of free time, and intense pressure to be up on the latest medical knowledge. Upon completion of their residency or fellowships, they may be able to reclaim certain aspects – they will begin drawing a paycheck, they will have more control over their daily routine, some will even “man their own ship” in private practice – but not all of them.

Unfortunately, the characteristics that a make a good clinician may also lead the physician further and faster down the road to burnout. The field of medicine and often the physicians themselves set very stringent standards to be followed. These standards can be identified in the form of self-imposed limitations.

Physicians must…

  • Work until the work gets done
  • Not permit downtime, as downtime is time wasted
  • Handle everything that comes their way without complaint or assistance
  • Be highly conscientious
  • Try to be all things to all people – patients, staff, family, colleagues, etc.

On top of all that, the medical environment brings other components. Physicians are faced with repetitive tasks on a daily basis. While the diagnosis may change, the seeing of patients often becomes routine as physicians move from one room to the next. Physicians are often faced with problems that lack solutions, accompanied by demanding and chronically ill patients. Life and death issues are faced on a daily basis. In short, there is no time to emotionally recharge.

After several years of holding themselves to such high standards, a number of physicians are being forced to reevaluate their career, their life’s decisions. Many feel increasingly dissatisfied with their daily lives, and struggle to find a coping mechanism.

Symptoms of Burnout

There are many symptoms of burnout, some emotional, others physiological. Just as he or she would query a patient about the symptoms of an illness, the physician must stop and query himself or herself to identify common burnout symptoms. Examples of these include:

  • Negative perceptions of self
  • Negative practice habits
  • Lack of empathy with patients
  • Unhealthy lifestyle
  • Dissatisfaction with career
  • Sleep disturbances

Identification of the symptoms, and eventually the cause, is critical for two reasons. First, it is the only way the physician can work to overcome burnout and its significant effects. Second, failure to address burnout can foster an environment where the “it-just-doesn’t-matter“ attitude turns into a malpractice claim.

Preventing Burnout

Given the above situations and environments, is it possible to cope with burnout? Research indicates physicians who take charge of their lives and strive to ensure balance, are far more successful than most.

Prevention and/or mitigation can be divided into several areas.

Physical:

  • You should acknowledge that you, too, can get sick, and you should take normal steps to prevent it.
  • Have an annual physical to identify health concerns promptly.
  • If you can’t get motivated alone, hire a personal trainer so someone is expecting to see you at the gym.
  • Ensure you get enough rest.
  • Maintain a healthy diet.

Environmental:

  • Maintain control of your schedule.
  • Schedule non-patient appointments when they are convenient for you, and assign a time limit.
  • Evaluate your other commitments; be willing to say no when asked to serve on just one more committee or handle one more obligation.
  • Set priorities. Identify your daily tasks and divide them into one of four categories: urgent and important; urgent but not important; important but not urgent; and neither important nor urgent. Try to take a realistic approach and avoid lumping everything into “urgent and important.”
  • Meet with your staff on a regular basis. This helps prevent their burnout, and subsequently yours if you are not having to deal with staffing issues on top of everything else.
  • Chart throughout the day. Several sources agree charting at the end of the day allows a dreaded task to cut into personal time.

Emotional:

  • Volunteer
  • Find a hobby or leisure activity that does not pertain to medicine to give yourself an outlet.
  • You should get involved in your church or a community project that is important to you.
  • Spend time with friends or colleagues where you can be yourself.
  • Modify your perspective. Instead of saying, “There is no way I can get all this done today,” say “I will do only that which I can get to today.”
  • Learn to handle conflict. Resolving conflict instead of just living with it will improve your emotional outlook in a number of areas.

Financial:

  • Avoid overextending yourself financially. Stress over finances makes most individuals feel they have given up control of their lives – they must now work to meet their financial demands, and not just to achieve career goals or personal satisfaction.
  • Indebtedness may prevent someone from implementing other key steps to preventing burnout.

Is it hopeless? No. Is it easy? No. But today’s environment is highly stressful, and unfortunately, it is not likely to change for the good any time soon. This means physicians must either learn to cope with the forces battering at them on a daily basis or continue to feel ever increasing despair and frustration from their chosen career.

Article contributed by Sae Evans and Maddox Casey, Members, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

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REPORT: Nearly Half of Resident Physicians Report Burnout

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REPORT: Nearly Half of Resident Physicians Report Burnout

ROCHESTER, Minn. – Resident physician burnout in the U.S. is widespread, with the highest rates concentrated in certain specialties, according to research from Mayo Clinic, OHSU and collaborators. The findings appear in the Journal of the American Medical Association. Physician burnout is a dangerous mix of exhaustion and depersonalization that contributes to physicians making mistakes while administering health care.

The study found 45 percent of respondents experienced at least one major symptom of burnout, with those in urology, neurology, emergency medicine and general surgery at the highest risk. Regardless of specialty, high levels of anxiety and low levels of empathy reported during medical school were associated with burnout symptoms during residency.

“Our data show wide variability in the prevalence of burnout by clinical specialty, and that anxiety, social support and empathy during medical school relate to the risk of burnout during residency,” says Liselotte Dyrbye, M.D., a Mayo Clinic researcher and first author of the article.

Residents with burnout had more than a threefold increase in odds of regretting their decision to become a physician. When asked, “If you could revisit your career choice, would you choose to become a physician again?” those in pathology and anesthesiology were also most likely to respond “definitely not” or “probably not.” Similarly, the higher the level of anxiety reported during medical school, the greater the chance of regretting becoming a physician.

Previous research has shown physician burnout has some relation to gender and ethnicity. Residents who identified as female had a higher risk of burnout symptoms, matching studies of later-career physicians.

Although the problems facing female physicians have been reported, the study illustrated the less-studied plight of residents who self-identified as Latino or Hispanic. These individuals were more likely to regret their specialty choice. While the study did not examine the cause directly, the authors speculate that minority physicians often are pressed into participating in various institutional diversity initiatives that overtax their schedules compared to nonminority physicians.

Not all of the study’s findings were negative. The majority of residents are satisfied with their career choice and specialty. In particular, participants who reported high empathy scores during medical school appeared to be more resilient to burnout during residency. This is counter to the common narrative that physicians need “thick skin” or an emotional aloofness to perform.  Similarly, high empathy scores during medical school were associated with a willingness to choose the same specialty again. In addition, participants who reported higher emotional social support during medical school were generally happier with their specialty choice.

Other burnout studies have focused on physicians-in-practice. This was the first national study to longitudinally follow medical trainees from the beginning of medical school into residency to explore predictors of burnout. The study included nearly 3,600 participants who were surveyed in the fourth year of medical school with follow-up in second year of residency. It was derived from a larger study of medical students called the Cognitive Habits and Growth Evaluation Study that has tracked a group of students from their first year of medical school through the last year of residency.

About 50 medical schools were included in the research. Residents were asked to provide information about their specialty, ethnicity, educational debt and other demographic characteristics. They then completed surveys that have previously been developed to measure anxiety, emotional social support, empathy and burnout.

The study was supported by a grant from the National Heart, Lung and Blood Institute, and the Mayo Clinic Department of Medicine Program on Physician Well-Being. Researchers from Mayo Clinic, Syracuse University, University of Minnesota, Yale University, Stanford School of Medicine, and OHSU distributed, collected and analyzed the surveys. Michelle van Ryn, Ph.D., OHSU School of Nursing was the principal investigator.

 

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STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

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STUDY: Doctor Burnout in Small Practices Is Dramatically Lower Than National Average

Physicians who work in small, independent primary care practices — also known as SIPs — report dramatically lower levels of burnout than the national average (13.5 percent versus 54.4 percent), according to a study led by researchers at NYU School of Medicine published online July 9 in the Journal of the American Board of Family Medicine. The findings indicate that the independence and sense of autonomy that providers have in these small practices may provide some protection against symptoms of burnout.

Physician burnout is a major concern for the health care industry. It is associated with low job satisfaction, reduced productivity among physicians, and may negatively impact the quality of care. Multiple national surveys suggest that more than half of all physicians report symptoms of burnout.

Research on physician burnout has focused primarily on hospital settings or large primary care practices. The researchers say that this is the first study that examines the prevalence of burnout among physicians in small independent primary practices — practices with five or fewer physicians.

Researchers examined data collected from 235 physicians practicing in 174 SIPs in New York City. The rate of provider reported burnout was 13.5 percent, compared to the 2014 national rate of 54.4 percent. A 2013 meta-analysis of physician surveys conducted in the United States and Europe found that lower burnout rates were associated with greater perceived autonomy, a quality and safety culture at work, effective coping skills, and less work-life conflict.

“Burnout is about the practice culture and infrastructure in which primary care doctors work. So the obvious question is: what is it about the work environment that results in low burnout rates in small practices?” says Donna Shelley, MD, professor in the Departments of Population Health and Medicine at NYU Langone Health, and the study’s senior author. “It’s important to study the group that’s not showing high burnout to help us create environments that foster lower burnout rates. The good news is that a culture and systems can be changed to support primary care doctors in a way that would reduce the factors that are leading to burnout.”

How the Study Was Conducted

Researchers analyzed data as part of the HealthyHearts NYC (HHNYC) trial, which is funded by the Agency for Healthcare Research and Quality’s (AHRQ) EvidenceNOW national initiative. AHRQ is a division of the U.S. Department of Health and Human Services. The HHNYC trial evaluates how practice coaching or facilitation helps SIPs adopt clinical guidelines for the treatment and prevention of cardiovascular disease.

Each physician answered a multiple choice question with response options indicating various levels of burnout. Options ranged from no symptoms of burnout to feeling completely burned out and questioning whether or not to continue practicing medicine. The question was validated against the Maslach Burnout Inventory, a nationally recognized measure that identifies occupational burnout. Physician respondents were categorized as burned out if they checked one of the last three options in the multiple choice question.

As part of the HHNYC trial, physician respondents were also asked a number of questions about the culture of their practices. The tool used specifically measures “adaptive reserve,” or a culture where individuals have opportunities for growth and the ability to learn from mistakes by talking and listening to each other. Physicians who described this kind of culture in their practice reported lower levels of burnout. According to Dr. Shelley, practices, where employees feel they are included in decisions and have control over their work environment, are referred to as having “high adaptive reserve.”

Dr. Shelley is careful not to minimize the challenges faced by physicians working in solo practices or SIPs. She cites that even though burnout rates are lower, many of these practices are struggling financially, and many of these physicians are on-call all of the time.

“The more we can understand what drives low rates of burnout, the more likely it is that we’ll find solutions to this problem,” says Dr. Shelley. “The hope is that our research can inform ways for larger systems to foster autonomy within practices so that there is space to carve out a work environment that is aligned with doctors’ needs, values, and competencies.”

Dr. Shelley lists a number of the study’s limitations. Since the findings are representative of physicians working in small practices in New York City, the study does not capture burnout rates in other cities across the country. It is also possible that the researchers underestimated the number of hours worked by physicians, since hours worked is associated with burnout. Dr. Shelley also cited the lack of data linking physician burnout to patient outcomes.

In addition to Dr. Shelley, study co-authors include Nan Jiang, PhD; Carolyn Berry, PhD; and Gbenga Ogedegbe, MD, MPH, of NYU School of Medicine; Chuck Cleland, PhD, of NYU Rory Meyers College of Nursing; and Batel Blechter of Johns Hopkins University.

The research was supported by the Agency for Healthcare Research and Quality (AHRQ).

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Let’s Talk About Physician Burnout

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Let’s Talk About Physician Burnout

According to Medscape’s 2018 Annual Physician Lifestyle Report, Burnout and Depression Section, 42 percent of physicians surveyed have reported burnout symptoms in the last year. Fifteen percent of physicians admitted to experiencing either clinical or colloquial forms of depression. The National Institute of Mental Health reports 6.7 percent of all American adults suffered at least one major depressive episode in the past year.

To say that burnout and depression have reached epidemic proportions among the medical community is an understatement.

The Medscape report also revealed a higher percentage of female physicians — 48 percent — suffered from symptoms of burnout than their male counterparts — 38 percent. Age may also be a factor. According to the report, about 35 percent of young physicians feel some sort of burnout whereas about half of physicians ages 45 to 54 feel the pinch.

The report also showed that while physicians in all specialties are susceptible to feelings of burnout, some medical specialties tend to show higher rates of burnout:

  • Critical Care — 48%
  • Neurology — 48%
  • Family Medicine — 47%
  • Obstetrics/Gynecology — 46%
  • Internal Medicine — 46%

What is burnout?

The dictionary defines burnout as exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration. But for a physician, burnout is much more…with much more at stake.

Physicians are trained to endure long hours and stressful situations. However, practicing medicine in today’s highly charged political climate filled with intrusive government regulations tends to take a toll with not only the lives of the patient, but quite possibly the physicians, hanging in the balance. There are symptoms of burnout which can easily be missed or overlooked. These include excessive fatigue, insomnia, depression and anxiety. Unfortunately, prolonged exposure to these symptoms may lead one to self-medicate with alcohol or prescription medications…or worse.

Part of the problem is that few in the medical community want to talk about burnout. However, talking about burnout is not only the beginning of a solution but can also save lives.

Fighting burnout begins with a conversation.

Physicians dealing with mental, emotional and physical exhaustion become less able to provide quality care to their patients and find themselves leaving the medical profession altogether…or worse. It’s the “or worse” scenario that worries Dr. Debbie Booher Kolb of Madison.

As president of the Madison County Medical Society, Dr. Kolb wanted to make a difference in the lives of her colleagues. Together with a wellness committee she chairs, they began to formulate a plan to help physicians in their area who felt overwhelmed in their medical practice and to help everyone achieve a better work-life balance. They had no idea the vast support they would have for the Physicians Resource Network Wellness Program.

“My father is a retired radiologist,” Dr. Kolb explained. “I remember being in school and hearing about a friend of my fathers who changed careers. I was mystified by that. I didn’t know that was even an option. I’d never heard of a physician changing careers. It’s not even on your radar once you’re in the medical profession. If you do change careers, it’s to go into pharmaceuticals, medical directorships, or to be a life coach. For physicians, it’s truly a business decision once you leave the profession. It’s sad really to think you could burn out so badly that you leave the profession you loved so much completely behind you.”

But, it’s happening more and more to physicians. With the added pressures of government regulations, such as MACRA, electronic health records, ICD-10, and Medicaid funding, the practice of medicine has become even more complicated today than it was just a decade ago. Unfortunately, these pressures have caused physicians to burnout and not only voluntarily leave the profession of medicine, but also to lose their medical license for inappropriate behavior, or died by suicide.

Dr. Kolb’s mission is to help her colleagues prevent burnout by learning how to cope with its symptoms and finding a better work-life balance. Her mission began in 2014 at the annual meeting of the American Academy of Family Physicians where she first met Dr. Dike Drummond, better known as The Happy MD, and discovered his book, Stop Physician Burnout. Dr. Drummond’s website is www.thehappymd.com.

“This book transcends medicine, and his website is great, too. I was so impressed with his actionable advice. What he taught was good nuts-and-bolts information that made me want to bring him to Huntsville so my colleagues could hear him locally. We’ve had three physician suicides in two
and a half years in Madison County alone. It became more and more apparent that we needed to do something. This is heartbreaking and preventable. All of this coalesced to really be something that we could all get behind.”

And everyone did. Laura Moss, executive director of the Madison County Medical Association, said it wasn’t difficult to get everyone on board with the idea to make the physician wellness initiative a continually evolving priority for Madison County.

“Physician burnout is a trending topic because it’s a huge problem among those in health care. Our hope is that the more we talk about it, and the more solutions such as coaching, counseling and workshops we offer, the more intentional our physicians will become about the decisions they make regarding their own health,” Moss said. “We also hope the more it’s out in the open, the less physicians will feel alone and turn to addiction or worse — suicide. This is not something many physicians were taught about in medical school, and we want to be here to offer ways to help prevent or overcome burnout in a healthy way. MCMS is excited to be focused on taking care of the caregivers and to be giving back to our members in a meaningful way.”

As Dr. Kolb and her colleagues admit, everything begins with a discussion. Little did they know how many lives they were about to touch when they rolled out the first component of the burnout program. The first step was an evening event with Dr. Drummond, which sold out 200 seats and had a waiting list for attendees. Burnout Proof LIVE was a huge success, and it’s just the beginning.

“Burnout transcends specialties, and that’s why our physicians have been so appreciative of this program. After the event with Dr. Drummond, we had people commenting and sharing their stories on social media. That’s what we’re trying to do — effect a paradigm shift in the culture of medicine. We really want to let our colleagues know this is more common than they may realize because physicians just don’t talk about it. We want to start talking about it,” Dr. Kolb said.

How can physicians get help for burnout?

The program in Madison County is an excellent start for awareness and healing, according to Rob Hunt, D.Min., director of the Alabama Physician Health Program, but there’s still more work to be done.

“More programs like the one in Madison County that get people in the medical community talking about burnout is a good start. Unfortunately, there are still so many doctors who don’t understand the warning signs, especially medical students. Female residents are among the biggest burnout populations. I think the key is education. The more they can learn about what burnout is and how to avoid it early in their careers, the better it will be on our physicians and our medical system,” Dr. Hunt said.

APHP is a member benefit for physicians of the Medical Association. It is a confidential clinical resource for physicians, physician assistants, residents and medical students created in 1990 by state law to provide a program for early detection and treatment of medical professionals with problems related to possible impairment due to alcohol, drugs, psychiatric disorders or behavior. About 90 percent of physicians who enter the APHP successfully complete the program and return to their medical practices and see patients.

“Most don’t truly understand exactly what APHP can do until they become part of the program as participants. We are here to help them, and we advocate for them to help them keep their medical licenses. We try to keep or get them healthy and keep them in their medical practice and in the State of Alabama. Our opinion is that a doctor who has gone through APHP as a participant and is being monitored is a safer physician, a better physician, than those who have problems and haven’t gone through our program,” Dr. Hunt explained.

According to Dr. Hunt, most physicians may not even realize they are burning out until the situation becomes substance abuse, disruptive behavior, or other issues that stem from being burned out. It’s these overt signs that APHP can help physicians treat.

“Physicians work as much as 80 or more hours a week easily, and they’ve done that for years and years,” Dr. Hunt said. “Some take medications to cope with that stress. They may not know it, but it gets out of control, and they become addicted. What we see are more middle-aged physicians. Older physicians have learned to cope with that stress. We’ve seen many doctors retire because of EMR, ICD-10 and other government regulations. They just refused to put up with it, so they took that step and closed their practices. It was too much stress. It’s still happening with more and more government regulations that physicians have to navigate. It takes them away from the one thing they trained their entire lives for — medicine.”

Still, if more physicians can learn about what burnout is and how to avoid it early in their careers, the better it will be for our physicians and our medical system.

Could YOU have burnout?

There are specific signs of professional burnout. Ask yourself these questions:

  • Am I overly cynical or critical at work?
  • Do I have to drag myself to work or have trouble getting started once I arrive at work?
  • Am I irritable or impatient with co-workers or patients?
  • Do I lack the energy to be productive at work?
  • Does work consistently satisfy me?
  • Am I disillusioned by the practice of medicine?
  • Have my sleep habits or appetite changed?
  • Do I have headaches, backaches or other physical complaints that don’t subside with rest?
  • Do I use food, drugs or alcohol to feel better or to simply not feel at all?

If you feel you are suffering from symptoms of burnout and would like to get help, please contact the Alabama Physicians Health Program at 1-800-239-6272. APHP is a member benefit of the Medical Association. If you live in Madison County and would like more information about the Physician Wellness program, call (256) 881-7321.

Article written by Lori M. Quiller, APR, Director of Communications, and Mikala McCurry, Communications Assistant.

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Burnout Proof – Healing the Healers with Debbie Booher Kolb, M.D.

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Burnout Proof – Healing the Healers with Debbie Booher Kolb, M.D.

MADISON — According to a recent study by the Cleveland Clinic, more than one-third of physicians are in a silent battle with professional burnout. Physicians dealing with mental, emotional and physical exhaustion become less able to provide quality care to their patients and find themselves leaving the medical profession altogether…or worse. It’s the “or worse” scenario that worries Dr. Debbie Kolb of Madison.

As president of the Madison County Medical Society, Dr. Kolb wanted to make a difference in the lives of her colleagues. Together with a wellness committee she chairs, they began to formulate a plan to help physicians in the area who felt overwhelmed in their medical practice and achieve a better work-life balance. They had no idea the vast support they would have for the Physicians Resource Network Wellness Program.

“My father is a retired radiologist,” Dr. Kolb explained. “I remember being in school and hearing about a friend of my fathers who changed careers. I was mystified by that. I didn’t know that was even an option. I’d never heard of a physician changing careers. It’s not even on your radar once you’re in the medical profession. If you do change careers, it’s to go into pharmaceuticals, medical directorships, or to be a life coach. For physicians, it’s truly a business decision once you leave the profession. It’s sad really to think you could burn out so badly that you leave the profession you loved so much completely behind you.”

But, it’s happening more and more to physicians. With the added pressures of government regulations, such as MACRA, electronic health records, ICD-10, and Medicaid funding, the practice of medicine has become even more complicated today than it was just a decade ago. Unfortunately, these pressures have caused physicians to burnout and not only voluntarily leave the profession of medicine, lose their medical license for inappropriate behavior, or commit suicide.

Dr. Kolb’s mission is to help her colleagues prevent burnout by learning how to cope with its symptoms and find a better work-life balance. Her mission began in 2014 at the annual meeting of the American Academy of Family Physicians where she first met Dr. Dike Drummond, better known as The Happy MD, and discovered his book, Stop Physician Burnout.

“This book transcends medicine, and his website is great, too. I was so impressed with his actionable advice. What he gives you to do is really good nuts-and-bolts that made me want to bring him to Huntsville so my colleagues could hear him locally. We’ve had three physician suicides in two and a half years in Madison County alone. So it really became more and more apparent that we needed to do something. This is heartbreaking and preventable. All of this coalesced to really be something that we could all get behind.”

As Dr. Kolb and her colleagues admit, everything begins with a discussion. But, little did they know just how many lives they were about to touch when they rolled out the first component of their burnout program. The first step was an evening event with Dr. Drummond, which sold out 200 seats and had a waiting list for attendees.

“Burnout transcends specialties, and that’s why our physicians have been so appreciative of this program. After the event with Dr. Drummond, we had people commenting and sharing their stories on social media. That’s what we’re trying to do — effect a paradigm shift in the culture of medicine. We really want to let our colleagues know that this is more common than they may realize because physicians just don’t talk about it. We want to start talking about it,” Dr. Kolb said.

Learn more about Madison County’s Physician Wellness program.

*Thanks to the following physicians, committee, Madison County Medical Alliance members, as well as our sponsors whose generosity in time and funding helped make this program a reality:

Wellness committee volunteers include: Board of Trustee members Drs. Aruna Arora, Greg Bouska, James Gilbert, Dawn Mancuso, Paul Tabereaux, Sherrie Squyres and Tarak Vasavada; therapist Dr. Violet Gilbert; Madison County Medical Alliance President Christina Tabereaux; and MCMS Executive Director Laura Moss. While not a committee member, MCMS Past President Dr. Amit Arora has also been instrumental in supporting this mission.

Burnout Proof LIVE was made possible by the generous donations of Huntsville Hospital, ProAssurance, the Madison County Medical Alliance, Blue Cross Blue Shield of Alabama, ServisFirst Bank, Fyzical Therapy and Balance Centers, Crestwood Medical Center, Dr. Hayes Whiteside and the Medical Association of the State of Alabama.

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Physicians Spend More Than Half of Work Day on Electronic Health Records

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Physicians Spend More Than Half of Work Day on Electronic Health Records

Primary-care physicians spend more than half of their workday on electronic health records during and after clinic hours, a University of Wisconsin School of Medicine and Public Health and American Medical Association study has found. The study, published online in the Annals of Family Medicine, shows physicians spent 5.9 hours of an 11.4 hour work day on electronic health records.

“While physician burnout happens for a number of reasons, spending a good deal of the work day and beyond on electronic health records is one of the things that leads to burnout,” said Dr. Brian Arndt, associate professor of family medicine and community health.

Arndt said 142 family-medicine physicians in the UW Health system were part of the study and all EHR interactions were tracked over a three-year period from 2013 to 2016 for both direct patient care and non-face-to-face activities.

He found that clinicians spent 4.5 hours during clinic each day on electronic health records. Another 1.4 hours before or after clinic were used for electronic health records documentation for a total of 5.9 hours each day.

That means that primary-care physicians spent nearly two hours on electronic health records per hour of direct patient care.

“When you factor in the non-electronic health records duties, it adds up to a workday of 11.4 hours, representing a significant intrusion on physicians’ personal and family lives,” said Arndt.

Order entry, billing and coding, and system security accounted for nearly half of the total electronic health records time (2.6 hours). Clerical duties like medication refills, interpretation of lab and imaging results, letters to patients, responding by e-mail to questions about medications and incoming and outgoing phone calls accounted for another 1.4 hours of every work day.

“It is imperative to find ways to reduce documentation burden on physicians,” said Arndt. “There are a couple of things to consider. Having clinical staff enter verbal or handwritten notes (based on a standardized checklist) could save time and allow physicians to focus more on the patient. In addition, documentation support by staff and additional training in documentation optimization should be available for interested physicians.”

Arndt said the electronic health records event logs used in the study can identify areas of electronic health records-related work that could be delegated to reduce workload, improve professional satisfaction and reduce burnout.

UW Health Chief Medical Information Officer and Senior Vice President Dr. Shannon Dean said the health system leadership supports and appreciates the work of Dr. Arndt and his colleagues in identifying areas of concern and supports reducing any undue burdens on physicians by proactively looking for ways to make the electronic health records system more efficient and distributing appropriate work amongst the clinical care team. Electronic health records systems do offer major benefits to patient care, so preserving their value is also a key goal.

Dean said initiatives include the recent deployment of single sign-on technology that addresses the time spent simply logging in and out of the system and the rollout of advanced voice-recognition software to allow providers to “dictate” directly into the system rather than type.

“UW Health acknowledges that the electronic health records and increased documentation requirements are contributing factors to physician burnout and has invested significant resources in education, optimization and support teams to ensure providers have ‘at the elbow’ support for doing their work,” said Dean. “Our support teams are currently meeting one-on-one with every provider to review their use of the electronic health records and provide them with tips and tricks to improve efficiency.”

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ProAssurance Establishes the Nation’s First Academic Research Program Dedicated to Physician Wellness

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ProAssurance Establishes the Nation’s First Academic Research Program Dedicated to Physician Wellness

BIRMINGHAM – ProAssurance Corporation has announced the establishment of the ProAssurance Endowed Chair for Physician Wellness at the University of Alabama at Birmingham. This academic chair is the first of its kind in the United States and demonstrates ProAssurance’s commitment to its role as a leading advocate for America’s physicians.

The initial $1.5 million gift to the UAB School of Medicine will endow an academic chair and also will support a research team dedicated to addressing health issues unique to physicians as they deal with the stress and pressures associated with providing care to their patients in today’s rapidly evolving health care environment.

As he announced the gift, ProAssurance Chairman and Chief Executive Officer Stan Starnes underscored the importance of the research that will emerge.

“Physicians have always been subject to the high levels of stress from a variety of factors such as society’s expectations for successful outcomes, the threat of litigation and the effect of their professional obligations on the quality of their lives, and their families’ lives. As medicine evolves to address the changing dynamics of health care in America, we must find ways to address these pressures,” Starnes said.

“UAB leadership is committed at the highest level to provide our physicians, residents, fellows and trainees the same type of world-class care they provide for the citizens of Alabama and beyond every day,” said UAB President Ray L. Watts. “This generous investment by ProAssurance to fund a first-of-its-kind academic chair will enable us to recruit an expert in the field of physician wellness who can implement well-designed interventions that enhance our sustainable culture of wellness and provide trainees with tools and resources to manage stress and burnout. The result will be more engaged physicians who can provide the highest-quality care to their patients.”

ProAssurance also expects to provide an additional gift of $500,000 to fund various initiatives in support of physician wellness. The company’s Chief Medical Officer, Hayes V. Whiteside, M.D., said such programs are a logical extension of ProAssurance’s role as a trusted partner with physicians and the nation’s health care community.

“Assisting physicians has always been a high priority for ProAssurance. Now more than ever, we need to ensure that today’s physicians maintain their commitment to our high calling, and that future physicians are equipped to deal with the realities of their vital chosen profession,” Dr. Whiteside said.

“We are fortunate to have some of the best physicians in America right here in Birmingham as part of our School of Medicine, and it is important that we consistently work to provide them an environment that promotes wellness opportunities to help them flourish in their field,” said Selwyn Vickers, M.D., Senior Vice President of Medicine and Dean of UAB’s School of Medicine. “Doctors who take care of themselves are better role models for their patients and for their children, have higher patient satisfaction and safety scores, experience less stress and burnout, and live longer. We are grateful to ProAssurance for their gift, which will greatly enhance our training programs and enable them to create a sustainable culture of wellness.”

In addition to the funds being committed to addressing physician wellness, ProAssurance plans to make an additional financial gift to the UAB School of Nursing to enhance the future of nursing care in Alabama. “Nurses are a crucial part of the care delivery team in our state, and their role will become increasingly important as our healthcare delivery systems expand to meet the demands that will come with the exponential growth of an aging population,” said Starnes.

“Nursing is one of the most versatile — and vital — occupations in the health care workforce, and we strive to train innovative leaders who will transform health care,” said Doreen Harper, Ph.D., Dean and Fay B. Ireland Endowed Chair in UAB’s School of Nursing. “The ever-evolving landscape of health care and the changing profile of the population demand a fundamental shift in the health care system to provide patient-centered care. More nurses will be needed to deliver primary care and community care, ensure seamless care, foster interprofessional collaboration and enable all health professionals to practice to the full extent of their education, training and competencies. This shift will result in reduced errors, increased safety and the highest-quality care for patients. We are delighted and appreciative that ProAssurance is providing this support to help us shape patient-centered health care by preparing recognized nurse leaders who excel as clinicians, researchers and educators in Alabama, nationally and internationally.”

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