Beating Burnout
burnout is a challenge at all career
stages.6 After evaluating professional life
and career satisfaction among earlycareer (those who had been working in
the health-care field for 10 years or less),
middle-career (11-20 years), or latecareer (21 years or more) professionals,
researchers found that early-career
physicians had the lowest satisfaction
with overall career choice, the highest
frequency of work-home conflicts, and
the highest rates of depersonalization.
Middle-career physicians seemed
to fare even worse: They worked more
hours, took more overnight calls, had
the lowest satisfaction with specialty
choice and work-life balance, and had
the highest rates of emotional exhaustion
and burnout.6 It is no wonder, then,
that middle-career physicians were
most likely to plan to leave the practice
of medicine for reasons other than
retirement in the next 24 months (4.8%,
12.5%, and 5.2% for early, middle, and
late career, respectively).6
Ten Steps To Prevent Physician Burnout
Institutional Metrics
1. Make clinician satisfaction and well-being quality indicators.
2. Incorporate mindfulness and teamwork into practice.
3. Decrease stress from electronic health records.
Work Conditions
4. Allocate needed resources to primary-care clinics to reduce health-care disparities.
5. Hire physician floats to cover predictable life events.
6. Promote physician control of the work environment.
7. Maintain manageable primary-care practice sizes and enhanced staffing ratios.
Career Development
8. Preserve physician ‘career fit’ with protected time for meaningful activities.
9. Promote part-time careers and job sharing.
Self-Care
10. Make self-care a part of medical professionalism.
Source: Linzer M, Levine R, Meltzer D, et al. 10 Bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2013;29:18-20.
Expectations Versus Reality
In a survey of oncology fellows,
Dr. Shanafelt and colleagues found that the
clash between expectations and reality is
felt the deepest by fellows and early-career
hematologists and oncologists.7 The frequency
of burnout was highest among first-year fellows,
but decreased during the subsequent two years
of fellowship (from 43.3% at year 1, to 31.7% at
year 2, and 28.1% at year 3).
Fellows expected that after completion of
training, they would be working a median of
six hours per week less than what practicing
oncologists actually reported working.
Mounting student loan debt also lowered career
satisfaction and made fellows more likely to
pursue private practice and to shy away from an
academic career.7
That doesn’t mean physicians automatically
become more fulfilled with their work lives once
they have a few years under their belt, though.
According to Dr. Shanafelt’s poll, practicing
oncologists had lower fatigue and better quality
of life than oncology fellows, but were ultimately
less satisfied with work-life balance and their
choice of specialty.7
It seems that the stresses don’t dissipate;
instead, the sources of stress change. “In
training, the stress was mainly from trying
to impress attendings,” Dr. Goldsborough
recalled. “As a practicing physician, the
stress is from trying to always make the right
recommendations for patients.”
Does Stress “Go Viral”?
Burnout doesn’t just affect doctors; it has
far-reaching implications for the health-care
system as well. “While burned-out physicians
attempt to maintain quality of care at their
own expense, work conditions that result
in burnout are associated with poorer care
quality,” wrote Mark Linzer, MD, an internal
medicine specialist at Hennepin County Medical
Center in Minneapolis, Minnesota, and his
colleagues. “Burned-out doctors are more likely
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ASH Clinical News
to leave their practice, thus reducing access
to care. Turnover sacrifices continuity, and
replacement costs are at least $250,000 per
primary-care physician.”8
This is a substantial problem: One in four
respondents (24%) of ASH’s practice-based
survey indicated that they are considering
retiring in the next five years.3
Can Anything Be Done?
There are steps that institutions can take to
help their clinicians battle burnout – and help
themselves in the process.
“The key is to measure stress, burnout, and
their predictors, then meet to discuss plans to
make change to address the findings, make the
changes, and then measure again,” Dr. Linzer
told ASH Clinical News. “Incorporate wellness
metrics into the ongoing organizational plan,
and acknowledge that one of the best ways
to meet organizational goals is to address
wellness.”
In 2013, Dr. Linzer and colleagues
outlined 10 steps to prevent burnout in a
commentary in the Journal of General Internal
Medicine (TABLE). Echoing the results of the
ASH Practice-Based Survey, they identified
increased use of information technology (IT)
as one of the main challenges clinicians face in
the modern health-care environment.8
“We suggest elbow-to-elbow training in
the clinic with IT specialists, with the use of
more templates and smart phrases, and also
exploring the use of documentation specialists
or medical scribes in the clinic,” he said. “The
costs of scribes can be supported through
additional patients seen when documentation issu W2&R