The Daily Dose • Sunday, May 19

Healthy Physicians Make Better Clinicians

By Adaora M. Chima, MBBS, MPH, from the IARS, AUA and SOCCA 2019 Annual Meetings*

Three energetic speakers for this panel, Santhanam Suresh, MD, Professor and Chair of Pediatric Anesthesiology, Northwestern University; Jeffery Vender, MD, Professor of Anesthesiology, University of Chicago; and Gregory Hammer, MD, covered the gamut of the epidemiology of burnout, and contributing factors and strategies to address it during the session, Physician Wellness in Hospital Medicine: Thriving, Not Simply Surviving.

Dr. Suresh opened up the session with epidemiological details of burnout in medicine and anesthesiology in general. Wellness comprises emotional, physical and mental well-being, while burnout is a maladaptive syndrome linked to chronic stress and often manifesting as emotional depletion, and uncaring attitudes towards patients and work. A commonly used index is the Maslach Burnout Inventory describing three facets of burnout: emotional exhaustion, personal accomplishment and depersonalization.

Anesthesiology burnout rates rank high among all disciplines, prevalent in every phase of anesthesia training or career. Anesthesiology professionals also scored in the 25th percentile for medical professionals that admit to feeling happy/extremely happy in their professions. These results are complementary and indicate the need for the current focus on the topic of burnout. Burnout has consequences of impaired team relationships, increased conflicts and an increase in medical errors adversely affecting patient safety, for example, a $50,000 ICU admission cost due to an unanticipated reintubation.

Contributing factors to burnout include time constraints, daily stressors such as life-threatening scenarios, external stressors (e.g., increased workload/demand with expanding surgical centers).

Burnout is associated with delays in professional development in young anesthesia professionals, resulting in a vicious cycle of dissatisfaction with personal accomplishment and its downstream effects as described by the Maslach Inventory.

In order to reduce burnout rates, transformative strategies targeting known contributing factors are necessary and should be deployed in a top down approach ensuring administrative buy-in and provision of resources. Examples of such goals are appropriate job role distribution to minimize the time physicians spend on extraneous administrative tasks; duty hour targets that protect clinicians from working while potentially impaired by fatigue/exhaustion; a dedicated chief wellness officer; measurement of milestones to track progress and identify failures; and counseling programs to help with coping after critical events.

Dr. Jeffery Vender who has held numerous leadership positions focused on the role of leadership and culture in the phenomenon of burnout. He emphasized the relationship between happiness and productivity, stating that medical providers who are well cared for provide good patient care. He cautioned about the need to “place providers first” and provide them with resources to perform their duties.

One of his observations is that stress from change is a cause of burnout. The medical field is a constantly evolving field and there are multiple components that are persistent stressors for physicians. Examples are EMRs, cost reduction, loss of autonomy, early retirement/layoffs to name a few.

In an institutional culture, a dysfunctional culture can be traced back to leadership. Leaders have a responsibility to foster engagement among their staff, which in turn will drive wellbeing. The relationship between leadership and burnout is supported by studies that show an inverse relationship between leadership composite scores and the incidence of burnout. Positive and supportive institutional culture can equip physicians with the tools to thrive in the presence of these stressors.

Dr. Hammer brought the message home with a presentation on personal strategies for wellbeing. He underscored that personal care in the form of adequate sleep, exercise and nutrition are necessary in order to be happy and highly functional. He reviewed the concept of mindfulness, being present in the moment, and limiting obsession with past mistakes and future possibilities (within reason), which can detract from the present. He also introduced the audience to his personal philosophy titled “GAIN” — an acronym for Gratitude, Acceptance, Intention and Non-Judgement, actions that he believes set the stage for a balanced professional and personal life. The session ended with a 3-minute meditation exercise that the audience was encouraged to incorporate into their morning rituals.

If you would like more comprehensive materials on physician wellness, Dr. Hammer invites you to contact him at [email protected].

The dialogue on physician burnout continues to grow as more recognition is brought to an issue that not only impacts physicians but their loved ones, patients and society. Interventions have to be multilevel and multifaceted to target the myriad of contributing factors that make this such a challenging issue. Not surprisingly, this event had an impressive turnout and active participation from the audience, members of whom shared details of their institutional wellness programs and successes.

*Coverage from Physician Wellness in Hospital Medicine: Thriving, Not Simply Surviving at the IARS 2019 Annual Meeting.