Speakers at a conference agreed that administrative requirements contribute to physician unhappiness, but they also blamed a toxic culture in many health care organizations.
October 17, 2017 - By Mandy Erickson
Physician burnout is worsening, but organizations and individuals can counter the trend, speakers asserted at a Stanford Medicine-sponsored conference on the topic.
“This is not just individuals acting out,” said Lloyd Minor, MD, dean of the School of Medicine. “This is a systemic issue that we face in the profession.”
The American Conference on Physician Health, which took place Oct. 12-13 in San Francisco, attracted 425 attendees, mostly physicians, from 44 states and seven countries. It featured a range of speakers, from medical students to experts on physician burnout. They shared personal experiences, presented research and offered tips on coping with stress. The conferences other co-sponsors were the American Medical Association and the Mayo Clinic.
Tait Shanafelt, MD, the chief wellness officer at Stanford Medicine, noted that nearly half of physicians — 45 percent — currently show at least one symptom of burnout. Not only do burned-out physicians provide lower-quality care, he noted, but replacing physicians who leave because of burnout costs the United States $5 billion a year.
He added that the problem can spiral within an organization: “There’s an infectious component of burnout,” he said. Other members of the care team “learn cynicism.”
Conference speakers agreed that administrative requirements — such as entering information into electronic health records, or EHRs, and filling prescriptions — contribute to physician unhappiness. But they also blamed a toxic culture in many health care organizations, along with a tendency among physicians to deny their own suffering.
‘Fear of showing weakness’
Abraham Verghese, MD, professor of medicine at Stanford and an award-winning author, discussed one of the most pernicious effects of physician unhappiness: suicide. When he asked conference attendees if they knew fellow physicians who had killed themselves, nearly all raised their hands. “Every year it takes three medical school classes to replace the physicians who committed suicide,” he said.
Verghese related the story of his friend David Smith, the subject of his book The Tennis Partner, who struggled with addiction before shooting himself. He said that the “loneliness of doctors” enabled Smith’s addiction. “We rarely expose our emotions,” he said. “There’s a fear of showing weakness.”
Conference speakers addressed three avenues to improve physicians’ job satisfaction: personal resilience, organizational culture and more efficient processes.
Kelly McGonigal, PhD, a health psychology lecturer at Stanford, encouraged conference attendees to practice “self-compassion.” Noting that while perfectionism “can get people into the medical profession,” she said that “it can be toxic when paired with a belief system of being hard on yourself.”
Self-compassion is more than just pampering yourself, she said; it’s allowing yourself to receive compassion from others: “Self-compassion means opening yourself to the compassion that’s available to you.”
“This is a skill that you can actually practice,” she said, offering examples such as meditating on connections with others, celebrating self-care, accepting condolences and remembering that no one is alone in suffering. Research has shown that such practices can decrease burnout, she said.
The right leadership
Creating a culture in health care organizations that encourages physicians’ well-being starts with placing the right people in leadership positions, said Vivek Murthy, MD, a former U.S. surgeon general. Organizations should hire people for the way they treat others, he said, not for their ability to win a Nobel Prize. “Kindness is spread more quickly than infectious diseases,” he said.
The Mayo Clinic studied the factors that affected physician satisfaction and found that good supervisors were critical, added Shanafelt, who came to Stanford this year from Mayo and is the director of Stanford's WellMD Center. It came down to “Leadership 101,” he said: “communication, appreciation, asking opinions and facilitating career development.”
After developing leadership skills and instituting practices such as regular colleague meetings, Mayo saw burnout levels drop. “As the national numbers continued to worsen, Mayo was able to reverse the trend,” he said.
EHRs take much of the blame for physician dissatisfaction, but better systems will ultimately reduce the administrative burden, said Robert Wachter, MD, chair of medicine at UC-San Francisco. Nearly all health care organizations have gone digital in less than 10 years, he said: “It’s a huge, huge transformation in a relatively short period of time.”
The kinks are still being worked out, he added. Many EHRs, for example, prompt caregivers to ask repeated, pointless questions. “The EHR is creating a huge amount of silly work for well-trained people,” he said.
Over time, he asserted, the EHR will improve, much the way smartphones have become easier to use. “Eventually, productivity gets better,” he said.
Christine Sinsky, MD, vice president of professional satisfaction at the American Medical Association, said organizations can save three to five hours a day of physicians’ work time by simply re-engineering practices. She provided an example of a physician whose two medical assistants take care of the administrative work. They accompany him to patient rooms, where they type information into the EHR; they also renew prescriptions and retrieve lab results.
A few simple equipment fixes — such as using card readers instead of requiring passwords, and having printers in patient rooms — can also shave time off a physician’s day, Sinsky added.
“We have physicians and nurses spending hours and hours per week that do not add value to the patient,” she said.
But Minor said that using medical assistants and scribes, who remotely transcribe conversations between patients and doctors, is “at best an intermediate step.” A better solution, he said, is to “design front ends that make workflow more efficient.”
Ultimately, improving physicians’ well-being will require a number of changes to the practice of medicine, with input from all parties. “We need to get our communities to help us,” Minor said, “and be intentional about involving everyone in our organization.”
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