How to Prevent Physician Burnout: Meeting Panelists Share Tips

SAN DIEGO—Efforts to fight physician burnout continue, and a panel of otolaryngologists here at the Triological Society Combined Sections Meeting shared insights on how to keep morale high and help stressed out physicians.

Even though “burnout” is a buzzword, the numbers are still jarring. Panel moderator Sonya Malekzadeh, MD, professor of otolaryngology at Georgetown University School of Medicine in Washington, DC, noted that 30% of physicians have said in surveys that they wouldn’t become a physician again if given the choice, and physicians experiencing burnout are twice as likely to commit suicide (Arch Intern Med. 2012;172:1377-1385).

“At the end of the day, what we want as physicians is to find meaning in our work and to feel professionally fulfilled,” she said. “We need a system that promotes efficiency of practice, and we need organizations and institutions to embrace a culture of wellness.”

Leadership Can Make a Difference

Alexander Chiu, MD, chair of otolaryngology-head and neck surgery at the University of Kansas in Kansas City, said a department’s leadership can help keep burnout levels low—a connection that’s supported in the literature. A 2015 study found a direct correlation between the leadership score of a chief or chair and the prevalence of burnout and satisfaction (Mayo Clin Proc. 2015;90:432-440).

Other findings provide evidence that elements most impacted by department leadership, such as organization, governance, transparency, and the focus on a mission, influence burnout levels (Acad Med. 2012;87:574-581).

A recent study based on a faculty satisfaction survey at the University of Michigan found that about 28% of the otolaryngology department physicians reported burnout, as compared with an average of about 35% across departments. Otolaryngology faculty reported electronic health records, emails, clerical burdens, and insufficient time for meaningful activities as the top contributors to burnout (JAMA Otolaryngol Head Neck Surg [published online ahead of print January 2, 2020] doi: 10.1001/jamaoto.2019.3731).

Dr. Chiu said that department leaders should create a sense of mission and cultivate a culture of autonomy, accountability, and collaboration, in which open, fearless conversations are possible. He said that, as a department chair, he is always asking whether the department is following through with its plans.

“Are we doing enough? Are we closing?” he said.

In the end, physicians need to remember the value of their work. Dr. Chiu said he was recently reminded of this at the moving funeral services of a friend and colleague, Stephen Goldstein, MD, with whom he started the otolaryngology-head and neck surgery program at the University of Arizona.

“We do really cool things,” he said. “We’re teachers, we’re learners, we’re educators. We care about our community. We inspire. We do innovative research, innovative clinical care. We make a huge difference in our patients’ lives—and yet sometimes we forget all that.”

You are the CEO of your body. Without health, you have nothing. —Michael Seidman, MD

Simplifying EHRs

J.P. Giliberto, MD, assistant professor of otolaryngology-head and neck surgery at the University of Washington in Seattle, offered some hope that EHRs could be changing to ease the load on physicians. Dr. Giliberto helps train physicians at his center to use the Epic electronic health record system to their advantage.

One change nationally, he said, is to the physical exam SmartBlock, a general-purpose form that often requires so many clicks that even Dr. Giliberto doesn’t use it. But a more otolaryngology- and user-friendly version is on the way, he said. Most of what otolaryngologists need will be on one page, with scripted and cascading boxes to streamline the input. The update is still being built and tested, and the goal is to have the new version ready by August.

In a study presented in a poster at the meeting, he and his colleagues reviewed data on provider efficiency profiles (PEP), a way of measuring how efficiently physicians and others use the EHR. Across several centers, they found physicians interacted with the system 70 minutes a day and 7.36 minutes per appointment (Triological Society Combined Sections Meeting. Abstract 35. Presented January 23-25, 2020, San Diego).

While those numbers might seem high, Dr. Giliberto said they varied across centers and among users at a single institution. Those on the lower end of the range could offer a “road map” for others on customizing their EHR and using their limited information technology resources to their greatest advantage.

He said he is part of a committee at his center that helps physicians get the most out of the EHR.

“EHRs are a current reality, and you can be involved in the change to shape what’s to come,” he said.

Finding Health and Happiness

Aside from adapting systems and hoping for better leadership, there are individual steps physicians can take to guard against burnout, said Michael Seidman, MD, medical director for wellness at AdventHealth Medical Group in Kissimmee, Fla. He reminded the audience that happiness isn’t something to postpone.

Dr. Seidman said physicians should be gentle with themselves. Too often, “[we’re] hardest on ourselves and flexible with others,” he said.

“Accept what is—and don’t let ‘what is not’ control you,” Dr. Seidman said.

Events or feelings that are negative have a bigger effect than things that are positive, but there are ways to try to keep negative emotions under control, including finding lessons in bad events, he said, and going on a “low bad diet,” in which you dwell on the positive and let the bad “slide off.”

Health, of course, is a big part of happiness, Dr. Seidman said. He reminded the audience about the basics: nutrition, getting enough sleep, exercising regularly.

“You are the CEO of your body,” he said. “Without health, you have nothing.”

How One Hospital Addressed Burnout

Julie Wei, MD, chief of pediatric otolaryngology and audiology at Nemours Children’s Hospital in Orlando, Fla., described changes implemented at her hospital to fill what she considered serious gaps in providing the right resources for physician and provider well being. Doctors previously had the same standard employee assistance program at their disposal as everyone else. This involved being given a list of local mental health counselors and being told to find one.

The problem, Dr. Wei said, is that doctors do not tend to seek help from employee assistance programs, largely out of a fear of being stigmatized. Department chairs might not be advocates of well being, or even believe in burnout.

Under Dr. Wei’s direction, the hospital created a medical staff health and wellness committee, followed by a resident and faculty well-being program. The program focuses on mental health support designed specifically for physicians and advanced practice providers.

The hospital is also in the process of creating a chief of clinician experience position and a chief wellness officer position. They also started an immediate mental health crisis line to give residents and faculty 24/7 access to psychologists, with an hour of orientation about the program provided to residents and a 90-minute group session available each month with a licensed psychologist, Dr. Wei said.

To encourage physicians to take stock of their own wellness and create a culture where it’s not a taboo subject, she organized a viewing of the documentary “Do No Harm,” on physician suicide, followed by a panel discussion. She co-sponsored and participated in a talent show at Nemours as a way to boost morale and build cohesion.

“When you’re drowning in systems and barriers and a thousand clerical burdens, you’re really not going to focus on your well being,” she said. “This is why system-based support solutions are necessary to create change and greater support for mental health for physicians.”

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Thomas Collins is a freelance medical writer based in Florida.