Physician burnout is a serious problem with serious consequences; it is associated with increased risk of depression, impaired quality of life, substance abuse, and suicide. Not surprisingly, in a recent survey of 7,500 physicians, 64% (half of whom had treated patients with COVID) reported that the pandemic had increased their sense of burnout. Nearly 20% of the US physicians said they were drinking more to cope with the stress of the pandemic, and almost half of those surveyed reported increased loneliness, which contributes to burnout. Even before the pandemic, physician burnout resulted from multiple issues, including dealing with electronic health records (EHR), increased patient volume, insurance struggles, decreased reimbursement, increased administrative demands, and lack of autonomy.
In addition to risks to the physician, burnout negatively influences the quality and cost of care delivered by physicians. As a second “wave” of COVID hits the US, it is critical that providers have a specific plan to combat physician burnout and help prevent the problem from getting worse. Following are four key strategies that have proven to be effective.
1. Connect With Colleagues
Community among physicians has changed over the years. Faculty lounges and libraries, previously common places for conversation and community, have become a rarity. During the social distancing of the pandemic, they seem little more than a fond memory–add to this the fact that many physicians are still practicing telemedicine at least part-time and are unlikely to be able to gather in groups in any setting. As a result, physician-to-physician relationships, which are important in job satisfaction, have suffered.
Efforts to restore conversations among physicians are helpful in mitigating burnout. A randomized clinical trial, in which the intervention was bi-weekly physician discussion groups incorporating elements of mindfulness and shared experience for 9 months, found decreased rates of burnout in the intervention group, suggesting the importance of connecting with colleagues. During COVID, these conversations can, and should, take place virtually. Setting up a clinical call to share challenges and questions and provide support to colleagues is one essential step for those practicing in group settings. For individual practitioners, this can be accomplished by joining a physician’s organization. Harvard Medical Faculty Physicians (HMFP) and Physician Performance LLC (PPLLC) have set up these types of calls for members, which has made it easier to connect with others, particularly during the COVID-19 pandemic.
2. Develop Self-Awareness & Recognize the Perfectionist Mindset
As physicians, we seek to cure our patients and may be disappointed when limited by poor or unclear outcomes, time, resources, knowledge, and technology. There is mounting evidence that perfectionism (ie, striving for flawlessness) and low self-valuation among physicians are associated with feelings of burnout. Physicians have typically entered their field after succeeding through several highly competitive processes, which increase the presence of these kinds of traits.
Personal strategies that embrace imperfection, reframe challenges as opportunities, focus on process rather than product, and seek self-acceptance with perceived shortcomings may be helpful in addressing feelings of burnout on a personal level. Introducing curricula during residency and at national meetings geared toward helping residents and physicians to focus on promoting resilience and a “growth mindset” could help to address the perfectionist phenomenon and the risk of burnout on a broader, specialty-wide level. Shifting both the selection and training processes from its heavy reliance on extrinsic motivation toward intrinsic motivation may also be a critical step in shifting culture.
3: Restore Meaning & Joy to Patient Care
The fundamental caring relationship between physician and patient has been degraded by trends that increase reliance on technology and prioritize volume over value. The pandemic has exacerbated this; if they are being seen in person at all, patients arrive alone, without the support of family members, and the physician and the patient lose the support and information those family members provide. In-person, wearing masks can hide essential facial expressions and the communication conveyed by them. Via telehealth, while patients and physicians can more easily read facial cues, they are separated, literally, by a more impersonal experience.
A recent literature review found an inverse relationship between empathy and burnout among healthcare professionals. Until more dramatic changes in the healthcare system occur, training in communication skills may enhance a physician’s ability to develop meaningful longitudinal relationships and facilitate the complex emotions that are a necessary component to provide successful patient care.
However, telehealth has also provided an opportunity for better conversations and connection with patients. Without the stress of having to arrive at a hospital or office, take time away from work and family, and enter a potentially intimidating environment, the patient may feel more at ease in the telehealth environment, which at this time most often occurs at home. Physicians report being able to “see” patients much the same way they would have making house calls, at times that are convenient for the patient, in a comfortable setting, and with the potential for more conversation. Focusing on creating fulfilling patient encounters, developing meaningful longitudinal patient relationships, and being grateful that we can reach patients in their homes–especially those for whom office visits were especially difficult (the elderly or those who live in remote areas, for example)–can restore value to the practice of medicine and remind us why we chose to become physicians in the first place.
4. Restore Autonomy & Control: Changes at the Institutional Level
It’s obvious that physicians cannot combat stress and burnout on their own. While they must advocate for themselves, institutions should be focused on working to combat burnout; the quality and safety of patient care, retaining the best physicians, creating a safe and positive work environment, and increased productivity and better patient outcomes are just a few of the rewards. As healthcare organizations often tie physician compensation to productivity, it is essential to carefully examine this practice. Increasing productivity by shortening the amount of time a doctor can spend with each patient or increasing the number of hours worked or surgeries and procedures performed, can be accompanied by increased physician stress and burnout. Some institutions have found innovative ways–other than pure salaried compensation structures–to improve patient care and physician satisfaction while decreasing risk of burnout, for example, incorporating self-care and well-being into the formula to calculate productivity-based pay, or tying compensation to patient satisfaction surveys. Other suggestions include innovative rewards that can decrease stress, such as flexible schedules and greater control over schedules, or protected and compensated time to pursue personally meaningful work (from research to volunteering) that can increase job satisfaction and personal fulfillment.
Office-based interventions, such as creating medical assistant dyads and delegating significant responsibility to non-physician staff, can promote efficiency and mitigate feelings of burnout. Providing clinicians with increased flexibility regarding scheduling and clinic workflow within standardized schedules and procedures may help to preserve feelings of autonomy at work and reduce burnout.
Doctors are twice as likely to be dissatisfied with work-life balance as other professional workers in the United States, and during COVID, this is likely amplified, with many physicians unable to work remotely while their children may be attending school remotely, and as other aspects of their home life may be complicated. It is not surprising that these challenges are often magnified for female physicians, and while it is yet to be seen if female physicians follow other women in the United States in the marked trend of leaving the workplace during the pandemic, there are ways that healthcare employers can alleviate some of the challenges and burdens faced by physicians with family responsibilities. Allowing physicians flexibility with their schedules has never been more essential. While this obviously can create challenges for the institutions, retaining physicians through the pandemic and decreasing stress and burnout may make the efforts worthwhile. And allowing them to decrease their hours (with a commensurate decrease in compensation) will also likely alleviate stress for some doctors. This may also be an excellent time to comprehensively examine benefits like vacation and personal time, coverage strategies, and opportunities for part-time work.
Conclusion
As physicians, none of us are immune to the demands that put us at risk for burnout. Many of us have increased responsibilities at home and at work due to the pandemic–when we are not seeing patients or practicing medicine, many of us are acting as tutors, full-time child care providers, and cooking, cleaning, and providing other services we may have been able to outsource prior to the pandemic. But as healthcare professionals, we have an obligation to take an active role in choosing how we will combat burnout. We must identify and employ strategies on personal, local, and national levels to ensure sustained satisfaction and vitality within our specialties and to ensure the health and well-being of ourselves, our colleagues, and the next generation of physicians.
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