Practice of Medicine

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Developing Resilience and Avoiding Physician Burnout

Executive Summary 

Many physicians struggle to incorporate self-care into their busy and high-stress schedules, resulting in fatigue and burnout over time. Physician burnout can be prevented by reducing stressors or adapting to uncontrollable stressors. Resilience increases the likelihood of avoiding burnout and medical errors. Once burnout has occurred, it is important for physicians to identify the factors that led to their exhaustion and take steps to remove or reduce the risk factors that led to their burnout.  

Recommended Actions 
  • Identify professional and personal stressors that could be contributing to feeling physically and/or mentally exhausted. 
  • Consider prioritizing tasks and completing the most important tasks when your energy level is highest. 
  • If burnout has occurred, take a break from the activities that deplete energy and seek support from a trusted source. 

Physicians seldom receive training on time management and/or self-care at any point in their career. As a result, many have difficulty creating balance in their lives or incorporating self-care into their schedules. Physicians who do not care for themselves are less effective at providing optimal care for others. Approximately 50% of physicians report burnout and the suicide rate among physicians is significantly higher than observed for the general population. 

In addition, burnout exposes physicians to the risk of medical errors and litigation. In recent decades, the role of physician fatigue in causing medical errors has led to the implementation of duty hours for physicians in training. There is now growing attention to the need for strategies to prevent and treat physician burnout.  

Physicians who recognize when they are overextended and implement corrective strategies are less likely to end up entirely depleted than doctors who do not make an effort to address their fatigue. Below we provide recommendations for managing physician burnout causes, fostering resilience, avoiding fatigue and addressing burnout. 

Preventing Physician Burnout by Managing Its Cause 

Physician burnout is physical and/or emotional exhaustion due to an extended period of stress and/or frustration. Multiple factors put physicians at risk for burnout. Their subspecialty matters; for example, the risk of burnout is significantly higher for emergency medicine physicians compared to physicians who specialize in preventive medicine. Physicians who practice in specialties that are more prone to burnout may benefit from taking additional precautions to avoid it. Factors implicated in physician burnout include: 

  • Lack of autonomy/control over work 
  • Long work hours 
  • Too many responsibilities 
  • High patient volume 
  • Complex patients 
  • Information overload 
  • Unclear or overly demanding job expectations 
  • Short deadlines 
  • Unpleasant work environment 
  • Monotonous tasks 
  • High stress tasks 
  • Frequent exposure to adverse events 
  • Feeling unappreciated 
  • Threat of malpractice suits 

Personal causes of physician burnout include: 

  • Inadequate time for recreation, relaxation and/or sleep 
  • Inadequate time spent socializing 
  • Poor stress management skills 
  • Lack of confidence 
  • Lack of supportive relationships/feeling isolated 
  • Type A personality/perfectionistic tendencies 
  • Pessimistic view of yourself and the world 
  • Financial stress 

Eliminating stress completely is not feasible; however, burnout can be avoided by removing stressors where possible and adapting your response to stressors that cannot be controlled. Below are recommendations that may improve the ability to avoid burnout by modifying stressful circumstances. 

  • Work in teams to decrease workload. 
  • Incorporate periods of down time when working long shifts. 
  • Don’t use down time to complete charts or perform other work related activities. 
  • Develop time management skills . 
  • Know the facility/institution’s policies for handling burnout and use available resources. 
  • Avoid excessive workloads by saying no when appropriate. 
  • Pack meals/snacks if you don’t have easy access to healthy meals while at work. 
  • Get adequate sleep — between 7 to 8 hours of sleep is recommended per night to avoid fatigue. 
  • Foster personal relationships and avoid spending prolonged periods in isolation. 
  • Seek advice on managing finances. Many physicians start their career with large student loans. Obtaining advice from a financial counselor can alleviate financial stress. 

Fostering Resilience 

Although medicine is a stressful profession, many physicians are able to practice without experiencing burnout. Developing resilience increases the likelihood of avoiding burnout. Resilient individuals typically have a more optimistic outlook, remain calm in a crisis, have a good sense of humor and are less daunted by challenges. An individual could be naturally resilient but physicians who are not resilient by nature can develop habits that increase it. 

Enhancing Resilience through Effective Time Management 

A major source of stress for physicians is the burden to perform a large number of tasks and see an increasing number of patients in a limited amount of time. Doctors often identify competing demands as one of the factors contributing to missteps that result in medical errors. The strategies below can improve a physician’s time management and help reduce stress. 

  • Set limits on time for work. 
  • Prioritize tasks (personal and work-related). 
  • Work on the most important tasks when your energy level is highest. 
  • Decrease time spent on activities that rob you of the time needed to complete more important tasks. 
  • Create to-do lists and set reminders instead of relying on memory. 
  • Do not schedule more tasks for a single day than can be realistically accomplished. 
  • Focus on the tasks assigned for that day. 
  • Do not take on more tasks than you can accomplish in the time available and avoid setting or committing to unrealistic deadlines. 
  • Get adequate rest so that you can perform optimally 
  • Set deadlines and don’t procrastinate. 
  • Use waiting time to accomplish tasks (for example, while waiting in line, check voicemail/email messages). 

Self-Care as a Path to Resilience 

Resilient physicians typically engage in positive thinking and are willing to face challenges. They seldom get frustrated when problems arise and they usually rebound from adversity. Self-care is a central component of developing resilience. Caring for yourself includes nurturing your personal interests as well as nourishing your mind, body and soul. 

Ironically, some of the traits that prove helpful in advancing a medical career are the same traits that lead to burnout if taken to the extreme. For example, an individual who is altruistic and compassionate can develop compassion fatigue. A person who is a perfectionist and high achiever is prone to low self-esteem and workaholic tendencies. 

One of the most useful strategies to develop resilience and avoid burnout is being self-aware and making time for self-care. Below are self-care recommendations for increasing resilience and reducing the likelihood of burnout. 

  • Create balance in your life by including time for exercise and recreation on a regular basis, preferably for at least 30 minutes on most days of the week. 
  • Nurture your physical self by eating healthily and getting adequate sleep. 
  • Utilize meditation and/or other relaxation techniques to reduce your stress level: massage therapy, stretching exercises, aerobics, yoga, biofeedback, deep-breathing, guided imagery, progressive muscle relaxation. 
  • Use mindfulness (focusing on the present moment) to facilitate relaxation. 
  • Establish care with an objective physician. Do not attempt to be your own doctor. 
  • Ask yourself what matters most and invest time in the things that make your life meaningful. 
  • Consider serving/volunteering as a means adding purpose to your life. 
  • Spend personal time with the people who matter most to you and avoid or limit time with people who drain your energy. 
  • Acknowledge your feelings. 
  • Schedule time alone. 
  • Ask for help when needed and work in teams. 
  • Avoid overextending yourself and learn to say no when appropriate. 
  • Leave work at the office/hospital as much as possible. 
  • Focus on the aspects of your job that you find meaningful. 

The Road to Recovery 

Physician burnout can manifest in different ways depending on the severity. Individuals experiencing mild degrees of burnout may appear to function normally, with their limitations only surfacing when high-stress situations occur. On the other hand, an individual experiencing severe burnout may struggle to perform daily tasks and get frustrated easily when faced with challenges. In extreme circumstances, individuals experiencing burnout may reach a breaking point and jeopardize their career and relationships. 

The first step to recovering from physician burnout is recognizing and acknowledging that it has occurred. Indicators of burnout include emotional exhaustion, depersonalization and a sense of hopelessness.  

Although burnout is not a recognized disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), it is associated with an International Statistical Classification of Diseases, 10th revision (ICD-10) code (Z73.0). Once burnout has been identified, focus should be placed on ensuring the recovery of the burned-out physician.   

Physicians suffering from burnout should spend time identifying the factors that led to their exhaustion, then take steps to remove or reduce the risk factors that led to their burnout. External factors contributing to burnout are often easier to identify and manage than internal contributors. 

Physicians experiencing burnout should seek support by reaching out to someone they can trust. It is also recommended that physicians seek help from another physician instead of trying to treat themselves. Unfortunately, however, physicians often avoid expressing the need for help due to a fear of being viewed as incompetent. In addition, persons experiencing burnout tend to prefer isolation, which increases the potential for unfavorable consequences of burnout such as suicide attempts or completed suicide. 

Although physicians may feel concerned about their professional image, it is important that they recognize that their failure to seek help could result in a personal or professional crisis. Persons experiencing hopelessness, depression or suicidal ideation are encouraged to seek prompt medical advice.  

Physicians experiencing burnout need to understand that recovery will not occur overnight. The exhaustion/fatigue associated with burnout often takes weeks to months to resolve and typically requires a change in personal habits. 

When burnout occurs, it is important to take an immediate break from activities that deplete one’s resources and devote time to restoring energy. The initial break, however, has to be followed up by long-term strategies for addressing burnout. Although taking a vacation is a good strategy to remove oneself from a stressful environment, a single vacation will not adequately address burnout. Additional measures will be required to ensure that the physician not only gets a restorative break but also develops skills to prevent a recurrence. The self-care approaches recommended to avoid burnout in part 2 of this series can also be employed in treating burnout. 

Recommendations for recovering from burnout include: 

  • Take a vacation to recuperate. 
  • Make an effort to identify why burnout occurred and plan a strategy to avoid recurrence. 
  • Reassess your goals, both personal and professional, then prioritize. 
  • Learn to share responsibilities and delegate tasks instead of trying to do everything yourself. 
  • Set aside time each day for personal time. 
  • Try to avoid doing work at home. If you do have to do work at home, try to limit the work space to a specific place in the home and avoid doing work in more personal spaces in your home such as your bedroom. 
  • While recovering from burnout do not undertake any new responsibilities/tasks. 
  • Train your mind to think about the positive aspects of your career. 

Healthcare systems and medical practices need to ensure that the work environment is pleasant and that physicians are given reasonable workloads. Hospital administrators need to provide resources to support physicians experiencing stress and ensure that doctors know about the resources available to them. 

Lessons Learned 
  • Establish open communication between physicians and healthcare organizations to discuss reducing stressors to prevent physician burnout. 
  • Implement a protocol for physicians to follow when they believe they have experienced burnout. 
  • Consider hiring a trained professional who can implement strategies to prevent and treat burnout among practicing physicians. 
Potential Damages 

Burnout exposes physicians to the risk of medical errors and consequently litigation. Although the rate of claims brought from medical errors caused by burnout is uncertain, defending against such claims can be costly and time-consuming.  

Quiz 

Answers are provided below 

True or false?  

Question 1: Indicators of physician burnout include emotional exhaustion, depersonalization and a sense of hopelessness. 

Question 2: Some healthcare specialties are more prone to physician burnout than others. 

Question 3: Untreated physician fatigue and burnout may lead to medical errors. 

Answers 

Question 1: True. A tool is available to screen physicians for those factors and help identify burnout.  

Question 2: True. Some healthcare specialties or subspecialties demonstrate a higher risk of burnout, such as emergency medicine, and physicians in those specialties may benefit from taking additional precautions to avoid burnout. 

Question 3: True. Burnout exposes physicians to the risk of medical errors and subsequent litigation. Managing the potential causes of fatigue and fostering resilience against sources of stress can help avoid burnout. 

12/22

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Disclaimer

The information provided in this resource does not constitute legal, medical or any other professional advice, nor does it establish a standard of care. This resource has been created as an aid to you in your practice. The ultimate decision on how to use the information provided rests solely with you, the PolicyOwner.