Physician Burnout: Going from Taboo to Treatable

Physician burnout has been called a “silent epidemic” that not only overwhelms physicians but can impact the care they deliver to patients. A number of programs are starting to confront the problem head on—giving doctors hope that someone is listening.

Widespread problem

Twenty-two years in private practice and the departure of his long-time professional partner finally wore Jimmy McLean, MD, down—to the point he was ready to flat-out quit his career as a physical medicine and rehabilitation doctor. As a last resort, he went to his employer, Novant Health, based in Winston-Salem, N.C. McLean was referred to a program Novant had created three years earlier to help physicians feeling the stress and pressures of their jobs. He joined 16 other physicians at a three-day retreat that enabled him to “reset my mind as to what was really important” in both his professional and personal lives, and lay the foundation for a complete attitudinal change. “To find other people who were feeling the same way and to get some solutions for how to better cope with things made a huge difference for me,” he remembers. “The program gave me new energy and made me a better doctor, too, because I now see my patients in a different light.”

According to 2014 poll conducted by Mayo Clinic, more than half of U.S. physicians are experiencing professional burnout (Mayo Clin Proc 2015;90[12]:1600-13). The stressors of anxiety, fatigue, sleeplessness and depression are byproducts of a well-known litany of grievances. Almost any physician will describe how today’s clinicians are whipsawed by documentation overload, declining pay and mounting rules and guidelines around how they practice. What’s new to the equation, however, is how a growing number of healthcare organizations and practices are tackling the problem, rather than sweeping it under the carpet.

Culture of support

While Novant Health’s initiative, known as the Leadership Development Program, acknowledges the external forces that batter physicians, it works to address them from within by helping clinicians take leadership over their own lives.

“As doctors, we’re used to working very hard, never saying no and accommodating everyone,” explains Tom Jenike, MD, a Novant physician who urged leaders to establish a systemwide program after he personally “hit the wall” six years ago. “We ask people to better understand the patterns of thought, feelings and behaviors in their lives because we’ve found these internal conditions can lead to burnout more often than the external forces we can’t control.”

Novant says its program—which also offers mentoring and year-long “onboarding” to provide physicians new to the organization with personal and professional support—has assisted more than 500 providers and won the gratitude of a surprising number for saving their careers and, in some cases, their marriages, according to Jenike.

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What is “shocking” about the Mayo Clinic findings is the number of physicians who screened positive for depression and thoughts of suicide, says Dike Drummond, MD, who in his role as CEO of TheHappyMD.com works with physicians and organizations on burnout prevention. Drummond recommends a 24/7 physician crisis hotline and a proactive crisis intervention program as key parts of a strategy to prevent and reverse burnout.

Another tactic he employs to help doctors cope with the isolation of their jobs is socializing with peers outside the office. “We want to form a supportive culture where members know you and support you and have your back,” says Drummond, who quit his family practice nearly 20 years ago after experiencing burnout, and turned years later to professional coaching in the same field that led to his exit. A staple of his burnout prevention program is a core working group that the adopting organization forms to build an awareness of burnout—and change the internal culture around it. Among other things, the group works with physicians to compile a list of the three biggest stressors in their professional lives and then zeroes in on one for a quick-fix improvement project. A target frequently in their cross hairs: the electronic heath record (EHR).

The WellMD Center at Stanford Medicine in California is also working to take some of the administrative burden off of physicians’ shoulders as part of a program that’s injecting itself into the growing national discussion over burnout. “Not only do we need to help people take care of themselves, we need to take care of the environment they’re practicing in and make it more supportive, more usable, and require less of a heroic effort just to take good care of patients,” emphasizes Bryan Bohman, MD, associate chief medical officer at Stanford Hospital and Clinics, who helped establish the WellMD Center in 2016. That support includes coaching doctors to become more efficient users of EMR.

Another popular program is the WellMD Center’s Literature and Medicine series, which coaxes doctors to open up about themselves over dinner discussions around evocative pieces of literature. “It also gives them a chance to build relationships with people they’ve never met before across different disciplines,” notes Mary Lou Murphy, MS, administrative director of the WellMD Center. In addition, a peer support program provides a pathway for physicians who are feeling distress from a jarring case or patient outcome to find comfort in conversations with colleagues.

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Embracing a wellness model

For physicians, who are often conditioned to suck it up and deal with any situation that comes their way, the WellMD Center offers a compelling alternative. It provides a robust set of tools (programs, classes, newsletter and website) around themes like resilience, work–life balance, spirituality, getting healthy, increased exposure to humor and planning a vacation. As if to underscore the urgency of its message, Stanford recently appointed nationally known physician wellness expert Tait Shanafelt, MD, as its chief wellness officer, making it the first academic medical center in the country with such a position. Moreover, program leaders believe the wellness model they’re still rolling out has applicability across any medical practice or discipline where physicians grapple with the daily demands of a job that many say they no longer recognize.