Combating physician burnout: ‘Silence is not the answer’

Physician burnout

You’re about to start another long day. Traffic was grueling, you’re late for your first appointment, and the paperwork and meeting schedule that awaits you is daunting. You’re chasing the clock, today and most days, and your patients and co-workers are feeling the effects.

This scenario and countless variations of it are common drivers of physician burnout — a condition affecting 35 percent of U.S. physicians, according to The American Academy of Family Physicians (AAFP). The condition is the result of prolonged stress involving emotional exhaustion, depersonalization and a sense of reduced personal accomplishments.

Physician burnout rate 35 percentBoston Children’s Psychiatrist-in-Chief and Director of the Office of Clinician SupportDavid R. DeMaso, MD, says physician burnout has reached epidemic levels and is impacting all medical specialties, career phases and demographics.

“Physician distress is felt across a spectrum and may be very mild and transitory, or present as a mental health disorder,” says DeMaso, who counsels physicians and staff on burnout. “The consequences of burnout includes negative effects on patient care and professionalism, a physicians’ own care and safety, and the viability of the health care system.”

Burnout starts early: The impact on pediatric resident physicians

In a new study published in Pediatrics titled, “Pediatric Resident Burnout and Attitudes Toward Patients,” Tamara Baer, MD, MPH, of Boston Children’s Division of Adolescent and Young Adult Medicine, and colleagues examined the association between resident burnout and patient care.

The study found 39 percent of those surveyed — 258 pediatric residents in 11 different pediatric residency programs — experienced burnout, four percentage points higher than the general physician population. “We found that residents with burnout reported making more errors, not fully discussing treatment options and paying less attention to the impact of illness on a patient’s life,” says Baer.

Burnout work life balanceCommon stressors including irregular work schedules, workload compression, expanded medical record documentation requirements, sleep deprivation, personal issues and limited leisure time may place residents at high risk for burnout, the study finds.

“Residents want to spend time working with and helping their patients and their families,” she says. “But these demands may drive additional stress and decreased job satisfaction.”

The toll on physicians: Warning signs of burnout

To self-screen for burnout, DeMaso says physicians should ask themselves two questions: Do I feel burned out by my work? and Have I become more callous toward people since I took this job? If the answer to either question is “a few times a week” or “daily,” this is a positive screen for burnout, DeMaso says.

Warning signs of burnout include:Burnout symptoms

  • persistent sadness and anxiety
  • weight and sleep changes
  • difficulty concentrating
  • decline in work quality
  • misuse of drugs or alcohol
  • isolation
  • loss of compassion for patients
  • feeling a lack of personal resources
  • co-worker concern

While these warning signs often overlap with depression, DeMaso notes that not all physicians with depression have burnout, and not all physicians with burnout are depressed. Those with a depressive disorder generally struggle with more intense feelings of sadness and hopelessness as well as loss of interest in doing things nearly every day.

‘Silence is not the answer’

Keeping quiet is not the way to handle distress, DeMaso says. “Don’t ignore your distress because taking care of yourself is directly connected to taking care of others,” he adds. “There are a lot of asks of physicians, nurses and health care professionals to care for other people. It’s important to understand that burnout is an occupational hazard and self-monitoring is key.”

Tips to find balance

Find time to de-stress. “It might be relaxing, having a cup of tea or talking to someone,” DeMaso says. “And it doesn’t have to be a therapist. It could be talking to a peer or colleague.”

Finding balanceSelf-screen. Do I feel burned out? Am I more callous? If you feel burned out every day, even every few days, or feel disconnected and callousness towards patients, you are most likely burned out.

Schedule personal time. “It’s important to get out,” DeMaso adds. “Interaction with family, friends or colleagues will help keep isolation at bay.”

Tools to help manage your time include:

  • Prioritize your schedule and create to-do lists.
  • Schedule time during the day to review emails.
  • Manage your meetings efficiently. How long do meetings really need to be?
  • Make time for non-work-related activities. Take daily walks at lunch, exercise, read and find time to relax.

The bottom line on burnout

Research shows physician burnout negatively impacts patient care, health outcomes, job satisfaction and physician well-being.

When asked about his bottom-line recommendation for managing stress, DeMaso says, “Removing one or two stressors, self-monitoring and finding time for rest and relaxation can have a positive impact on one’s health and overall patient care.”

Learn more Boston Children’s Office of Clinician Support.