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Hospitalist Burnout


 

Long hours, extreme dedication to their work, and an overload of responsibility can make physicians more prone to burnout than other professionals. And hospitalists are no exception because they may experience more causes of burnout than other types of physicians.

Here are some basic facts about burnout among physicians, how to determine if you are burning out, and what to do about it.

Facts about Physician Burnout

In her presentation “Burnout and Hospitalists” at the 2005 SHM Annual Meeting in Chicago, Tosha Wetterneck, MD, hospitalist and assistant professor of medicine at University of Wisconsin (Madison), defined physician burnout as “erosion of engagement with the job.” The components of this erosion can include emotional exhaustion, depersonalization (distancing yourself from your job), and reduced personal accomplishment.

“Burnout,” said Dr. Wetterneck in her presentation, “is caused by work overload and time pressure, as well as role ambiguity, lack of job resources or support, severity of patient problems, and lack of reciprocity from patients.” Other factors include a perceived loss of control and rapid changes on the job.

Hospitalists in particular may be prone to burnout because they work under high expectations—their own as well as others’—to provide better outcomes. A 1999 study by the National Association of Inpatient Physicians (SHM’s former name) revealed a 13% burnout rate among hospitalists, with an additional 25% at risk for burnout. That may sound high, but emergency and critical care physicians experience burnout rates of up to 60%.

What to Do about Burnout

Lidia Schapira, MD, an oncologist at Massachusetts General Hospital, Boston, has written and spoken on the subject of physician burnout.

“It’s a real phenomenon,” she explains, “and in part it reflects an exaggerated commitment to work. But a professional who loves what they do—if they have support—can [experience] enthusiasm rather than burnout.”

Without support from their organization or colleagues, a physician can become overwhelmed by the long hours and responsibilities of work, among other stressors. Here are Dr. Schapira’s steps for dealing with burnout:

1. Recognize it: “The symptoms [of burnout] are very similar to depression,” she points out. “One way to distinguish between burnout and depression is to take a little holiday from work. If your symptoms are connected to work, you’ll feel better. If you feel equally bad on vacation, you probably suffer from depression.”

2. Address your stressors: If you realize you are burned out, your next step should be to make a list of on-the-job stressors and prioritize them. Then tackle them one at a time. “You have to identify the things that are most stressful to you and make changes,” says Dr. Schapira. “For example, if your schedule is overloaded, find a way to build in breaks for food or fresh air.”

If there are specific parts of the job that are “horrible” for you, she says, try to delegate them to someone else on your team. By delegating or swapping tasks with others, you may be able to eliminate your burnout—and possibly theirs as well. Another important factor is having an ally. “Find someone on your team who you can talk to,” advises Dr. Schapira. “Chat with your colleagues about your problems.”

3. Work for organizational change: Hospitalists can talk to their administrators and colleagues about easy changes that can eliminate stressors, such as a change to the schedule, improved communications or additional secretarial help to ease the burden.

“Point out that a change may lead to more productivity,” suggests Dr. Schapira. “There’s a far better likelihood of having your changes accepted.” To help ensure that your employer is willing to make some changes, point out that burnout in general is associated with turnover and absenteeism, lower productivity, and stress-related health outcomes including alcohol and drug abuse.

Find a Good Fit

One key to avoiding burnout is to make sure you find an employer you can be happy with.

“There are as many different styles of management as there are hospitalist groups,” says Michael-Anthony Williams, MD, president of Inpatient Services, PC, in Denver. “It’s important that the doctors in a group share values and have the same goal. There’s no right answer.”

Dr. Schapira agrees. “There needs to be a good fit between the physician and the workplace,” she says. “If you’re the only person constantly upset by the system, maybe you’re not working in the right place.”

Dr. Williams, a co-presenter with Dr. Wetterneck in Chicago, outlined how his hospital medicine group has combated burnout by hiring physicians who seem likely to be a good fit. Dr. Williams realized that the hospitalists at Inpatient Services value time off over monetary gain.

“Our group is not motivated by finances,” he explains. “The salaries aren’t as high here, and Denver attracts physicians who aren’t seeking a lot of money.” Therefore Inpatient Services provides more time off. “Everyone gets one vacation request each month,” [per person] says Dr. Williams. “Day-to-day, the job is very unpredictable. So we try to give people control over their schedule.”

Burnout is a serious emotional condition that can lead some hospitalists and other physicians to seek a change in career—or lead them to substance abuse or other problems. The good news is that identifying it in the first place and then advocating to change workplace conditions can overcome it. TH

A National Epidemic?

The following apply to all professions in the United States:

  • One-fourth of employees view their jobs as the No. 1 stressor in their lives.
  • Three-fourths of employees believe workers have more on-the-job stress than a generation ago.
  • Problems at work are more strongly associated with health complaints than are any other life stressor—more so than even financial or family problems.

Sources: Northwestern National Life, St. Paul Fire and Marine Insurance Co., National Institute for Occupational Safety and Health, Princeton Survey Research Associates

The Book on Physician Burnout

To find out if you or other physicians in your hospital medical group are suffering from burnout, get the bible of burnout: The Maslach Burnout Inventory Manual, Human Services Survey, is a 22-item licensed research tool for assessing burnout in physicians. The assessment must be administered by an expert, but you can purchase a copy online at www.cpp.com/detail/detailprod.asp?pc=35.

Tips for Avoiding or Easing Burnout

NurseWeek published a list of suggestions for coping with professional burnout. Keep in mind the caveat that there are no quick fixes for burnout and then consider these tips from professional healthcare counselors:

  1. Ask your employer to establish a weekly or monthly support group.
  2. Ask that a task force be set up to study solutions if an entire hospital unit seems fatigued.
  3. Try staying within the same realm, but moving to a less stressful role if your job takes a tremendous amount of personal energy.
  4. Keep your staff informed about changes if you are a manager. This method helps take away the sting that change might incur. Also, allow them to give feedback, which decreases the feeling of powerlessness.
  5. Take advantage of any individual or group counseling offered along with educational programs.
  6. Try taking up an expressive activity such as dancing, yoga, painting, writing, or drawing to get your feelings out.

Source: www.nurseweek.com/features/97-2/burn3.html

More than Half of Physicians Burned Out

A Florida International University (Miami) study of physician burnout found that 58% of physicians assessed reported scores in high emotional exhaustion, the key indicator of burnout.

Source: Deckard G, Meterko M, Field D. Physician burnout: an examination of personal, professional, and organizational relationships. Med Care. 1994;32(7):745-754.

More Patients = More Nurse Burnout

A study of 10,000 nurses and 230,000 patients from 168 hospitals in Pennsylvania found that each additional patient assigned to an individual nurse resulted in a:

  • 7% increase in 30-day patient mortality;
  • 7% increase in failure-to-rescue rates;
  • 15% increase in the likelihood of nursing job dissatisfaction; and
  • 23% increase in the likelihood of nurse burnout.

Source: Center for Nursing Advocacy, www.nursingadvocacy.org/news/2002oct23_ jama.html

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