Running on Empty: A Prescription for Healing Physician Burnout. Jeff Morris MD, MBA, FACS: Physician Coach & National Speaker Studer Group

Transcription

1 Running on Empty: A Prescription for Healing Physician Burnout Jeff Morris MD, MBA, FACS: Physician Coach & National Speaker Studer Group The Silent Epidemic 1

2 Physician Burnout 3 Burn out (noun) exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration - Merriam-Webster 4 2

3 American doctors are suffering from a collective malaise. We strove, made sacrifices - and for what? For many of us, the job has become only that - a job. Part One Intro: Jauhar, S., Why Doctors Are Sick of Their Profession,, The Wall Street Journal August 29, Maslach Burnout Index (MBI) 3 Dimensions of Burnout Emotional Exhaustion: Sense of being emotionally drained while working with other people and the dread that accompanies thoughts of having to go to work. Cynicism: This dimension may be expressed as depersonalization, withdrawal, and compassion fatigue. Ineffectiveness / Lack of Efficacy: Loss of desire to accomplish great goals and make the world a better place. To access the MBI, visit 3

4 Burnout - Definition Progressive loss of idealism, energy, and purpose. Physician Misery Index Survey, Geneia, March 5, 2015, The Geneia Physician Misery Index 4

5 Burnout Rates by Specialty Cri>cal Care Emergency Medicine Family Medicine Internal Medicine General Surgery HIV/Infec>ous Diseases Radiology OB/Gyn & Women's Health Neurology Urology Pulmonary Medicine Cardiology Diabetes & Endocrinology Orthopedics Nephrology Plas>c Surgery Pediatrics Oncology Anesthesiology Rheumatology Allergy & Clinical Immunology Ophthalmology Gastroentrerology Pathology Psychiatry & Mental Health Dermatology The 2015 Medscape survey results reflect the highest burnout rates found in criccal care (53%) and emergency medicine (52%), and with half of all family physicians, internists, and general surgeons reporcng burnout 53% 52% 50% 50% 50% 50% 49% 49% 49% 48% 47% 46% 45% 45% 45% 45% 44% 44% 44% 43% 43% 41% 41% 39% 38% 37% Peckham, C., Physician Burnout: It Just Keeps Getting Worse, Medscape Physician Lifestyle Report January 26, Burnout Rates by Age Source: Medscape Physician Lifestyle Report 2015; Carol Peckham, January 26,

6 Why are Physician So Burned Out, Anyway? 11 Healthcare Industry Trends Shaking Up the Industry Healthcare funding has reached worrisome levels Physician shortage Aging population Volume / Acuity Malpractice liability Patient expectations Value-based purchasing Transparency Technology Increase physician employment 12 6

7 Physician Hurdles Physicians feel overworked Many physicians are sleep deprived Physicians feel they spend too little time with patients Physicians feel they spend too much time doing everything else Electronic Medical Record implementation brings another set of time pressures More than 80 percent of doctors say they are overextended or at full capacity Survey of American Physicians: Practice Patterns and Perspectives, The Physicians Foundation by Merritt Hawkins, September _Physicians_Foundation_Biennial_Physician_Survey_Report.pdf. 7

8 Burnout Psychological Factors Physicians are experiencing a severe loss of control There has been too much change, too fast Physicians face downward pressure in compensation, coupled with heavy debt Physicians face a growing sense of disconnection from patients and community Physicians must cope with the inherent stress of practicing medicine Training Related Issues Many physicians need additional skills today beyond great clinical expertise The fund of medical knowledge is now growing and changing too fast for humans to keep up with, and the facts you memorize today might not be relevant five years from now, says NYU s Dr. Triola. Beck, M., Innovation is Sweeping Through U.S. Medical Schools, The Wall Street Journal, February 16,

9 Additional Skills Needed Knowledge base Electronic Medical Record Considering a patient s economic big picture Communication skills Engage patients as partners Teamwork Know LEAN (process improvement) and cost reduction strategies. 17 Individual Change Unconsciously skilled Consciously unskilled Unconsciously unskilled Consciously skilled Source: Abraham Maslow; 1940; Four Stages for Learning Any New Skill ; Gordon Training International by Noel Burch;

10 Why Physician Burnout Matters 19 Ways Physician Burnout Hurts Burnout can hurt clinical outcomes Harm patient perception of care Drives up an organization s recruitment and retention costs Harms physician productivity Increases operating costs Makes episodes of incivility more likely Leads to malpractice litigation Blocks change initiatives Compassion fatigue 10

11 Does Burnout Matter? Ç Medical Errors Williams ES et al, Health Care Manage Rev. 2007;32: Firth-Cozens J & Greenhalgh J. Soc Sci Med. 1997; 44: Shanafelt TD et al. Ann Intern Med. 2002;136: È Pa.ent Compliance DiMa]eo MR et al. Health Psychol. 1993; 12: Ç Medical Malprac.ce Suits Jones JW et al. J Appl Psychol, 1988; 73: È Pa.ent Sa.sfac.on Linn LS et al. Med Care. 1985; Haas JS et al. J Gen Intern Med. 2000;15: Choosing Resilience; Wayne M. Sotile, Ph.D.; Founder of Center for Physician Resilience, Davidson, NC 21 Ways Physician Burnout Hurts Physician burnout threatens patient safety 8.9 percent of 7,905 American surgeons reported having committed a major medical error in the preceding three months. Many of these physicians manifested burnout. * 2010 article in the Annals of Surgery, Shanafelt 11

12 Recognizing Physician Burnout (Diagnosis) 23 12

13 Leading Indicators of Physician Burnout (not always easy to recognize) Disengagement Disinterest Disconnection Burnout Symptoms A sense of creeping cynicism and lack of passion Depersonalization (treating patients and coworkers as objects) and emotional disengagement Physical and emotional exhaustion Headaches Inability to concentrate Depression or anxiety Irritability Chronic complaining or blaming Explosions of anger on the job Insomnia Drug or alcohol abuse Suicidal thoughts / behaviors Physician Burnout: Preparing for a Perfect Storm. Straight A Review, Studer Group

14 Suicide Lifeline National Suicide Prevention Lifeline Diagnosing Physician Burnout and distinguishing from the disruptive physician Burnout Disruptive Physician 1. Emotional exhaustion (blunted affect with absence of discretionary effort). 1.Use a combination of verbal and behavioral tactics to intimidate or derail team members. 2. Depersonalization, especially of the patient. 2. Disparaging or derogatory toward staff. 3. Belief that efforts no longer make a difference. 3. Believes that he or she is the only one doing it correctly. Burned-out or Disruptive, Rob Schreiner,

15 We Are All in This Together: Tools and Tactics for Treating Physician Burnout 29 To Heal Physician Burnout Physician Burnout Organizational Responsibility Individual Responsibility Engagement 15

16 Healing Physician Burnout Tactics Organizational Responsibility Key drivers of Physician Engagement QUALITY Physicians want to know their pa>ents are receiving quality care and a great pa>ent experience. EFFICIENCY Physicians want to work with team members who have the informa>on needed at hand to discuss their pa>ents. Over the course of a day this efficiency will save the physician 30 minutes or more. INPUT Physicians need a seat at the table to provide input when decisions are being made that affect clinical outcomes. Round on physicians and consistently ask them, Do you have everything you need to provide excellent care to your pa>ent? APPRECIATION Physicians value a thank you and acknowledgment when things are going well. They also want to see follow-up on their input in the form of tangible change. 16

17 Physicians Must Haves Involve Physicians in Goal Setting & Skill Building Round on Physicians Focus, Fix, Follow Up AIDET (Enhanced Communication Skills) Reward & Recognize Organizational Responsibility How do other industries treat elite performers? 17

18 Johnny Cueto #47 SP Will perform once every 5 days 162 games per season Will pitch in about games per year Will pitch on average 7 innings per game 18

19 Healing Physician Burnout Tactics Individual Responsibility Physician - Heal Thyself Work life Home life Emotional life 38 19

20 Take Care of Yourself at Work? Rethink work-life balance Take regular vacations See patients as partners Create a collaborative culture Own your training / professional development Share feelings / experiences Physician - Heal Thyself 40 20

21 Take Care of Yourself at Home? Do for yourself what you would advise others: Exercise, sleep, eat well Volunteer Cultivate hobbies Nurture relationships Prioritize Take Care of Yours Emotional Being Manage stress Maintain self-awareness Practice mindfulness Count your blessings 21

22 Resources 2016 Physician Insight Series Physician Burnout Page Title Author Release Date Rx for Healthcare Woes- Build Engagement or Combat Burnout? Yes! George Ford, MD January 26 th, 2016 Physician Burnout and the Loss of Collegial Relationships: A Reversible Trend? Women in Medicine and Leadership: Work Life Blend and Preventing and Healing Burnout Richard A. Rubin, MD, MBA, FACP, FACE Barbara Roehl, MD, MBA February 2 nd, 2016 February 9 th, 2016 Burned-Out or Disruptive? Rob Schreiner, MD February 16 th, 2016 Burnout in Cancer Care: How Physician Leadership Can Make the Change Ted James, MD, MS February 23 rd, 2016 Physician Burnout and the Emergency Physician Dan Smith, MD, FACEP March 1 st, 2016 Five Things Physicians Need to be Fully Engaged Simulation Labs: Creating a Safe Space for Physicians to Practice Rob Schreiner, MD March 8 th, 2016 Jason Ruda March 15 th, 2016 Burnout Among Physicians In-Training Rob Schreiner, MD March 22 nd, 2016 The Impact of Electronic Medical Records on Physician Burnout Anthony Schuster, MD, MBA, CPE March 29 th,

23 Slide 45 Thank You! Insert Your Photo Here Jeff Morris MD, MBA, FACS: Physician Coach & National Speaker Studer Group Cell: (30)