More than half of U.S. physicians are now experiencing professional burnout, found a recent study.1 Of 6,880 physicians surveyed, 54% reported at least one symptom of burnout, compared to 46% to a similar study done in 2011. Satisfaction with work-life balance also declined (49% in 2011, compared to 41% in 2014). In contrast, the general U.S. working population had only minimal changes in burnout or satisfaction with work-life balance during the same time period.

Of 369 gynecologic oncologists surveyed in another recent study, 33% screened positive for depression, and 34% reported impaired quality of life.2 Interventions targeted at improving quality of life, treatment of depression, or alcohol abuse may have an effect on burnout, the researchers suggest.

“More attention is being paid to physician well-being,” says Gene Beresin, MD, MA, professor of psychiatry at Harvard Medical School in Boston, who authored a recent paper on this topic.3 “What are our obligations in training, to optimize the growth and resilience of our providers?” he asks. Beresin notes that providers have an ethical obligation to provide care that respects the dignity and rights of their patients. Similarly, he sees an ethical obligation to consider and foster the well-being of providers themselves.

“We need to look at what enables physicians to be able to perform their duties in a way that does not promote burnout,” says Beresin. “It’s the flip side of safety training: What provides safety for physicians?”

A Moral Obligation

Burnout is detrimental to patient care, adds Beresin, as it contributes to lack of empathy and medical errors. “We’ve realized that what’s good for the patient tends to be good for the physician,” he says. “It becomes an ethical obligation and a professional obligation. They go hand in hand.”

Beresin concludes that healthcare leaders have a moral and professional obligation to ensure providers are mentally and physically healthy. “We can only provide optimal care if we take care of ourselves. That means paying attention to all aspects of physician well-being,” he says.

Obstacles include a physician shortage, decreased reimbursement, excessive caseload, and more regulations and administrative burdens. Beresin says, “Once we accept that we have an ethical imperative to promote physician well-being, we have to look at the elements that work against it.”

Stigma against psychiatric disorders makes some physicians reluctant to seek help. “The important news is, we have data to show physicians do have a higher rate of depression and burnout than others in the population. We can talk openly about it,” says Beresin.

Beresin would like to see medical schools include well-being in the curriculum, and health systems to take steps to address well-being of practicing clinicians. As for what medical schools and residency programs are actually doing, says Beresin, “it’s all over the map. What we have not codified are the kinds of activities that support resilience. On the other hand, we have sound research about the kinds of activities and methods that prevent burnout.”

While many accreditation organizations support well-being, they’ve stopped short of mandating specific practices.

Beresin would like to see a core requirement for a skill set promoting well-being. This could include modules on nutrition, reflective writing, group discussions, cognitive behavioral therapy, yoga, sleep, exercise, and meditation. One study found that participation in a mindful communication program was associated with short-term and sustained improvements in well-being, and attitudes associated with patient-centered care.4

“Given our social contract to care for other people who are entrusting their well-being to us, we have an ethical obligation to keep our providers healthy as well,” says Beresin.

REFERENCES

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015; 90(12):1600-13.

2. Rath KS, Huffman LB, Phillips GS, et al. Burnout and associated factors among members of the Society of Gynecologic Oncology. Am J Obstet Gynecol 2015; 213(6):824.e1-9.

3. Beresin EV, Milligan TA, Balon R, et al. Physician well-being: A critical deficiency in resilience education and training. Academic Psychiatry 2016; 40 (1): 9-12.

4. Krasner MS, Epstein RM, Beckman H. Association of an educational program in mindful communication with burnout, empathy and attitudes among primary care physicians. JAMA 2009; 302(12):1284-1293.

SOURCE

Gene Beresin, MD, MA, Professor of Psychiatry, Harvard Medical School, Boston. Phone: (617) 726-8471. Fax: (617) 724-8690. Email: eberesin@partners.org.