Physician Burnout in the Emergency Department
‘Canary in the coal mine’
As recently reported in Hospital Employee Health, researchers continue to quantify increasing physician burnout, tying well-being and work unit safety grades to major medical errors.1 (For more information, see the September 2018 issue.)
Previous research has shown that among various specialties, emergency providers are particularly vulnerable to burnout, given the stress and time pressures they deal with daily. Laura McPeake, MD, FACEP, director of wellness for the department of emergency medicine in the Lifespan Health System in Providence, RI, notes the issue is multifactorial.
“I think the ED is kind of the canary in the coal mine for a lot of changes that are happening in medicine in general, with the EMRs [electronic medical records] and a lot more administrative requirements,” she says. “We are seeing a lot of fallout from the opiate epidemic. A lot of that falls on the ED in terms of blame, but I don’t think we are actually responsible for a lot of it. I don’t think we have control over a lot of it.”
The ED is the main door to the hospital, offering the biggest snapshot of what goes on in the hospital regarding boarding and crowding from the patient’s point of view, she adds.
“Yet, we have very little control over the availability of inpatient beds, staffing models, and things like that,” she says. “A lot of responsibility falls on us without a lot of the power to [make changes]. We know that is a big driver of burnout. The lack of ability to control and manipulate your environment leads to burnout.”
What are the indications that burnout is an issue? A big warning sign is when clinicians become emotionally exhausted, McPeake advises.
“They may depersonalize and see patients as things rather than people,” she says. “When they are just clicking boxes and trying to get through the day, and when they are more engaged with their computers than with interpersonal interactions, those are all signs that things are off balance.”
When that happens, it is important to start engaging in conversations with people, McPeake explains. “That has two benefits. It has the personal benefit of venting and getting out what is on your plate, and also [the benefit of] reaching out to others and realizing there is a community connection,” she says.
By communicating with colleagues and finding a way to express concerns and empower yourself, you can give voice to the issue at the administrative level, she says.
Of course, leadership teams can’t address issues if they don’t know about them, she adds.
“There is a tendency among physicians in general and emergency physicians in particular to just keep their heads down and go on to the next thing,” she says. “We are good at advocating for others, but we are not used to advocating for ourselves. The only way we can really take care of patients is if we are really taking better care of ourselves.”
1. Tawfik DS, Profit J, Morgenthaler TI, et al. Physician burnout, well-being, and work unit safety grades in relationship to reported medical errors. Mayo Clin Proc 2018 Jul 4. pii: S0025-6196(18)30372-0. doi: 10.1016/j.mayocp.2018.05.014. [Epub ahead of print].
Researchers continue to quantify increasing physician burnout, tying well-being and work unit safety grades to major medical errors.
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