Throughout 2018, The Doctors Company’s patient safety risk managers provided hundreds of our members with live continuing medical education (CME) seminars that addressed burnout. The program evaluations asked members to tell us about actions they took as a result of participating in the seminars. The responses were wide-ranging, and some of them were understandably skeptical. Below is a synopsis of real-world actions taken by physicians and advanced practice providers to counteract burnout.
The most common strategies provided by peers from their own experiences relate to scheduling or setting limits. Strategies include the following:
- Allow more time for each patient visit, making visits more fulfilling.
- Schedule adequate/more time off.
- Provide more gaps in the schedule to allow for catch-up work or to make phone calls to patients.
- Say no to more on your schedule.
One CME participant offered an additional strategy related to setting limits: “Say no to overly complex cases.” Dr. Howard Marcus, an internal medicine physician in Austin, Texas, remarked, “Saying no to complex cases is in direct conflict with our obligations to take care of every patient to the best of our ability. People get old, sick, and complicated. It’s not their fault. That is the human condition. The solution is more time, not a refusal to see the patient. This is one area in which administrators should be willing to be more flexible so that physicians with the skill and the will to manage complex patients are provided adequate time and resources.”
Other members recommended important first steps, such as being more aware of the signs of burnout in themselves and in colleagues. Suggested steps include the following:
- Assess yourself for symptoms of burnout.
- Provide mutual support so that all practice partners look for signs of extreme fatigue or burnout in each other.
- Develop more awareness about the impact of job stresses on patient care.
System and process changes implemented by members to address burnout often required collaboration with partners and staff. Suggested system changes include the following:
- Review and revise electronic health record (EHR) templates.
- Improve office systems for patient management.
- Take steps to reduce nonclinical work that adds to daily burdens.
- Improve workflow to streamline processes and outcomes.
- Improve the patient intake and registration process.
- Minimize administrative time.
- Make documentation easier, allowing more time to focus on patients.
- Increase efficiency to provide patients with the best care possible.
- Facilitate timely review and action on lab results.
Staffing and delegation improvements also helped to reduce burnout. Members offer these options:
- Provide extra office help to decrease physician frustration.
- Assign a nurse practitioner or another clinician to address EHR usability issues with the vendor and provide staff education on EHR use.
- Use a scribe.
Members described and recommended individual and interpersonal efforts to advance well-being:
- Take care of yourself so you can take better care of your patients.
- Exercise regularly.
- Start doing yoga.
- Find comfort in spirituality and faith.
- Seek counseling with local practitioners, such as psychologists, who are familiar with burnout.
- Learn to be more tolerant of your patients and exhibit more patience with them.
Rebuilding or Creating Community
Members articulated a desire to create support groups or to find better ways for physicians to connect so they can support each other. It was a call for community. The theme of physician community and connectedness is strong. An article in NEJM Catalyst reported on an initiative to better understand the community of care. Among the findings: Those who simply gather for a meal can quickly move “from the complaints of the present to the possibilities of collective action. And in that experience, a community of peers and change agents was born.”1
Additional feedback from members expressed a need for interventions that combat burnout to begin at the earliest stage—even in medical school. Strategies for early interventions are in no short supply. One excellent resource is the National Academy of Medicine’s (NAM’s) Action Collaborative on Clinician Well-Being and Resilience. The Resource Center on the Clinician Well-Being Knowledge Hub website, which lists more than 100 resources on the topic of Learning Environment, is a comprehensive resource repository for those seeking to promote clinician well-being in their organizations and in their personal lives. As further evidence of its commitment to early intervention, the NAM Action Collaborative on Clinician Well-Being and Resilience hosted a live and web-streamed meeting titled “Redesigning the Clinical Learning Environment” in May 2019.2
Where to Begin
It is clear that members identified a variety/combination of individual, structural, system, and organizational strategies that can help physicians reduce burnout and focus on what matters most to them. For anyone feeling paralyzed and not knowing where to begin, think globally and act locally. As a colleague shared: “Don't wait for the perfect solution at the peril of not starting something.” Start somewhere; that’s how change begins.
The National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience, Clinician Well-Being Knowledge Hub. https://nam.edu/clinicianwellbeing/.
- Métraux EL, Hiniker D, Kinner P. “Breaking bread” to combat burnout. NEJM Catalyst. March 14, 2019. https://catalyst.nejm.org/breaking-bread-burnout-community/?utm_campaign=Connect%20Weekly&utm_ source=hs_email&utm_medium=email& utm_content=70937477&_hsenc=p2ANqtz-8R3PXSW_je7p67ax-4TkjQeOZhfTAxZzF39ASr_cpC7ARoEylKjz9htYUCedKn_ TRtxv0xo5Up6S09lQDh0BYCmxnL_Q&_hsmi=70937477. Accessed May 21, 2019.
- Action Collaborative on Clinician Well-Being and Resilience. National Academy of Medicine website. https://nam.edu/event/establishing-clinician-well-being-as-a-national-priority-meeting-5/?utm_source=National+Academy+of+Medicine&utm_campaign=f74219fdff-CR+July+meeting+registration_COPY_01&utm_medium=email&utm_term=0_b8ba6f1aa1-f74219fdff-146476909. Accessed May 21, 2019.
The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.