The most dedicated doctor in your practice is suddenly dragging in late, snapping at the staff, and giving patients short shrift — and you've got the complaints in hand to prove it. You'd chalk it up to stress, but somehow this feels different. It's out of character. It's more pervasive. It's burnout, says Jonathon Halbesleben, an associate professor at the University of Alabama, who has conducted research on stress in the healthcare setting. "Stress is something we experience to some degree constantly, but burnout is where that stress accumulates to the point where you experience emotional exhaustion and start to detach from work," he says. "You start treating patients as cases rather than people."
Indeed, the incidence of burnout is well documented among healthcare providers, not surprising given the physical and emotional demands of the job. Exactly half of the nearly 8,000 surgeons who responded to a 2008 survey by Johns Hopkins University School of Medicine reportedly met the criteria for burnout, while 27 percent of primary-care doctors reported burnout in a study published by the University of Wisconsin's School of Medicine and Public Health in 2009.
For most physicians, burnout manifests itself as emotional exhaustion, depersonalization (or withdrawal from patients), and a marked loss of professional purpose and job satisfaction. That, in turn, can lead to cynicism, reduced productivity, doubts about one's competency, and increased conflict in the physician's personal and professional relationships. With so much at stake, then, office managers and administrators must learn to recognize the signs of burnout among their providers and take steps to intervene where necessary.
Reducing stress
Practices should find ways to reduce the workplace stressors that lead to burnout in the first place, says Nancy Devenger, past president of the New Hampshire Medical Group Management Association and an administrator for the last 30 years. "Burnout in private practice is often a problem of scheduling," she says. "The doctors run from the hospital to the office and they get there late so they have to skip lunch and they get exhausted. The work gets done, but only because they stay later and later at night. It's a vicious cycle."
Unlike depression, burnout is generally confined to job-related stress, according to the Mayo Clinic. The symptoms usually disappear when the stress factors are eliminated. As practice administrator, you can start by ensuring your doctors aren't overworked, says Devenger. For example, if the number of patient visits per physician exceeds industry standards, you may need to consider hiring additional help. Practice management consultants note that bringing on an additional mid-level provider to handle routine care can free up your doctors to focus on more complex cases.
You can also help your providers by using your existing staff more effectively, says Devenger. All tasks should be assigned to the person on your team with the most appropriate level of training required for the job. Don't let your physicians tackle paperwork that could be done more cost-effectively by administrative staff. "Insufficient administrative and nursing support often leads to burnout," Devenger says. "Physicians wind up doing nursing functions and working below the scope of their practice because they can't afford the level of staffing they need, including clerical and nursing tasks."
Finding solutions
Depending on your practice, it might make sense to consider handing off hospital functions to a hospitalist group, says Devenger, which eliminates the time-consuming task of running back and forth between the office and the hospital. "There's a huge move away from outpatient practices trying to do it all," she says. "The hospitalist group does what they do and returns the patients back to the practice."
It worked for PRA Behavioral LLC, a 40-provider psychiatric group in Schaumburg, Ill. "We've been in operation just over 20 years and early on our physicians made a decision to stop being on rotation at the hospital, which decreased stress levels tremendously," says administrator Paula Comm. "Now, we're on no hospital call lists at all and we don't even do inpatient work anymore. We are strictly outpatient."
It was a risk, to be sure, but the partners at PRA Behavioral made a conscious decision to make work-life balance a priority, says Comm, which has helped the practice reduce staff turnover significantly. "We put all our energy into building a very successful outpatient practice so we weren't dependent upon the hospital," she says. "We thought we'd lose our referrals and we didn't at all."
In the pursuit of a healthy workplace, Halbesleben notes all office managers should sit down with their doctors and ask what can be done to make their day run more smoothly. "A lot of burnout centers around poor work design, having to do work you shouldn't have to do, or the fact that supplies aren't where you want them to be," he says. "I think a lot of managers go in thinking they have all the solutions, but they don't really know what the actual stressors are because they're not doing that job. Sit down with the doctors, nurses, and staff and ask them what drives them nuts, day in and day out. Ask them for solutions too, which makes them personally invested in seeing it gets fixed."
Finally, encourage your doctors to be cognizant of their own energy levels. "A big part of it is about helping them manage their own energy effectively," says Liz Farrin, a senior consultant for Physician Wellness Services in Minneapolis. "Instead of spending 90 minutes at night, when they're exhausted, going over charts for the next day, they might be able to do it in 40 minutes by coming in earlier in the morning when they have more energy." Building in five- or 10-minute breaks during the day can also go a long way toward helping doctors feel more clearheaded and revitalized.
Candid communication
If a doctor in your practice is already exhibiting signs of burnout, of course, it's time to intervene. But start with confirmation, says Larry Vickman, an emergency physician and founder of The Vickman Group, which helps healthcare providers who have "lost the joy in their personal and professional lives." "You may have a sense that things aren't right, but ask the staff what they think as well," he says.
When speaking with the physician, make an effort to be both direct and respectful, says Vickman. "It's one thing to say the nurses think you are being a jerk and another thing to say 'I don't know what this is but it seems a little out of the ordinary. I've seen short outbursts of anger, you're not answering the phone, and we're getting patient complaints.' Describe what it is you see without being judgmental and ask them what's up."
It might also be something that's troubling the doctor in his personal life, which may require outside resources like an employee assistance program. "You have to try to get them to open up and if they say 'None of your business,' you have to be able to say 'Wait a minute, it is our business. We have a behavior policy and you are crossing it,'" says Vickman.
Comm agrees that candor is key. "If I see that someone is doing too much, or I start to see a lot of mistakes and the staff are getting frustrated, I'll mention it to the physician and ask them when was the last time they took some time off?" she says. "It's never comfortable to pull someone in and say we want to let you know how your behavior affects the bigger picture and how it affects morale, but we don't ignore signs of distress."
You should also encourage your doctors to make themselves a priority, says Farrin. "Doctors are so focused on helping other people that they're often very disconnected with their own wants and needs," she says. Remind them how diet and exercise can lower stress and increase energy. Meditation, yoga, and Pilates also helps put them more in touch with their own bodies, she says. "You need to help them break it down and help them figure out how they can make that happen," says Farrin.
Shelly K. Schwartz, a freelance writer in Maplewood, N.J., has covered personal finance, technology, and healthcare for more than 17 years. Her work has appeared on CNBC.com, CNNMoney.com, and Bankrate.com. She can be reached via editor@physicianspractice.com.
This article originally appeared in the July/August 2011 issue of Physicians Practice.
