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Struggling with your work-life balance? Professional organizations offer solutions for burnout, from lobbying to hands-on help.
Physician burnout has become one of the most serious problems in health care today. From job dissatisfaction to depression, from reduced quality patient care to medical errors, burnout can have dire, even deadly consequences. The issue and its causes and effects have been well covered by the media.
Physicians searching for practical solutions are increasingly turning to their professional associations for help, and they’re finding it. Here are a few physicians associations providing their members with a variety of tools for fighting burnout.
Physicians Helping Each Other
Burnout is largely driven by factors that are beyond the control of individual physician, according to the National Academy of Medicine. Experts agree that as much as 80 percent of burnout is due to systemic rather than individual problems. These are factors such as excessive paperwork and regulatory requirements and poorly designed EHR systems.
In order to address burnout by attacking these root causes, the American College of Physicians launched a program called Patients Before Paperwork in 2015. The program’s goals are to improve physician wellness by identifying the administrative tasks that eat up so much physician time and determine and implement methods to reduce those tasks. “We’re working with policy makers, such as [CMS] and EHR vendors, to make sure regulations meet their intentions,” says Susan Hingle, MD, ACP Board of Regents Chair and Chair of the ACP’s Wellness Task Force.
However, the ACP’s approach is not all directed at policy makers. “A lot happens at the national level but there is also a lot you can do locally,” Hingle says. In that vein, the ACP has been training a cadre of ACP members called Wellness Champions. These are volunteers, Hingle says “who are trained nationally and work locally.”
An ACP physician who needs help can request a consultation with a Wellness Champion, who will then come to the individual’s practice, do an evaluation, and make suggestions for improvement. These suggestions might be for changes to the organizational structure of the practice, ideas about how to streamline workflow, or something more personal-such as how to best recharge during time off. This colleague-to-colleague approach is aimed at not only addressing the problems doctors face in their day-to-day practices, but giving physicians a chance to support each other on a personal level.
“One of the elements of dissatisfaction that we hear from our members,” says Hingle, “is that the regulations are put in place by people who don’t understand what it’s like on the ground in practice. Champions do.”
The ACP is still working out how best to measure the success of these initiatives. They offer a burnout screening tool on their website and their annual survey of the ACP’s 152,000 members includes questions about these programs. A subcommittee of the ACP’s Wellness Task Force is looking at additional ways to measure success. Meanwhile, they are doing research and collecting member input for how to address this problem in a way that will be most helpful for physicians. “It’s a big area. We’re trying to figure out how to offer something a little different,” says Hingle.
Taking Back Control
The American Academy of Family Physicians has identified physician wellness as one of their top four priorities, says H. Clifton ‘Clif’ Knight, MD, vice president of education, who leads the organization’s wellbeing initiative. Knight says that even though culture tends to blame the individual, the AAFP “recognizes that burnout is a problem of the health care system.” Yet, while working to repair the system, the AAFP wants to help its members not only “survive, but thrive.”
Under the slogan, “Caring for patients starts with caring for yourself,” the AAFP Physician Health First portal has a wealth of practical and useful tools for physicians seeking help, including some that earn continuing medical education credit. Possibly the best stop for physicians visiting the site for the first time is the Maslach Burnout Inventory. Members can take this online evaluation at no charge to get a gauge of how severe is their burnout.
There are also dozens of articles on topics such as how to “use your EHR to foster human connection,” “rethinking workflow for greater efficiency,” and how to “embrace change.”
The portal’s heft is both its biggest advantage and one of its weaknesses. There is so much material there it can be overwhelming for the busy physician. However, this month, the AAFP is adding a well-being planner to the site. This feature will allow physicians to personalize a menu of resources, save articles to read later, and keep up with their progress with programs they have engaged with.
The portal’s metrics give the AAFP an idea of how well the initiative is working for its members; repeat visits and frequent downloads suggest that physicians are finding it useful. However, the most direct feedback will come from the organization’s yearly internal survey, which asks if members find the resources useful, but also includes questions the answers to which can be harbingers of burnout, such as, “Would you choose to be a family physician again?”
Also in April, the AAFP will hold its first annual Health and Well Being Conference. Some of the sessions at this conference will qualify for CME, but many will not, explains Knight. For that reason, the organizers feared the conference might not be well attended. However, based on registration so far, they are expecting an impressive turnout-over 500 attendees. “This tells us that people are looking for solutions,” says Knight. The conference will approach the problem via three tracks: organizational factors; practice-based solutions; and individual skills.
“One message we heard from our members,” says Knight, “was ‘don’t fix me, fix the system.’” And indeed, the AAFP is working at the national level to effect changes that will improve working conditions for its members. “However,” says Knight, “we have to look at best practices at the practice level. I’m a big believer that there’s no one approach that will fix everything. I worry about slipping into a victim mentality and the root of that is loss of control. We physicians will have to take responsibility for this problem and fix it ourselves.”
In it for the Long Haul
The American Medical Association has made addressing physician burnout a priority since 2012, when the AMA-RAND study found that national health policy and lack of efficiency in health care systems was driving physician dissatisfaction. The organization’s Steps Forward initiative is designed to “create the conditions where physicians can put the joy back in practicing medicine,” says Christine Sinsky, MD, the AMA’s vice president of professional satisfaction. The approach is solutions focused, based on academic research and practical experience on the ground. Changes such as focusing on team-based care have made the work of patient care more efficient and more enjoyable. This kind of restructuring has made a huge difference in several practices.
The method works like this: A physician assistant sees the patient first and sets the agenda for the visit. When the physician is in the room, the PA does real-time documentation, freeing the doctor to engage with the patient. After the physician goes on to the next patient, the PA takes care of the after-visit details, such as sending prescriptions to the pharmacy and so on. “This is the single most powerful initiative to prevent burnout,” says Sinsky. “I’ve had this model in my own practice for eight years. Most practices find that if they can see two more patients a day, and this model makes time for at least two more patients, it will cover the expense of the PA.” And of course, shifting the physician’s emphasis from data entry to patient engagement addresses one of the most commonly cited reasons for burnout.
Other things AMA members have found useful on the Steps Forward initiative are tips and tricks for more efficient use of EHRs and arranging practices for optimal work flow. In light of the current opioid crisis, an upcoming module will advise doctors on how to treat pain. Ideas like these are the mainstay of the Steps Forward program, though it also includes more personal suggestions for improving wellbeing, such as improving resiliency and recognizing the signs of depression and anxiety.
The AMA designed the Steps Forward website to be as frictionless as possible. It’s free and does not require a password. As of this writing, it has garnered more than 350,00 unique users, which is the main metric the organization uses to gauge the effectiveness of the program. Modules are continually added based on new research and input from members. “This is not a short-term, trendy topic,” says Sinsky. “We’re in it for the long haul, helping physicians find and keep the joy in medicine.”