Burnout part 2
Myron Yaster MD and Amy Benedikt MD
The entire issue of Anesthesiology Clinics (Volume 40 issue 2) is devoted to physician health, well-being, quality of life, and burnout. Over the next couple of weeks the PAAD team will review some of them. In today’s PAAD, 3 of the most prominent thought leaders in this field, all of whom are pediatric anesthesiologists and chairs of SPA’s and the ASA’s well-being committees describe physician well-being as a “wicked problem”, that is, social or cultural problems that are ill-defined and do not have a clear cut solution. I don’t actually believe this. I think the problem is very well defined AND there are evidence based solutions. The real problem is really a lack of will and accountability because the solutions require system and hospital and departmental leadership changes which are not quick fixes and puts the onus of solutions on the very people who created the problem in the first place. But before diving into this article, sit back, and watch this short video on burn out by the noted Dr. Glaucomflecken. (Since discovering Dr. Glaucomflecken on YouTube, I have been laughing, really gaffowing, out loud and trying not to binge watch them). Myron Yaster MD
Review article
Jina L Sinskey, Rebecca D Margolis, Amy E Vinson. The Wicked Problem of Physician Well-Being. Anesthesiol Clin. 2022 Jun;40(2):213-223. PMID: 35659395 PMCID: PMC9066294
“Many physician well-being initiatives continue to fixate on the individual, reinforcing the idea that clinicians are solely responsible for their own burnout...Initial attempts at fixing the burnout problem leaned heavily on individual interventions such as mindfulness classes, yoga, and resilience training. Further, every time physicians were asked to attend mandatory well-being lectures and retreats during their free time or fill out a well-being survey without clear follow-up or accountable change, they lost confidence that the time and energy spent participating in such efforts translated into tangible improvements to their workplace and well-being. Over time, this rightfully led to further dissatisfaction, demoralization, and disengagement in the health care workforce”.1
The consequences are catastrophic. “The COVID-19 pandemic blew open the existing cracks in the health care system and continues to take an immeasurable toll on the physical, mental, and emotional health of health care professionals. A once highly motivated, engaged workforce of health care workers is now threadbare from moral injury, watching a nation divided and science repudiated”.1
Sinskey et al. make the point that treating burnout is akin to treating an abscess. You treat an abscess by incision and drainage (structural change) not by covering it up with a bandaid (yoga, resilience training, and checking the well-being box). What are some concrete solutions?
1. Stop the glorification of excessive self-sacrifice
2. Litigation reform: Stop blaming and shaming doctors
3. Normalize peer and mental health support.
a. many states have barriers to medical licensure if physicians have a history of seeking treatment for depression or anxiety or take an antidepressant medication.
4. Stop strip-mining. The reimbursement structure of medicine in the United States is flawed and motivates health care institutions to prioritize short-term gains over sustainability.
5. Empower physicians to be the architects of their own environment. Physicians are often asked to take on leadership roles without additional pay or protected nonclinical time. I (MY) would add that in academic practices, these activities do not lead to promotion and may in fact prevent or delay promotion. This has simply got to stop.
6. We would add:
a. Fix the electronic medical record which is a billing tool that has eviscerated our souls.
b. Hold leadership accountable. If hospital administration, department and division heads fail in fixing these problems remove and replace them.
The solutions listed above shift the focus from “blaming and shaming the clinician” to a “systems approach to physician well-being.” When can we expect to see significant organizational change? Although it’s hard to say, we are encouraged to see healthcare worker wellness highlighted, not only in our medical literature, but in the mainstream media as well. For example, the U.S. Surgeon General, Dr. Vivek Murthy, released an advisory bringing attention to the serious problem of health worker burnout. The authors share with us that it’s not only major medical societies that are addressing the need of a systems approach to the problem. National organizations such as the ACGME (Accreditation Council for Graduate Medical Education) and NAM (National Academy of Medicine) are also onboard. Hopefully, these calls to action coming from varied sources will help to expediate a “cultural overhaul of the medical system.”
References
1. Sinskey JL, Margolis RD, Vinson AE: The Wicked Problem of Physician Well-Being. Anesthesiol Clin 2022; 40: 213-223