Douse Physician Burnout

Most physicians have probably seen colleagues experience - or may have experienced themselves - the draining emotional, physical, and financial impacts of professional burnout. If not kept in check, these problems can quickly escalate, and even the most stalwart physician can find himself an emotional wreck. But steps can be taken to ease the devastating effects of career exhaustion among physicians - even before they occur.

For example, look at Larry Vickman, MD, who spent 18 years as an emergency physician at two hospitals in Boise, Idaho. In 1994, he found that “some issues” were getting in his way of “feeling happy and fulfilled in the practice of medicine.” At the time, he was a divorced parent raising two teenagers, and also running his medical group.

“I was way too serious. I was personally bearing a load of anger, and it made me unpredictable,” Vickman says. “I was a good physician, but I was a hard person to work with. I could see when I hurt somebody else’s feelings, and it broke my heart. But I didn’t know what to do about it.”

Time for a break

He decided to take a break from clinical practice and sought a sabbatical from the group. When negotiations fell through, he decided to move his family to Barcelona, Spain, where he worked for two years as a consultant in the Spanish healthcare system. It was a decision, he says, he has never regretted. When he returned to Boise, Vickman decided to leave clinical medicine permanently for independent consulting.

Today, as head of his own company, The Vickman Group, he writes, speaks, and edits a newsletter about topics such as burnout and well-being. He is first to acknowledge that, besides moving to Spain, there are other ways for physicians to “establish balance in their lives.”

“[The move] was a transforming experience in our lives,” Vickman says. Importantly, it underscores the fact that “physicians have to acknowledge they are all human and therefore are all at risk.” This means considering individual “preventive counseling” sessions for physicians to let them know how they are coping and whether they are at risk for burnout.

“I think [counseling is] valuable. When we get into trouble at the hospitals or in our practices or in our personal lives ... we really [need to] stop and find the professional help to [deal with] it,” Vickman says.

Often, when it comes to their own problems, physicians “are blind,” he adds. “MD equals ‘malignant denial.’ We deny like crazy.”

New skills, new goals

That cult of denial may be starting to change - albeit slowly. When physicians contact Gigi Hirsch, MD, an emergency medicine physician who founded a physician career consulting business, she finds they are often coming to her at an earlier stage of burnout - or even before they reach that first stage.

“They are aware of the landscape. They are hearing a lot of people are burning out. They’re not burned out yet, but they are being very proactive in thinking to the future,” says Hirsch, CEO of Boston-based MD IntelliNet, LLC.

At the company’s Web site, physicians answering a survey say they’re interested in seeking their next career stage.

Hirsch, author of a new book, Strategic Career Management for the 21st Century Physician, published by the American Medical Association, is not surprised by the change. She says that the old medical model of “heavy training in a narrow area of technical expertise” in which physicians stay for their entire careers, is a blueprint for burnout.

Instead, she says, physicians should start as early as possible in their careers to “develop at least one other skill set that allows them to use their medical expertise in a way other than direct patient care.” This can include clinical research, medical software development, medical informatics, and medical-legal consulting.

“Some piece [of the physician’s] time - maybe a day or a week - can be spent on these diverse activities. They can diversify their income streams and develop other skill sets and experiences,” Hirsch says, adding that diversifying also helps “prevent burnout or slow down the burnout process.”

‘Clash of expectations’

One area that can cause burnout is the “clash of expectations” that can occur within a practice over issues such as autonomy, appropriate infrastructure support, or technology use, says John-Henry Pfifferling, PhD, founder and director of the Center for Professional Well-Being in Durham, N.C. When these clashes occur, “there’s always an emotional cost - the burnout stress syndrome in the early, middle, or late stages,” he says.

But a number of actions can be taken to reduce the occurrence of burnout among physicians in a practice. They include:

• Addressing excess workloads. Physicians expect to have appropriate time with patients to listen, be empathetic, and take a suitable history. However, the time allotted for this can be strictly limited under certain payment models - and can become a hindrance to some physicians in providing appropriate care. According to Pfifferling, this “creates a tremendous clash” for conscientious providers. To reduce burnout, practices need to take a careful look at time spent in relation to the complexity, intensity, and volume of various tasks - and modify appropriately.

• Emphasizing collegiality. “A community of caring” needs to be available as physicians and other health professionals work together, Pfifferling says. “If I’ve got to be an island - and I don’t take advantage of what the benefits of teamwork and cooperation offer - then I’m in trouble. The more community ... or collegiality or cohesiveness, the less burnout.”

• Establishing appropriate reward systems. Rewards can mean anything from more money to a better parking space to more help. For instance, a physician who handles the difficult cases in a practice, but who is swamped with paperwork, could receive additional assistance from a medical scribe.

• Ensuring congruent values. Incongruent values are established if a practice says it values honesty but the individuals rewarded are dishonest, or if it says it values confidentiality but gossip is rewarded. “If you want burnout, don’t walk your walk,” Pfifferling says.

• Promoting creativity. This encourages new ways of thinking. “Make sure that you offer creativity training so [a provider’s] left brain and right brain are nurtured,” Pfifferling says.

• Offering conflict resolution and med-iation options. Mediation is not about winning or losing, Pfifferling emphasizes. However, it can be useful in turning practices around when conflict or disagreement exists, and in reducing burnout stress syndrome in the long run.

Janice C. Simmons can be reached at editor@physicianspractice.com.

This article originally appeared in the March/April 2001 issue of Physicians Practice.