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Physician Wellness Services and Cejka SearchPhysician Stress and Burnout: Cause, Effect and What Can Be Done About It

Alan Rosenstein, MD, MBA, Medical Director, Physician Wellness Services


Physician Wellness Services

Physician Wellness Services provides a coordinated, comprehensive and confidential suite of services designed specifically for physicians and the organizations that employ them. National in scope, with wide-ranging expertise in every aspect of behavioral health. The Physician EAP Physician Intervention Services Training and consulting services

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Physician Stress and Burnout: Causes, Effects and What Can Be Done About It

Develop a better understanding of physician stress and burnout

Identify and address organizational factors that may be contributing toward physician stress and burnout

Demonstrate increased understanding of and commitment to physician well-being in the existing physician population and to potential candidates

Design wellness programs for physicians to help them cope with the stressors in their lives

Formulate retention and recruitment strategies and initiatives to reduce turnover

Learning Objectives


Physician Stress and Burnout Survey

Web-based survey deployed in September, 2011 to nationwide, multi-specialty panel of 115k

2069 completed surveys representing 99% confidence level, +/- 3% margin of error against 750k active physician population in the US• Slight skew to non-primary care physicians• Skew more female, somewhat younger

than active physician population; average age 45.3 years

• Average years in practice: 13.1 • Employed by hospitals (41.3%), single or

multi-specialty practice (41.0%)

Methodology



Almost 87% of physicians identified themselves as moderately or severely stressed and/or burned out

37.7% identified themselves as severely stressed and/or burned out

70.4% scored themselves in the upper 50th percentile

Prevalence of Stress and Burnout


Stress Level

Not at all 1

2

3

4

5

6

7

8

9

Extremely 10

0.0% 5.0% 10.0% 15.0% 20.0% 25.0%

1.8%

3.8%

7.5%

7.4%

9.0%

12.3%

20.4%

22.4%

11.2%

4.2%



62.3% of physicians identified themselves as more stressed and/or burned out compared to 3 years ago

The largest number of respondents (34.3%) identified themselves as “much more stressed” than they were 3 years ago

Change vs. 3 Years Ago


Stress Compared to Three Years Ago

Much less stressed than I was 3 years ago

Somewhat less stressed than I was 3 years ago

About the same level of stress as 3 years ago

Somewhat more stressed than I was 3 years ago

Much more stressed than I was 3 years ago

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

7.5%

11.2%

18.5%

28.6%

34.3%



Stress and burnout had multiple causes, measured across 3 sectors:• External factors• Work-related factors• Personal life-related factors

Effects were measured across work life and personal life

Difficult to control or address for external factors directly, but there are more options regarding the work and personal life

Survey Results: Cause and Effect



Top 3 external factors were:• The state of the US economy, in general (51.6% of

all respondents)• Healthcare reform (46.4%)• CMS policies (41.2%)

Top 3 work-related factors were:• Paperwork and administrative demands (39.8% of

all respondents)• Too many hours of work (33.3%)• On-call schedules and expectations (26.2%)

Top 3 personal life-related factors were:• Not enough time to relax or for leisure/recreational

activities (52.6% of all respondents)• Not enough time for exercise or wellness activities

(50.6%)• Concerns about work/life balance, in general

(45.0%)

Top 3 Factors Causing Stress and/or Burnout—External, Work-Related and Personal-Life Related Sectors



The top 2 work-related impacts of stress and/or burnout were:• Lower job satisfaction (51.2% of

respondents)• Desire to work fewer hours (41.2%)

The next cluster indicated an overwhelming desire by respondents to do something different than what they are currently doing, job- and career-wise:• Desire to retire early (29.9%), desire to

leave the practice of medicine entirely for another career (27.6%), desire to switch jobs (21.8%) and desire to switch to a new practice (15.9%)

Work-Related Impacts of Stress and/or Burnout



The top 3 personal life-related impacts of stress and/or burnout were:• General feelings of tiredness (41.4% of

respondents)• Less sleep or problems sleeping

(36.7%)• General feelings of irritability and

moodiness (33.9%) The next cluster involved impacts on

their personal health (24.7%) followed closely by more conflict with a spouse or partner (22.6%)

Personal Life-Related Impacts of Stress and/or Burnout



Decreasing job satisfaction Decreasing productivity Insufficient work/life balance Conflict at work and at home Feelings of irritability, moodiness, anger and

hostility General tiredness, lack of sleep and difficulty

sleeping Negative impacts on physical health Negative impacts on mental health such as

depression and anxiety, or symptoms such as apathy and cynicism, less interest in engaging with others, or in normal activities

Patient safety-related concerns such as difficulty making decisions, communicating effectively with others, and increased risk of medical errors

Physicians Are Suffering From a Number of Effects of Stress and Burnout



Increased turnover and retention challenges

Patient safety and quality issues Lower productivity Disruptive behavior and lower

morale

Consequences for Healthcare Organizations



What are organizations doing—and what should they be doing?

What are physicians doing—and what do they want and need?

Survey Results: What is Being Done—and What is Needed?



When asked, open-ended, for the top 3 things that would reduce stress and burnout, physicians said:• Better work hours and/or less call

(32.5% of respondents)• More or better work/life balance

(30.7%)• Improved finances, compensation,

reimbursement (29.0%) Generally, throughout the survey,

financial-related factors were far down the list relative to other factors

Top 3 Things to Help Reduce Stress and Burnout



When asked if their organization currently provided support for stress and/or burnout, only 15.7% said yes

The top initiatives cited were:• Wellness initiatives (30.6%)• Workshops and education (29.3%)• Onsite exercise facilities or classes (19.1%) • EAP, counseling or other behavioral health

services (15.4%) Several respondents noted that it was

difficult to find time to utilize services, especially during normal clinical hours, and some were not available after hours

Current Organization-Sponsored Initiatives to Address Stress and Burnout



When asked what organization-sponsored initiatives they would like to help address their stress and burnout, physicians asked for:• More ancillary support, such as physician

aides, to deal with things like paperwork and charting (63.0%)

• Onsite exercise facilities or classes (38.9%) The next cluster involved wellness

initiatives (27.8%), workshops and education on managing and coping with stress and burnout (23.8%), concierge-type services (19.8%) and coaching and mentoring resources (18.5%)

Desired Organization-Sponsored Initiatives to Address Stress and Burnout



When asked what they were doing, themselves, to combat stress and/or burnout, the top 2 choices were:• Exercise (62.8%)• Spending time with family and friends

(56.9%) The next clusters were taking vacation

or time off (47.8%), watching movies or listening to music (44.3%), reading (38.0%) and getting more sleep (35.8%)

Several respondents noted that finding the time or money to do things to relieve stress was a challenge

What Physicians Are Doing to Combat Stress and Burnout



There were 3 primary areas where physicians asked for help:• More time, and more control over their

time—for the things that are most important to them at work, and to carve out more time for their personal lives and interests

• More opportunities for self-care, such as exercise and other wellness activities

• More support in helping them more effectively deal with the stress and burnout in their lives

Next Steps: What Do Physicians Need the Most?



Physicians need greater flexibility and control over their working hours to mitigate burnout and stress:• Provide more ancillary support to free up

physician time for patients, achieve better work/life balance

• Facilitate part-time and flexible work schedules

• Look for creative ways to address call:o Make it more lucrativeo Reduce regular hours surrounding callo Encourage each practice to brainstorm and

develop its own plano Allow for reduced call for those with children

under the age of 3 and those over the age of 60

What Can Organizations Do?



Physicians need more opportunities for and assistance with taking better care of themselves, and to understand and practice better self-care:• Onsite exercise facilities or classes• Workshops• Facilitated support groups• Physician wellness committees• Individual coaching• Time to take advantage of all resources• Easy accessibility—times, locations




Physicians need support on multiple levels in dealing with stress and burnout in their lives:• Physician-specific employee assistance

program (EAP)—counseling resources, coaching and mentoring, concierge-type services

• Strong Physician Wellness Committee• Education—grand rounds, workshops• Cultural change through training and

facilitated discussions—communication skills, stress and anger management, dealing with workplace conflict, building resilience, etc.

• Normalizing work/life balance




Promoting a “culture of wellness” creates a sense of being valued and increases satisfaction

• Address factors within your control: work environment, personal life impacts at work

• Provide support services• Normalize seeking help when it’s

needed—remove the stigma from doing so

• Be sensitive to physician barriers and priorities

Keeping Physicians: Retention and Recruitment



A robust Physician Wellness Committee can provide valuable support and outreach, promote a “Culture of Wellness” Clear mission and scope Committee expertise and

commitment Administration support Resources—administrative support,

budget Benchmarking results vs. goals

Physician Wellness Committees: Best Practices



The data on the negative impact of sleep deprivation on patient safety and personal health have accelerated my burnout. I feel that in the near future working more than 12-18 hours and having an adverse outcome will expose me to liability based on sleep deprivation alone.

Physicians’ burnout negatively affects patients in a myriad of ways. Many doctors feel trapped and feel they can't leave. Coaching helped me have the strength and courage to leave. I am a much better doctor since I left and came back because I take care of myself first. It took me a long time to learn how to do that. Self sacrifice is rewarded but causes so many problems.

Physician Comments From the Survey



It is a problem with so many contributing issues. Most docs I work with are unhappy. I, myself, am miserable, depressed, drinking too much and unable to formulate a plan to change—while all day I help others.

We have to find a way to help docs recognize burnout. We didn't get through medical training by thinking about how it affected us; we just put our heads down and muscled through. You can do anything for 8 years, but you can't live that way for 40 years. We need to encourage ourselves to develop an external barometer so someone can tell us we're burning out.

I think surgeons in my generation are squeezed between those who are getting ready to retire and those who are starting but already set limits on what they are willing to do (hours, time and salary). The difference is carried by those of us who aren’t at either end. No wonder we are burned out.

Physician Comments From the Survey



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For a copy of the survey results:[email protected]

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