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Modest changes should be given priority over mandatory wellness interventions
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There are too many gaps in our understanding of physician burnout to require mandatory regular wellness interventions. We support modest strategies, including: open forums to discuss the challenges of practicing medicine in an organization, offering voluntary screening and intervention programs and, most importantly, asking physicians what really matters. Although burnout may be a national problem, the solutions, we believe, will require changes that can only occur on a local level.
We are struck by the paucity of qualitative or mixed-method studies of physician burnout. Survey data tell us very little about why physicians report feelings of emotional exhaustion, callousness toward others or low sense of personal accomplishment. Nor do we have enough data to know how these feelings vary over time and what factors alleviate or exacerbate them. Surveys published to date show an impressive array of correlations with adverse consequences. It bears remembering, however, that correlations are not proof of causal links or directionality.
If we were to intervene, what intervention would we choose? An organization can enhance the work environment by fostering a more collaborative team approach, improving the efficiency of patient care (clinic patient flow, transfer of patients and admission process) and physician workflow (reducing interruptions, improving the ease of documentation process, and improving the ease of ordering tests and treatments). Such interventions would have broad and positive effects on providers, patients and families. In the meantime, identifying challenges with physician self-care and offering voluntary programs to improve coping make some sense. The opportunity costs are real and should be taken into account.
There may be unintended consequences of mandatory interventions. We believe a greater risk to physician well-being is incorrectly identifying burnout as the most pressing problem and then failing to provide effective interventions — in a sustained manner — that make a difference to providers. The sense of urgency about intervention may reflect the interests of researchers, educators and administrators more than the interests of practicing physicians. Furthermore, mandates are, by definition, forced upon physicians. They may increase anxiety and reduce autonomy.
Mandates should be directed toward the most relevant challenges identified by physicians and given justifiable attention and resources. Let’s take our time and get it right.
For more information:
Jose M. Azar, MD, is a hematologist-oncologist at Indiana University Health. He can be reached at 535 Barnhill Drive, RT 473, Indianapolis, IN 46202.
Larry Cripe, MD, is a hematologist-oncologist at Indiana University Health. He can be reached at Indiana Cancer Pavilion, Suite 473, 535 Barnhill Drive, Indianapolis, IN 46202.
Disclosures: Azar and Cripe report no relevant financial disclosures.
Editor’s note: On March 1, we corrected the institution name of Drs. Azar and Cripe to correctly list it as Indiana University Health. The Editors regret this error.