Isolation, changing landscape may lead to burnout; expert says physicians need ‘support’
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As the medical profession continues to advance and change, support – both from colleagues and organizations – may be key to reducing physician burnout, according to the director of the Stanford WellMD Center.
Citing evidence that showed burnout is more common in individuals who pursue a career in medicine compared with those working in other professions, Tait Shanafelt, MD, also chief wellness officer at Stanford Medicine, told the audience at ASN Kidney Week that he was invited to give his presentation before the COVID-19 pandemic occurred. However, he stressed that burnout has presented health care workers with challenges well before the pandemic.
“I think none of us anticipated what we’d be dealing with now and how much the pandemic has changed all aspects of our personal and professional lives,” he said. “And yet, we were dealing with some chronic challenges even before the pandemic. The last decade has been a particularly challenging time for physicians. Extensive literature has documented a host of domains of occupational distress as being a challenge for health care workers broadly and physicians specifically.”
Shenafelt defined burnout as a syndrome of depersonalization (“treating patients as if they’re objects”), emotional exhaustion (“losing enthusiasm for your work”) and low personal accomplishment (“losing the sense that you’re making a difference or that your work matters”). All of these factors can cause physicians to have decreased effectiveness at work, according to Shenafelt.
“This syndrome differs from the global impairment of depression, because it specifically relates to your professional sphere of life and is most common among individuals whose work involves an intense interaction with other people,” he said.
In addition to the fact that physicians often work more hours than those holding other forms of employment (with 44% working more than 60 hours a week vs. 8% in other professions), Shenafelt argued there has been an increase in rates of physician burnout in recent decades, which coincides with significant changes in the medical realm.
These changes include more regular use of electronic health records and e-prescribing.
“Over the last 2 decades, we’ve become more isolated,” he said. “Medicine has always been emotionally demanding work, and one of the things that has gotten us through is the amazing colleagues who we work with – people who are committed to supporting each other. And as we’re moving faster with greater productivity and more time spent documenting in the EHR, we’re less connected to one another and that perhaps has weakened something that has protected us from the challenges all these years.”
While he maintains that support from colleagues is essential to mitigating burnout, Shenafelt stressed organizations must also provide adequate support.
For example, he said Stanford has extended the time in which junior faculty can be promoted so they do not have the additional stress of a “ticking promotion clock.” This allows for flexibility and focus on what matters to them outside of their careers.
“Our organizations need to create feedback channels that enable physicians and other health care workers to tell them and the leaders what they need,” Shenafelt said. “We need to try to provide the support we can for tangible needs.”
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Shanafelt T. Reducing physician distress: Organizational approaches to improve physician well-being. Presented at: ASN Kidney Week. Oct. 22-25, 2020 (virtual meeting).
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