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Sense of control, autonomy key to decreasing burnout

To reduce the high rates of physician burnout, health care systems must allow clinicians to increase their sense of control and autonomy, according to a viewpoint published in JAMA Psychiatry.

“An extensive literature describes potential solutions, including meditation and mindfulness, stress and resiliency training, small discussion groups, coaching, time management, exercise and reduced work shifts,” Frederick Seacrest Southwick, MD, department of medicine, University of Florida College of Medicine, and Steven Mark Southwick, MD, department of psychiatry, Yale University School of Medicine, and the VA National Center for Post-Traumatic Stress Disorder, wrote. “In our view, these approaches do not adequately address a primary contributor to burnout.”

Instead, according to the authors, resilience research provides a neurocognitive construct that allows for a better understanding of the factors that can lead to burnout and a scientifically informed approach to prevention. The degree of control someone exerts over a stressor impacts both the behavioral and physiological effects of that stressor, they explained. High levels of control and autonomy are related to high levels of job performance and well-being along with low levels of work-related stress, Southwick and Southwick wrote. Resilience research shows that clinicians can most effectively deal with stress by using active coping mechanisms.

Today, clinicians are more likely to take part in large health care systems as opposed to private practice settings, which can leave little room for personal decisions about which tests to perform, which treatments to give and how much time to spend with patients, according to the authors.

To get clinicians to take control of their work and reduce burnout, the authors urge health care organizations to implement a specific leadership model that that supports their active participation.

“Modern health care is highly complex and interdependent, and it is crucial to effective service provision that physicians share administrative and policy leadership positions with nonphysician health care administrators,” they continued. “With their clinical expertise and training in the scientific method, physicians bring invaluable experience to administrative teams and can contribute to improvements in every process that affects patient care.”

The authors predict that the rates of burnout will stay high until health care systems get involved in helping clinicians increase their sense of control and autonomy, which will entail increased physician input in local and national health care policy, allocation of administrative time, resources and training.

“To reduce burnout, we must find meaningful and effective ways to reduce uncontrollable stress and increase the sense of control over the practice of medicine,” the researchers wrote. “Substantial scientific evidence supports our strong recommendation that physicians play a major role in actively leading the redesign of our health care delivery systems.” – by Savannah Demko

Disclosures: Steven Mark Southwick reports funding by the VA National Center for PTSD and the Glenn H. Greenberg Professorship of Psychiatry, PTSD and Resilience.