Q&A: Multifaceted approach key to address ‘many different drivers’ of physician burnout
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Key takeaways:
- Workplaces can lessen the impact of physician burnout by providing organizational support to employees.
- Teamwork and technology may be crucial areas of research to reduce burnout.
The COVID-19 pandemic has had a significant impact on the overall well-being of the health care workforce.
As Healio previously reported, 46% of all health care workers in 2022 said they felt burned out, and 44% said they intended to look for a new job.
The January issue of Psychiatric Annals, which featured a guest editorial, “Promoting Workforce Well-Being,” by Gaurava Agarwal, MD, focused on a range of workplace initiatives to reduce burnout and improve the well-being of health care providers.
Healio spoke with Agarwal, associate professor in the departments of medical education and psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine, chief wellness executive at Northwestern Medicine and director of faculty wellness at Northwestern University, to learn more about the roles that organizational support, teamwork and technology can play in reducing physician burnout.
Healio: You begin your editorial by describing how the COVID-19 pandemic has had lasting effects on physician burnout and well-being. Can you describe the current state of the health care workforce? How prevalent is physician burnout?
Agarwal: There are many definitions of burnout that can lead you to see different prevalence rates. Although these rates are not back to pre-pandemic levels, we’re starting to see them come down in several areas. Places that are intentional about recovery and providing greater resources to their clinicians are likely seeing outsized gains. Those of us who study disaster psychiatry or psychology expected that the rest of society would recover after the pandemic, whereas the people managing it would see delayed recovery. For this reason, I hope leaders of health care systems are mindful of providing intentional recovery to their workers.
Healio: In your editorial, you write that there is no “silver bullet intervention that will fix workplace well-being for all.” Given that, how should health care systems address well-being?
Agarwal: If we look at the current conceptual models on what causes burnout for health care workers, there are many different drivers. Because each of these drivers is affected at several different system levels, it makes sense that there isn’t a one-size-fits-all solution. I always advise organizations that this is a journey that is going to take time, commitment and dedication to really see movement. For me, that means identifying a dedicated person and team who can create and drive an organizational well-being strategy; resourcing them appropriately is the place all heath care systems must begin.
Healio: You mention a decrease in civility in health care as being one driver of physician burnout. Can you describe how bias and discrimination at the bedside are becoming increasingly problematic?
Agarwal: As trust in science, health care and the medical profession decreased during the pandemic, civility did as well. Often, the comments that arise from moments of incivility veer into harassment, discrimination and microaggressions. I usually think of stress as cumulative; our brains only experience the total amount of stress. However, specific types of stress, such as discrimination, harassment and microaggressions, may be best thought of as traumatic stress. These stressors can trigger a traumatic response in some individuals with a lifetime of such experiences, and that’s why sometimes they might have responses that seem disproportionate. However, viewing it from a trauma perspective can reveal why a particular experience was so impactful.
Most of the good parts of medicine are derived from caring for patients, but when those very same patients and their families or visitors are the ones who hurt us or demean us, that impact is significant and differentially experienced in our view than potentially some other sorts of stresses.
Healio: Why should workplaces provide organizational support for these sorts of events?
Agarwal: There’s an opportunity for two types of betrayal when these events occur:
1. the trauma of patients and their visitors hurting us through discrimination bias and 2. when we feel like our organizations, leaders or colleagues don’t have our backs.
For some people, the latter hurts even more than the former.
In terms of organizational support, workplaces should send a clear message that although patients are central to our mission, that doesn’t mean we can’t also protect our workers and ensure that they have safe working conditions. When our workers feel like someone has their backs, the impact of this trauma can be lessened significantly.
In the article, we talk about the concept of saying, “I see you, I saw what happened and that wasn’t OK.” This proactive reach out to individuals who may have experienced these traumatic events is important.
Healio: How can workplaces enhance social connection among workers?
Agarwal: There are many mechanisms that workplaces use to enhance social connection, such as monthly meetings or retreats. In the article that addressed this topic, we emphasize that workplaces have to be intentional about building social connections to make sure people have them on their calendar. The program we created makes it easy to connect with your colleagues and incentivizes people to build their social capitol.
Social capitol is important because if you look at most organizations, everyone faces the same barriers to doing their job. The people who tend to succeed have created networks that help them overcome these barriers. These initiatives are important for both our clinical and nonclinical workforce, as nearly all workers identify their coworkers as key sources of what keeps them at their jobs and helps them provide the best care to patients.
Healio: Why are female physicians more likely to experience burnout?
Agarwal: Previous literature has shown that the rate of microaggressions, discrimination and harassment is higher for female physicians than male physicians. A couple of studies showed that once you correct for women having a disproportionate share of those experiences, women and men have the same level of burnout.
Additional research shows that male and female physicians interact with their patients differently, and patients interact with male and female physicians differently as well.
Female physicians tend to spend more time with their patients than male physicians do; this means they’re probably seeing fewer patients, which has a financial impact. Additionally, most data still suggest that women are doing more work at home, so if workload and stress are cumulative, that means there is more work at baseline.
Healio: What role can professional coaching play in reducing physician burnout?
Agarwal: There are many ways in which coaching can help. Physicians spend a lot of their formative time with their heads down just trying to make it to the next step of their training. Unless you have clarity about your priorities, it’s difficult to appropriately manage your time and prioritize the things you care about the most. In a field where time is probably the most valuable asset you have, getting better alignment about what your values are can be hugely impactful and help you figure out where you should and shouldn’t be spending your time.
Healio: How can the design of work be improved to mitigate shift work and circadian misalignment?
Agarwal: In this article, my colleague highlighted the idea of chronotypes, which is that some of us are night owls and some of us are morning birds; not recognizing this is a missed opportunity. It may make sense to have more night shifts if that’s when I’m most alert and at my highest performance. If people were more aware of their chronotypes, maybe they would know which shifts work best for them and therefore experience less physiological and psychological issues.
Another way you can begin to affect this work is by looking at the amount of recovery time we are giving physicians as we design the transition between shifts. We also discuss the responsibilities outside of clinical work that physicians have during recovery time. We should be mindful of the most important meetings, calls and lectures so we don’t schedule people when they are coming off call.
Healio: Beyond the areas discussed in this issue, what areas of burnout and well-being would you like research to address next?
Agarwal: There are two Ts that I believe are most likely to help us manage our growing workload: technology and teamwork. As health care begins to evolve from the hero doctor providing care to their patient to a team of people, it’s important that we ask, “How do we build teams effectively? How do we change our mindset and training to reflect the team-based aspect of this work?”
On the other hand, the hottest phrase in all our lexicons at the moment is artificial intelligence, and I have hope that AI will be able to automate some of the administrative tasks that wear people down. As we continue to research AI, it’s important that we bring in the end user from the beginning to make sure that the technology fits how we work and not the other way around. We don’t want to recreate the problems of the electronic medical record and have something that’s supposed to make our lives easier actually do the opposite.
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For more information:
Gaurava Agarwal, MD, can be reached at gagarwal@nm.org.