1. Metro Health – University of Michigan Health
Physician Burnout
David Berg DO
Emergency Medicine
Metro Health – University of Michigan Health
January 2018

2. Financial disclosures
None

3. Objectives Define burnout as it relates to the practicing physician
Provide a history and current update of physician wellness and how it is integrated into the current medical education system.
Discuss the extent, major contributing factors, and consequences of the burned out physician
Provide resources and diagnostic tools for recognition of clinical burnout

4. Scary Statistics
A study by Shanafelt and colleagues studied two groups of physicians from 2011 to 2014
Using the MBI, 3310 physicians surveyed in 2011, 45.5% had at least one symptom of burnout
In 2014, 54.4% of 3680 physicians surveyed

5. Scary Statistics
Physicians in front line specialties (Emergency Medicine, Internal Medicine, and Family Medicine) are at greatest risk Female physicians are 1.6 times as likely to experience burnout than men

6. Scary Statistics
Burnout is not just unique to physicians. A study completed by McHugh MD et al. found that 34% of nurses working in the hospital and 37% of nurses working the in nursing homes experienced burnout.

7. What is Burnout?
Webster defines burnout as: “exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration”
Physical, emotional and mental exhaustion caused by long term involvement in emotionally demanding situations

8. What is Burnout?
Truthfully is Difficult to define There is a huge literature base, many authors put their own spin on it, and it means different things to different people at different times Cristina Maslach, Professor of Psychology at the University of California at Berkley, had created the Maslach Burnout Inventory

9. Maslach Burnout Inventory
Defines burnout as: “an erosion of the soul caused by deterioration of one’s values, dignity, and spirit.” This Inventory model goes on to explain 3 components of burnout that are now widely used to define the burnout syndrome.

10. 3 components of Burnout
Emotional exhaustion or loss of passion for one’s work
Depersonalization, or treating patients as objects
3. Sense that your work is no longer meaningful

11. History
From: Constance Ange. Clinician burnout in Contemporary Medicine

12. How ACGME is getting involved
A task force was utilized to update Section VI of the Common program requirements
The revision was completed in February 2017 and most of these requirenments went into effect in July 2017

13. How ACGME is getting involved
The Learning and Working Environment
Patient Safety, Quality Improvement, Supervision, and Accountability
Professionalism
Well-Being
Fatigue Mitigation
Clinical Responsibilities, Teamwork, and Transitions of Care
Clinical Experience and Education

14. Welcome to 2018!!!
As the landscape of medicine changes and physicians continue to strive to provide safe, cost effective, quality care consider these daily obstacles
Try to make varied patient clinical presentations fit within the constraints of the EHR
Learn workarounds to maneuver through unfriendly EHR user interfaces
Hunch over keyboards performing data entry that could be done by others or by cognitive support
Click boxes to prove to CMS their meaningful use of the EHR
Hassle with payers over prior authorization issues
Pick the right diagnostic code from the 10-fold increase in choices following ICD-10
Answer questions coming in through the EHR’s patient portal

15. Welcome to 2018!!!
Check state opioid databases prior to prescribing narcotic pain meds
Ensure they are conforming with multiple quality measures to ensure maximal reimbursement in 2019 through MACRA
Explain to patients that the testing and treatment that Google recommended for their symptoms is not in their best interests
Get translators or language lines into the exam room for increasingly diverse patient populations
Learn virtual visits and figure out how to get paid for them
Spend thousands of dollars and hundreds of hours on maintenance of certification, performing tasks and taking tests to prove they are current and competent

16. Medscape Lifestyle Report 2017: Race Ethnicity, Bias and Burnout
More than 14,000 physicians from 30 specialties responded to this survey
Burnout rates have been trending upwards since 2013 (from overall 40% from the first survey to overall 51%)
Severity of burnout is not consistent with burnout rates

17. Medscape lifestyle report 2017

18. Medscape lifestyle report 2017

19. Respondents were asked to rate the severity of their burnout on a scale of 1 to 7 where 1 equals “it does not interfere with my life” to 7 “it is so severe that I’m thinking of leaving medicine altogether’. Of note, ER and primary care physcians did not have the highest rates of burnout severity.

20. Consequences of Burnout
Professionally 1. Decreased patient satisfaction 2. Increased medical errors 3. Increased litigation Personally 1. Increased rates of depression 2. Increased rates of substance abuse 3. Decreased quality of interpersonal relationships 4. Increased rates of early retirement

21. Medscape lifestyle report 2017

22. Medscape lifestyle report 2017

23. Scoring the MBI
Section A: Burnout Burnout (or depressive anxiety syndrome): Testifies to fatigue at the very idea of work, chronic fatigue, trouble sleeping, physical problems. For the MBI, as well as for most authors, “exhaustion would be the key component of the syndrome.” Unlike depression, the problems disappear outside work. Total 17 or less: Low-level burnout Total between 18 and 29 inclusive: Moderate burnout Total over 30: High-level burnout

24. Scoring the MBI
Section B: Depersonalization “Depersonalization” (or loss of empathy): Rather a “dehumanization” in interpersonal relations. The notion of detachment is excessive, leading to cynicism with negative attitudes with regard to patients or colleagues, feeling of guilt, avoidance of social contacts and withdrawing into oneself. The professional blocks the empathy he can show to his patients and/or colleagues. Total 5 or less: Low-level burnout Total between 6 and 11 inclusive: Moderate burnout Total of 12 and greater: High-level burnout

25. Scoring the MBI Section C: Personal Achievement
The reduction of personal achievement: The individual assesses himself negatively, feels he is unable to move the situation forward. This component represents the demotivating effects of a difficult, repetitive situation leading to failure despite efforts. The person begins to doubt his genuine abilities to accomplish things. This aspect is a consequence of the first two.
Total 33 or less: High-level burnout
Total between 34 and 39 inclusive: Moderate burnout
Total greater than 40: Low-level burnout
A high score in the first two sections and a low score in the last section may indicate burnout.
Note : Different people react to stress and burnout differently. This test is not intended to be a scientific analysis or assessment. The information is not designed to diagnose or treat your stress or symptoms of burnout. Consult your medical doctor, counselor or mental health professional if you feel that you need help regarding stress management or dealing with burnout.

26. Self care – Not the physicians’ strength
Less doctor visits for themselves
Self-prescribe drugs (i.e. will not see a doctor)
Perceived (??) stigma around seeking help or support
Willing to work when sick… and expect the same from colleagues (but not patients)
Denial and avoidance – physician coping strategies
Poor record of mutual support and positive feedback in the field
Protecting the privacy of colleagues
Doctors are self-reliant, individually driven, achievers who are industrious and self-sacrificing

27. What does self care look like for you…
Self-compassion
Reframing
Gratitude and appreciation
Humor
? Financial goals
Time for yourself
Sleep
Food
Aligning with your values

28. Resources for Physician Wellness
Did you know?????
Metro Health has its own resources for physician wellness available through the metronet!!

29. Resources for Physician Wellness
– Physician Health First

30. References
Harley, Phil; Beating Burnout: Physician Heal Thyself: A guide for busy, tired and stressed doctors. CreateSpace Independent Publishing Platform, 2016.
Gergen-Barnett, Katherine, “In Pursuit of the Fourth Aim in Health Care: The Joy of Practice,” Med Clin North Am Sep;101(5):
Stultz, Tara, “Would You Do It All Over Again?” Medical Economics, Oct. 22, 2010.
Dechant, Paul, “Stop Piling on Physicians : The Last Straw of Burnout”, KevinMD.com, Aug. 6, 2017
C. Maslach, S.E. Jackson, M.P. Leiter (Eds.), Maslach Burnout Inventory manual (3rd ed.), Consulting Psychologists Press (1996)