Most everyone in medicine knows the statistics: About half of all physicians are dealing with professional burnout, and the situation is even worse for emergency physicians, who have a burnout rate of about 65 percent. (Arch Intern Med 2012;172:1;1377; http://bit.ly/2KSjUfh.)
An increasing number of hospitals, however, are investing in clinician and staff wellness from the top down by naming chief wellness officers and charging them with implementing evidence-based interventions to promote clinician well-being.
“Having an engaged physician workforce is critical for health care organizations to meet institutional objectives and achieve their mission,” wrote Tait Shanafelt, MD, and John Noseworthy, MD, in an article on executive leadership and physician well-being. (Mayo Clin Proc. 2017;92:129; https://mayocl.in/2Xe7gxZ.)
“Given the strong links to quality of care, patient safety, and patient satisfaction, there is a strong business case for organizations to reduce physician burnout and promote physician engagement,” they wrote. “Although some factors driving burnout are larger than the organization, organizational-level efforts can have a profound effect on physician well-being.”
Shortly after that article's publication, Dr. Shanafelt joined Stanford Medicine as its chief wellness officer and the director of its new WellMD Center, a first for a U.S. academic medical center. The University of Alabama-Birmingham named David A. Rogers, MD, MHPE, a senior associate dean for faculty affairs and professional development in the School of Medicine, as its chief wellness officer in January 2018. The Icahn School of Medicine at Mount Sinai followed suit in May 2018 by naming Jonathan Ripp, MD, MPH, as the senior associate dean for well-being and resilience and the chief wellness officer.
Robust Wellness Program
Dr. Ripp helped to create the Collaborative for Healing and Renewal in Medicine (CHARM), which published a charter on physician well-being. (JAMA. 2018;319:1541.) “In the year since then, the group has grown to at least 15, and there are probably an equal number of institutions that are searching for someone to establish the position,” he said. “I fully expect our ranks to swell significantly in the coming year.”
Dr. Rogers pointed to four primary sources of stress for clinicians. “There is the ordinary stress of the work we do, the micro-environment and the groups we work within, the larger organization we work in, and factors outside the organization in the health system as a whole,” he said. “A robust wellness program in a hospital or health system will address all of these factors.”
A significant amount of workplace stress results from an imbalance between the demands placed on staff and the resources they have to meet those demands. “Some resources are things provided to you, and others are inherent in you,” Dr. Rogers said. “We are where we are in health care in large part because we've continued to layer on demands on our clinicians without giving them additional resources. A common theme we are hearing is that so much of clinicians' time is taken up with tasks that are not related to their core profession of physician, nurse, or advanced practice professional.”
Solutions to clinician burnout must go beyond the level of the individual, Dr. Ripp said. Past efforts have traditionally focused on providing additional skills and resources to encourage physicians to be more resilient, but the conversation has now become more robust, he said. “We shouldn't be putting the onus on the individual working within a complicated system that is placing increasing demands on them.”
One area of focus, for example, is the electronic health record and the added burden it places on clinicians. “It's been said that today's physician is the world's most highly trained data entry clerk,” Dr. Ripp said. “One way some of this can be addressed is through the role of the medical scribe, a fast-growing element of the health care system that allows the physician to focus on the higher-level clinical decision-making tasks for which they've been trained. But we're not going to fix this problem by addressing the EHR documentation burden alone. It's incredibly complex. We need multidimensional strategies focused on improving the culture at the micro-environment level, the institutional level, and in health care as a whole.”
Whether your institution has a chief wellness officer (yet), Drs. Shanafelt and Noseworthy listed organizational strategies to promote physician well-being in their Mayo Clinic Proceedings article, noting that “small investments can have a large impact,” many of which are cost-neutral. Some of these include:
- Harness the power of leadership. Characterize core competencies and establish formal strategies to identify, develop, and equip physician leaders. Have the courage to change leadership when necessary.
- Develop and implement targeted interventions. Identify work units with particularly high burnout rates and engage them in a collaborative process to identify factors that could be addressed quickly.
- Cultivate community at work. A dedicated meeting area at Mayo's Rochester campus with free fruit and beverages, computer stations, and lunch tables “rapidly became an incubator” for peer interaction and camaraderie within three years and was expanded to other campuses, they noted.
- Use incentives wisely. Rewards such as greater flexibility or protected time to pursue personally meaningful aspects of work can promote personal and professional fulfillment and might affect burnout and satisfaction more than financial incentives.
- Promote flexibility and work-life integration. Consider tailored work hours and flexible scheduling, and ensure that your approach to vacation and family benefits does not disincentivize the use of these benefits.
“I think health care has reached a place where there is a good understanding of the significance of this issue and the fact that it has an impact on almost every element of the health care system,” said Dr. Ripp. “It really is a moral imperative. Now we just need to keep pushing the agenda to drive the increasing recognition from the top of just how important this issue is, and the need for more institutions to make the commitments that ours have made.”
Ms. Shawis a freelance writer with more than 20 years of experience writing about health and medicine. She is also the author of Having Children After Cancer, the only guide for cancer survivors hoping to build their families after a cancer diagnosis. You can find her work atwww.writergina.com.