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Wellness
How to Measure Burnout Where You Work

ARTICLE IN BRIEF

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CHIEF EXECUTIVE OFFICERS of major health systems have pledged to address physician burnout.

How do you know if the neurologists in your practice are experiencing burnout? Organizations such as the American Medical Association, the Mayo Clinic, and the AAN are using specific surveys to answer that question in different ways.

Neurology leaders accept the research findings — US neurologists have the highest rate of burnout and a low rate of work-life balance, compared to other specialists. But how do you know it when you or your colleagues are feeling burned out?

While some are seeking to understand and address burnout among their physician colleagues, many are “quite blind to this,” says Heidi B. Schwarz, MD, FAAN, professor of clinical neurology at the University of Rochester Medical Center. “It's sort of ‘Oh, yeah—it's out there, but it's not at my place,’” said Dr. Schwarz, a member of the AAN's Task Force on Physician Burnout.

Considering that about 60 percent of neurologists report at least one symptom of burnout, most organizations have physicians who are struggling, whether they acknowledge it or not.

That is why the chief executive officers of 10 major health systems and the American Medical Association have pledged to address physician burnout. In a Health Affairs blog post, they committed to several steps, starting with this one: Regularly measure the well-being of our physician workforce at our institutions using one of several standardized, benchmarked instruments.

Neurologist John Noseworthy, MD, FAAN, chief executive officer at Mayo Clinic, has been a leader in physician-burnout research for the past decade. Mayo has been measuring burnout among its physicians since 2010 and subsequently started measuring engagement and satisfaction with work-life integration. At first, the assessments were conducted every two years, but Mayo moved to annual assessments starting in 2016.

Writing in Mayo Clinic Proceedings earlier this year, Dr. Noseworthy and co-author Tait Shanafelt, MD, said physician well-being should be a routine institutional performance metric, similar to patient volume, patient satisfaction, and financial performance.

“Organizations measure the things that they believe are critical to achieving their mission,” they wrote. “Overwhelming evidence indicates that physician well-being is equally important to the health and long-term viability of the organization, and, thus, it should be measured.”

HOW TO MEASURE BURNOUT

The wrong way to assess burnout is to ask the direct question: Are you burned out?

That is Dr. Schwarz's takeaway from a study her task force reviewed as it was preparing the Academy's survey. In that case, a group of surgeons responded to the question “Are you burned out?” and then completed a questionnaire developed by Mayo researchers.

“The majority of the people who were clearly burned out according to Mayo's validated scale felt they were not burned out,” Dr. Schwarz said. “It just shows our own lack of insight into our individual situation.”

There are many ways to assess burnout, both at the individual level and the organizational level. The important thing is to develop an assessment strategy that allows for meaningful analysis of results. This requires use of a standardized instrument, routine assessment so that changes in results can be tracked over time, and, if desired, use of an instrument with national benchmark data, which provides context for analyzing results.

ASSESS YOURSELF

Individual physicians who want to confidentially assess whether they may be suffering burnout have different options: The Mini Z Burnout Survey, a 10-item survey offered by the American Medical Association, asks participants to rate their ability to control their workload, to have sufficient time for documentation, and to describe the atmosphere of their work area (as calm, busy, hectic, for example), among other questions. Or they may want to take the nine-item screening tool developed by physicians at the Mayo Clinic, the Physician Well-Being Index; the survey is available for sale to organizations, but individual physicians can conduct their own assessments, as well.

ASSESS YOUR ORGANIZATION

At the organizational level, there is no consensus on the best way to assess the level of physician burnout. Randolph W. Evans, MD, FAAN, clinical professor of neurology at Baylor College of Medicine, suggests this approach: “Neurology groups could have their own meeting to discuss the issue after having taken the Physician Well-Being Index on their own and having done some background reading,” Dr. Evans said in an email interview. He pointed to the results of the Academy's survey as helpful information to give context to such a discussion.

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DR. HEIDI B. SCHWARZ said that while some are seeking to understand and address burnout among their physician colleagues, many are “quite blind to this. Its sort of ‘Oh, yeah — its out there, but its not at my place.’”

POPULAR SURVEY INSTRUMENTS

In recent years, Dr. Evans has spearheaded two burnout surveys — one of headache specialists and one of neurologists attending a Texas Neurological Society meeting. In both cases, he used the Maslach Burnout Inventory Human Services Survey, which asks more detailed questions about three components that define burnout: emotional exhaustion, depersonalization, and a sense of personal accomplishment.

The Maslach Burnout Inventory Human Services Survey is one component of the Academy's 2016 survey of burnout, career satisfaction, and well-being among its membership.

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DR. RANDOLPH W. EVANS: “Neurology groups could have their own meeting to discuss the issue after having taken the Physician Well-Being Index on their own and having done some background reading.”

A newer instrument that is gaining traction is the Stanford Physician Wellness Survey. First fielded among Stanford physicians in 2013, its primary finding — 26 percent of participating physicians reported at least one symptom of burnout — prompted its School of Medicine, Stanford Health Care, and Stanford Children's Health to create the WellMD Center to focus on physician wellness and start a national movement to address the issue.

The questionnaire was modified before a second survey was fielded in 2016, said Bryan Bohman, MD, chief medical officer for Stanford's University Healthcare Alliance. The new version asks respondents to evaluate domains including perceived appreciation, alignment of their personal values with those of the organization, peer supportiveness, perceived leadership support, control of their schedule, their experience with the organization's electronic health record system, self-compassion, sleep-related impairment, and meaningfulness of clinical work.

The survey instrument was developed to be generalizable to other organizations, Dr. Bohman said, and other large health systems around the country are using it to assess burnout in their own organizations. The WellMD Center and The Risk Authority Stanford, a consulting firm, recruited 10 health systems to create a Physician Wellness Academic Consortium to further develop the survey and create benchmarks that allow organizations to compare their results.

LINK UP FOR MORE INFORMATION:

• The Mini Z Burnout Survey: http://bit.ly/NTburnoutsurvey.
    • Busis NA, Shanafelt TD, Keran CM, et al. Burnout, career satisfaction, and well-being among neurologists in 2016 www.neurology.org/content/88/8/797.short. Neurology 2017;88(8):797–808.
    • Dyrbye LN, Satele D, Sloan J, et al. Utility of a brief screening tool to identify physicians in distress https://link.springer.com/article/10.1007%2Fs11606-012-2252-9. J Gen Intern Med 2013;28(3):421–427.
    • Evans RW, Ghosh K. A survey of headache medicine specialists on career satisfaction and burnout http://onlinelibrary.wiley.com/doi/10.1111/head.12708/abstract. Headache 2015;55(10):1448–1457.
    • Noseworthy J, Madara J, Cosgrove D, et al. Physician burnout is a public health crisis: A message to our fellow health care CEOs https://www.healthaffairs.org/action/showDoPubSecure?doi=10.1377%2Fhblog20170328.059397&format=full. Health Affairs blog, March 28, 2017. http://bit.ly/NT-healthaffairs-blog
      • Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: Nine organizational strategies to promote engagement and reduce burnout http://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/fulltext. Mayo Clin Proc 2017:92(1):129–146.