When Neil Young famously sang, “It’s better to burn out than to fade away,” it’s safe to say he didn’t have doctors in mind. Unfortunately, though, too many physicians are following the veteran rocker’s prescribed path.
Instead of putting in decades of service and easing gracefully into hard-earned retirement, U.S. physicians are experiencing professional burnout in greater numbers. Frustrated and emotionally drained, some are leaving the profession entirely.
The state most susceptible to burnout is Texas, which registered the lowest morale rate in the Physicians Foundation’s “2016 Survey of America’s Physicians.”
Pockets of organized medicine are stepping up to address burnout, to give physicians a place to talk about their problems and grievances, and to rekindle their professional fire.
For example, county medical societies are beginning to offer counseling and other services to their doctors. Last summer, the Travis County Medical Society (TCMS) began its own burnout buster, launching a Physician Wellness Program believed to be the first of its kind in Texas.
Efforts like that are imperative not only for physicians’ own well-being, but also because physician burnout affects patient care.
“We have [all] experienced a number of undesirable behaviors that reflect either personality issues but are most often precipitated by people who are just tired, burned out, and irritable,” said Virginia pediatrician Russell Libby, MD, a board member of the Physicians Foundation. “And we sometimes would overlook those as, ‘Oh, that’s just his personality,’ or ‘That’s just what happens at the end of a long workday.’
“But in fact, these are all reflections and really represent burnout in physicians, and it does impact the workforce.”
Someone to talk to
Physician burnout springs from many potential roots. Increased legislative and regulatory hurdles, such as the regulations that essentially force physicians to adopt electronic health record (EHR) systems, are typically cited as one common cause.
Brian Sayers, MD, chair of TCMS’ Physician Health and Rehabilitation Committee, (left) says loss of physician control over practices is one escalator. That can come from the slow erosion of the independent practice of medicine as more doctors become employees and/or join large groups. And the burden of navigating an EHR system often dictates how a physician spends his or her time.
“We have just lost control of our daily practice lives, almost at every turn you look at, so that’s part of it. Physicians have certain expectations about themselves and issues with being perfectionists,” Dr. Sayers said. “And when things go wrong, if you don’t have colleagues to talk to or some outlet for those worries or frustrations, that’s a big issue.”
The “2016 Survey of America’s Physicians” painted a fairly dire portrait of doctors’ enthusiasm. More than half of survey respondents, 54 percent, rated their morale as “somewhat or very negative,” and 49 percent often or always experienced feelings of burnout.
At the very bottom of the list, more than 60 percent of the Texas respondents in the survey described their morale and feelings about the current state of the medical profession as somewhat or very negative. (See “Texhaustion,” below.)
Counseling sessions through county medical societies may be one way to bring some negative numbers down. Inspiration for the TCMS wellness program came from a similar program maintained by Oregon’s Lane County Medical Society, based in Eugene. The Lane County society’s Provider Wellness Program began in 2012 after a series of physician suicides. The program includes confidential counseling with psychologists.
“Our starting point was that traditional CME-based programs and journal articles [alone] just don’t get the job done,” Dr. Sayers said.
He says the TCMS Wellness Program has three components:
- Continuing medical education (CME) programming, which he says still offers value;
- A schedule of small-group gatherings where frustrated physicians can speak freely and support each other; and
- The Confidential Coaching Program, a counseling service with a 24-hour support line.
“We looked at all of the things that keep physicians from getting help when they need help, whether it’s burnout or marital problems or mood disturbance or substance abuse,” Dr. Sayers said. “And we took those roadblocks one by one and developed this program where people could call completely anonymously; no medical records kept, no records of who called in the medical society office. … So it’s an anonymous, confidential, nonreportable, free counseling service, essentially.”
TCMS pays for at least the first four counseling sessions.
“The whole purpose is to get people in the door, because they’re not going to go to their colleague; they don’t know even who to go to,” said Belinda Clare, chief operations officer for TCMS. “If the hospital provides an employee assistance program, they still don’t trust that it’s not going to get back to the administrator. This is just to [say], ‘Here’s a safe place.’ ”
TCMS received a $150,000 grant from the Physicians Foundation last year to work with other medical societies to create a Physician Wellness Program toolkit for organizations that want to start their own wellness programs. More information is available at tma.tips/pf-travis.
The Harris County Medical Society (HCMS) is working to help burned-out doctors, too. HCMS President George Santos, DO, a Houston psychiatrist, says the society has made services available to help physicians navigate financial issues, challenges with insurers and their coverage denials, and work-life balance skills.
HCMS also had guest speakers attend branch meetings to talk to physicians about burnout. Those branch meetings, he says, have become sites where doctors can experience mentoring they don’t otherwise have time for.
“We’re trying to do that very early and engaging medical students and residents in the whole process of utilizing organized medicine as a support system as you go through training and go into practice and developing those things,” Dr. Santos said. “Especially for the things that physicians are probably not the best at and cause a lot of stress — like how do you deal with legal issues and contracting issues? And right now, there’s a growing number of employed physicians. We take a great deal of effort at trying to provide support services for physicians who are going into employment settings.”
“Anything that helps reduce red tape”
Another avenue to attack physician burnout is dialogue and advocacy, whether talking directly with influential lawmakers or battling for or against legislation and existing laws when appropriate. The Texas Medical Association’s Council on Legislation keeps close tabs on how the initiatives of lawmakers in Washington, D.C., and Austin affect the practice of medicine, and they always are on the lookout for proposals that could drive doctors into a career change.
County organizations play a role, too.
HCMS says its leadership has met a number of times with U.S. Rep. Kevin Brady (R-Texas), chair of the House Ways and Means Committee, to discuss regulatory burdens. At the state level, Dr. Santos pointed to medicine’s victory on step therapy during last year’s session of the Texas Legislature.
“Those kinds of efforts, which have been successful, are very helpful and really reduce a lot of the frustration for a physician when you’ve got some nebulous insurance company telling you what to do with your patients yet they’re not being held accountable for the negative outcomes of their decisions,” Dr. Santos said.
It’s all an effort to address not only the proven effect physician burnout has on doctors, but on their patients as well — an effect Dr. Sayers says has been shown in medical literature to be “pretty alarming.”
“Physicians who are burned out are impaired in their ability to deliver good care,” he said. “Just like they are impaired if they are having problems with alcohol or any of the other things that can impair people.” [Symbol]
The Physicians Foundation’s “2016 Survey of America’s Physicians” found Texas had the lowest physician morale rate in the nation. Some of the Texas results from the survey, covering 2,044 responses:
- 61.2% said their morale and feelings about the current state of the medical profession were somewhat or very negative — the highest rate in the nation.
- 69.1% were somewhat or very negative/pessimistic about the future of the profession.
- 70.6% said if they could get a do-over on their career, they would still choose to be a physician.
- 52% said they would not recommend medicine as a career to their children or other young people.
- 54.5% said they plan to accelerate their retirement because of changes in health care.
When asked what two factors were most satisfying about medical practice, Texans’ top responses were patient relationships (78.7%) and intellectual stimulation (57.8%). The top answers for the two least satisfying factors? Regulatory/paperwork burdens (64.1%) and erosion of clinical autonomy (36.5%).
TMA Can Help
Is burnout infecting your office? TMA’s practice management consultants can help identify what’s causing it and how widespread it is within your practice. From there, you can implement changes that could reinvigorate your team. Contact TMA Practice Consulting at (800) 523-8776 or practice.consulting[at]texmed[dot]org for more information.
The TMA Committee on Physician Health and Wellness promotes the health and well-being of physicians, including those dealing with burnout. Its services include continuing medical education courses, drug-screening programs for physicians, and a confidential help line: (800) 880-1640. Find more at www.texmed.org/PHW.
Tex Med. 2018;114(4):10-13