Fierce exclusive: Physician wellness experts on combating burnout

Like a lot of people, I suffered my first real heartbreak when I was in college. Don't tell any of my boyfriends from that four-year span, but I'm not talking about the demise of a relationship. What happened during that crisp New England cross-country track season of my junior year was that my body began to succumb to the effects of over-exercise. The harder I pushed my legs and lungs to go faster and farther, the slower, more painful and disappointing the task became. In races, my performances progressively declined.

I was burned out. With no physical illness or injury to blame for being sidelined, I felt like a failure and as though I'd lost a major part of my identity. Although the experience was temporary and not hinged to my career, it's not one I'd ever want to repeat, emotionally or physically.

And it is most certainly not a condition I'd want present in my doctor.

But according to a new study published in the Archives of Internal Medicine, 46 percent of more than 7,000 surveyed U.S. physicians reported at least one symptom of professional burnout, such as emotional exhaustion, low enthusiasm, cynicism, depression, suicidal tendencies, negative views on work-life balance and low professional esteem.

Members of the general public experience burnout, too, according to the researchers from the Mayo Clinic, but not at nearly the same rate as individuals with an M.D. or D.O.

To gain insights into the pervasive problem of physician burnout—and how to prevent it—FiercePracticeManagement spoke to physician-wellness experts Alan H. Rosenstein, M.D., a California-based internist and medical director for Physician Wellness Services (PWS) in Minneapolis, which provides employee-assistance programs and consulting services for docs; Mike Paskavitz, editor-in-chief at online physician learning collaborative QuantiaMD; and Michelle Mudge-Riley, D.O., president of Physicians Helping Physicians, an organization that provides career and personal development services for physicians and their families.

For starters, not one of the three was surprised by the research showing that nearly half of U.S. physicians experience symptoms of burnout. The findings were consistent with previous research conducted by PWS, according to Rosenstein, and perhaps even on the low side for some specialties, added Mudge-Riley.

Treat physicians as a precious resource
Although medicine has always been a demanding profession, Paskavitz said he suspects that significantly more physicians are experiencing burnout today than in the past. "Physicians are being measured in ways that previous generations never were," he said. "They're also facing an increase in the population and the population that needs the most healthcare, plus the shortage of primary care physicians. So you do all the math and it adds up pretty easily to what could be a burnout equation."

Awareness of physician stress and its consequences has improved in recent years, Rosenstein noted, but organizations' approach to addressing the problem still leaves much to be desired, as a mere 17 percent of stressed physicians PWS surveyed said their organizations had done anything to help their situations. As a result, the physician workforce continues to dwindle as doctors leave clinical practice for a more manageable lifestyle, he said. "Physicians are a precious resource," Rosenstein said, "and we really have to try to work with them to try to address what some of their issues are."

While practice leadership can't do anything to change CMS regulations or other external factors that impact physicians, they can provide tools and resources to help physicians better understand and cope with the issues they face by providing or directing physicians to appropriate coaching, mentoring or counseling services, Rosenstein said. But for physicians to be willing to take part, they need to be assured that information they share will be kept confidential, he added, and that the individuals they work with have the appropriate skill set to be helpful.

If your organization is too small to have its own physician wellness program, many state medical societies and other outside organizations may be able to help. Practices should also be aware of the ways they can take some pressure off of physicians through means they can control, such as helping them with scheduling, ensuring adequate staffing and reducing work hours if needed, he said.

Urge docs to care for themselves
Physicians can also proactively reduce their own stress by becoming better educated about the aspects of practice in which they received little to no training, such as coding, documentation and business management, noted Mudge-Riley, who often helps direct physicians to educational resources on such topics.

What's more, physicians need to take their own physical and emotional wellness more seriously. When PWS asked physicians what they should be doing for themselves to reduce stress and burnout, they admitted that they should sleep more, exercise more, take more vacation, volunteer for fewer committees and task forces and learn to say 'no' to patients.

"And that's all well and good," Rosenstein said, "but very few of them come through and do it. Everything else gets in the way and … other things become secondary priorities."

The good news, however, is that some of the most effective defenses against stress are rather simple.

"Personal wellness can actually be the one thing that can help a doctor be less stressed and help him or her balance things better and be a better doctor," Mudge-Riley said. To help ensure that activities such as exercise or quiet reflection actually happen, she suggested physicians block off the time to do so in their schedules. "There are going to be emergencies and it won't always happen, but just scheduling it in seems to help it happen more often," she said.

Finally, whether you are a physician or an administrator, remember that there are not one but two compelling reasons to make physician well-being a priority.

"One is just looking at physicians as human beings. And anyone experiencing burnout deserves compassion and support and relief," Paskavitz said. "But also look at the fact that the physicians are responsible, in the cockpit if you will, of taking care of patients who really need them to be on top of their game."

How does your practice work to keep physicians happy and healthy? As always, we love to hear your comments and feedback. -Deb (@PracticeMgt)

Read more on