By Alan H. Rosenstein MD, MBA, Michael R. Privitera MD, MS
There are a growing number of surveys and reports attesting to the increasing amount of stress and burnout impacting physicians in today’s health care environment, affecting nearly 80% of practicing physicians.1 The downstream impact of protracted stress and burnout can lead to a number of problems ranging from dissatisfaction, frustration, and anger, to more serious physical and emotional states that affect behavior and can compromise work relationships and patient care.2,3 While many organizations are beginning to recognize the impact of stress and burnout on satisfaction, productivity, care coordination, and clinical performance, there are still a number of barriers that need to be resolved.
First is the issue of perception. Many physicians are working at full capacity but may not recognize that their mind and body are working under stress. The cultural norm in pre-med, medical school, and residency is to push oneself beyond usual human abilities. Usual human feedback systems are often suppressed, and even when physicians realize stress may be taking a toll, many choose to handle it themselves and are often reluctant to seek outside help because of self- ego, stoicism, questions about competency, or concerns about confidentiality. Often problems related to stress are only addressed after a career-changing decision or disruptive event occurs where intervention may be focused more on damage control than emotional support.
The second issue is that of organizational response. With the changing priorities and incentives in today’s health care market many organizations are faced with increasing demands on physicians and supporting staff to meet the evolving challenges of health care delivery. Providers have their own concerns and at times feel that changes are being made without an opportunity for their input or discussion. Organizations need to be mindful of physician and staff concerns and take a leadership role in educating, involving, and engaging clinical staff in organizational decisions.
The third issue is socio-political perception. Patient safety initiatives and the Triple Aim efforts of improving the experience of care, improving the health of populations, and reducing per capita costs of health care may have unintentionally overlooked supporting the clinicians providing the care. Hospitals and health systems have had to rapidly adjust to uncoordinated mandates from multiple sources. Until recently, the trickle down incremental, cumulative effect on physicians and staff had been unrecognized as a major source of occupational stress. Reduction and prevention of physician occupational stress and burnout is beginning to be recognized as a patient safety concern and included in patient advocacy efforts.4 Recently, organizations such as The Joint Commission, National Patient Safety Foundation, and the American Hospital Association published recognition of the need to reduce stress and burnout.5-7
We have several recommendations. First is that the health care organizations recognize the need to support clinical staff to meet regulatory requirements while reducing occupational stress and sustaining wellbeing. The next step is to assess the current status of physician morale. Provide opportunities for physician input and involvement focused on ways to help them succeed. Surveys can help gather needed site-specific information. Inquiry should invite candid feedback about the positives and stressors of the work environment as well as actionable solutions. Results should be shared in aggregate form with management, physicians, and staff in a timely way to enhance trust through transparency. Using the results in future meetings can develop dialogue needed to encourage creative solutions. Using these dialogues as a basis, organizations can begin to provide education about the changing priorities and accountabilities in care delivery and work collaboratively with clinicians to pursue the mutual goal of providing appropriate, effective, high quality, safe, and satisfying patient care.
Maybe what’s most important is to provide the physician with emotional support. At one end is the issue of educating them about the dynamics surrounding health care delivery. Increasing awareness will increase understanding, which will lead to improved compliance and more satisfactory and effective hospital- physician- staff- patient relationships. Another level is to provide them with the skill sets to be more effective communicators and collaborators to enhance staff and patient relationships and satisfaction. Providing additional programs that focus on diversity management, cultural competency, Emotional Intelligence, stress, anger, or conflict management are helpful in improving behavioral compliance. In some cases individual coaching and counseling may be necessary which might be offered internally through Human Resources, Wellness Committees, a Physician EAP (Employee Assistance Program), or outsourced to a specialty vendor. In some cases, disciplinary action must be taken to address behaviors that could compromise patient care.8
We are all in this together. Physicians and all clinical staff are a precious resource whose focus is to deliver the best care. Hence, it is essential that the healthcare system administration, clinicians, and staff be seen as a team that through collaboration and aligned goals provides the best care possible to their community.
- Physician Stress and Burnout Survey 2015 Cejka Search and VITAL WorkLife Report VITALWorkLife.com/survey/Stress.
- Danielson, D., Ketterling, R., Rosenstein, A. “M.D Physician Stress and Burnout: Causes, Effects, and Impact on Performance and Behavior AMGA Group Practice Journal Vol.62 No.3 March 2013 p.38-41.
- Rosenstein, A. “Physician Stress and Burnout: What Can We Do?” American College of Physician Executives Vol.38 No.6 November/ December 2012 p.22-30.
- Privitera, M., Rosenstein, A., Plessow, F., LoCastro, T. “Physician Burnout and Occupational Stress: An Inconvenient Truth with Unintended Consequences” Journal of Hospital Administration Vol.4 No.1 December 2014 p.27-35.
- National Patient Safety Foundation, “Patient Safety News and Resources” https://npsf.site-ym.com/?page=January2015ENews.
- The Joint Commission, “Physician Leader Monthly” http://www.jointcommission.org/jc_physician_blog/the_impact_of_physician_burnout/.
- American Hospital Association, “Physician Leadership Forum” http://www.ahaphysicianforum.org/news/index.shtml.
- Rosenstein, A. “Bad Medicine: Managing the Risks of Disruptive Behaviors in Health Care Settings” Risk Management Vol.60 No.10 December 2013 p.38-42.
For more information, contact Alan H. Rosenstein MD, MBA, at email@example.com.