Preventing Provider Burn- OUT
Dr. Lowery: Throwing back his third cup of lukewarm 3-hour- old coffee as he’s running over an hour behind in clinic, the good doctor rolls his eyes as he picks up the chart to Room 7. It’s involuntary. His body becomes rigid and he struggles to put on his best fake smile as he enters the room. Like a psychic reading Tarot cards, he predicts the seemingly never-ending barrage of questions that await him as soon as he opens the door. His patient doesn’t disappoint. She is holding an entire page and a half of college-ruled hand written questions to go over… in detail…
Ethel Flannergan: Nervously moving her eyes from her watch to the back of the door in Room 7 and to the list of questions and symptom log she diligently poured herself into the night before, Ethel waits the hour and sixteen minutes to see Dr. Lowery. She has carefully addressed each symptom she’s had over the last few weeks, months, even years, in an effort to help her doctor sort out the debilitating fatigue she’s been experiencing. She’s been waiting over an hour, first in a waiting room with sick people coughing, and now in a cold and sterile room. She paid a $50 copay, but it’s worth that and more for a chance at regaining her quality of life.
These different perspectives are two sides of the same coin. The fictional Dr. Lowery is hands down one of the best in his field. He is an excellent physician but the strain of owning and operating a private practice is taking its toll. The hiring, firing, and staffing issues, along with insurance reimbursement, broken EMR systems, taxes, malpractice insurance, and the ever-present pressure that his patients’ lives are in his hands weighs heavily on his mind. He loses sleep over medical traumas he has seen in his career; he knows that losing a patient can put a permanent mark on a person’s soul. Ms. Flannergan on the other hand is a pleasant person who wants answers (and appropriate treatments) to get her life back on track.
Physicians, nurses, medical assistants, scrub techs, nurse practitioners, CRNAs, phlebotomy techs… you name it, provider burnout is real. And it is becoming a real problem. Burnout is the culmination of emotional bankruptcy, disconnection from patients and coworkers, declining career satisfaction, self confidence in your scope of practice, overall exhaustion, and a diminished sense of personal accomplishment. In today’s modern go-go-go society, it is becoming an epidemic. Medical schools and nursing programs train us to strive for excellence.
Anything less than superhero status is unacceptable. That can be a lot of pressure. Most of us can’t leap tall buildings in a single bound. We are just human. Oftentimes in medicine, decisions have to be made in the blink of an eye that can save (or cost) someone their life.
Medicine, while very rewarding, is a stressful career path. Chances are high you know someone in the medical field that can attest to their rigorous schedules. Increasing workloads, long hours, emotionally and physically challenging patients, high accountability, demanding family members, and a legal environment in which every other interstate billboard is a lawyer offering a big payout, takes its toll. Medical providers are at higher risk to abuse alcohol and drugs, and oftentimes have a higher rate of anxiety, depression, and even suicide. The numbers are shocking. According to the American Foundation for Suicide Prevention (AFSP), 28% of medical residents experience a major depressive episode during training compared to 8% of similarly aged individuals in the general U.S. population. The suicide rate among male physicians is 1.41 times higher than the general male population and among female physicians, the relative risk is 2.27 times greater than the general female population. In one study, 23 percent of interns had suicidal thoughts.
So, what’s the solution? AFSP suggests that physicians and healthcare workers who proactively address their mental health needs are better able to optimally care for patients and sustain their resilience in the face of stress. “Mental health problems are best addressed by combining healthy self-care strategies (which should not include self-medicating) along with effective treatment for mental health conditions.” Regular exercise, a healthy diet with proper nutrition, yoga, meditation, rest, and vacations are just a start. Addressing the emotional needs of the providers is crucial. Perhaps the most important step to addressing provider burnout is talking to someone about their mental health issues. Consider changing work hours, or even positions depending upon the level of stress and anxiety. Nurturing healthy relationships with family, friends, and colleagues is also integral in preventing provider burnout.
In a perfect world, Dr. Lowery would be able to take hours to address Ethel’s ailments, but in the real-world providers must manage their time to best serve patients while also preventing their own burnout. Providers aren’t superheroes, but most are compassionate caregivers that entered the medical arena in the hopes of helping others. Providers take a Hippocratic oath to do no harm. They are sworn to uphold specific medical ethics and to put the health of the patient above all else. But they also have a responsibility with that oath to take care of themselves. With a little self-preservation and self-kindness, they will be able to go on treating patients while treating themselves as well.
Helpful resources for providers in distress:
- Acumen Institute: Specializes in acute distress assessments and education for medical professionals. www.acumeninstitute.org
- Depression and Bipolar Support Alliance: An advocacy group that provides support, resources and information for people living with depression and bipolar diagnoses. www.dbsalliance.org
- National Suicide Prevention Lifeline: Provides confidential support to people in suicidal crisis or emotional distress. 1-800-273-TALK (8255) suicidepreventionlifeline.org
- Vanderbilt University Program for Distressed Physicians: Offers a 3-day course that provides help for distressed physicians in a confidential environment.
- The American Foundation for Suicide Prevention: Medical provider-specific suicide information, including the documentary Struggling in Silence. www.afsp.org
Kari Kingsley, MSN, CRNP is an otolaryngology nurse practitioner with over 8 years of ENT experience. She is a medical writing consultant for Inside Medicine and enjoys writing articles on pertinent material to keep the residents of North Alabama up to date on the forefront of medicine.