Burnout requires systemic change

By Mardi Chapman

22 May 2018

Well-meant resilience training for junior doctors won’t make a scrap of difference to the epidemic of burnout in the medical profession without systemic changes.

Dr Tait Shanafelt, a haematologist/oncologist who is also Chief Wellness Officer at Stanford Medicine, told ATS 2018 delegates about half of physicians were affected by burnout.

Critical care physicians in particular were in a high-risk discipline; respiratory physicians a little better off.

As well as the personal impact on relationships and rates of depression, drug and alcohol use and suicide, burnout also increased staff turnover and reduced the quality of patient care, patient satisfaction, productivity and work effort.

“If we had a systemic issue in our critical care units eroding care and patient satisfaction, we would mobilise our best to demand an action plan. We haven’t responded to this as we have to other quality issues.”

He said the number of hours worked each week was a contributory factor but it was also about work-life balance and the nature of the work.

Doctors currently spent more time in clerical and administrative tasks (39%) than in direct clinical work (33%).

Electronic health records had delivered a clerical load that was often shifted out of work hours into personal time and was also isolating.

Dr Shanafelt added that the system wanted competent doctors but expected them to access much of their CME in personal time.

“The most dedicated have trouble setting boundaries and are therefore at increased risk. Traits that make good doctors have a maladaptive component to them,” he said.

He said factors such as doctors’ exposure to trauma, morbidity and mortality, ethical issues and stress could not be changed.

However other known risk factors such as scheduling of rosters and conflicts within work units could be modified.

“Professional burnout is the occupational health risk for physicians but we haven’t given enough thought to protect them.”

Protecting physicians

Dr Shanafelt said better training and support for first line leaders in the work unit could reduce burnout and improve professional satisfaction.

As well, efforts to build a community at work and encourage collaborative action would pay off.

“It is not necessarily the project but the process that helps.”

He added that doctors needed the resources to be able to spend at least 20% of their time on the most meaningful aspect of their work.

“What is that thing you have a passion for?”

He said burnout, at an individual level, could be reduced by choosing to work part-time but that was not helping with meaningful generational change.

“It’s a worthy quest to heal the suffering going on in our professional colleagues.”

He said medical schools attracted students with better mental health and quality of life than other university students yet the pattern was reversed as early as second year.

Burnout also rose in the residency years and again about 10 years into a medical career.

He urged doctors to recognise that other members of the team such as nurses could also be affected by burnout.


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