Stress and rapid change: a prescription for doctor burnout

A recent study found that one out of two doctors reports signs of serious burnout. Doctors are hitting that wall of exhaustion and depression at a higher rate than people in other stressful professions. Hospitals are an especially fertile ground for the problem. So, what are local hospitals doing to address this issue?

 

After getting through a grueling residency training in a large Philadelphia hospital, Erin Lockard was proud she could handle all of her job’s many demands: long hours, very sick patients, life-and-death decisions, and night shifts.

“People say to you, ‘I can’t imagine doing that. That must be so hard,’ and there’s some little nerd inside of you that needs a gold star that says, ‘Yes, I do it,'” said Lockard.

But a few years ago, still at the same hospital, Lockard noticed a change in her attitude. She felt like her tasks just kept piling up with long lines of waiting, needy patients.

“I was having episodes at work where I felt so overwhelmed I needed to go hide in a room for a second, to collect myself,” recalled Lockard. “I just perceived that that shouldn’t be happening when you are five or six years into your career, and you’re confident, and otherwise happy.”

Changing conditions in an already tough profession

The core demands of the job have always been tough, but experts says dramatic changes in how medicine is practiced and paid for now add to the stress. Grading of outcomes, electronic records, intense cost pressure — it’s a lot.

Hospital doctors now talk more openly and frequently about leaving the profession, or switching to calmer, more lucrative boutique practices.

“We are right now right in between the old way of doing business in medicine, and the new way of doing business in medicine,” said Steven Sivak, chairman of medicine at Einstein Medical Center, a hospital in North Philadelphia.

“The new way of doing business in medicine is known as accountable care and that takes many forms, we’re stuck right in the middle and we’re challenged on how we’re going to get from where we are to where we need to be,” saod Sivak.

Several issues fuel the angst of physicians. Many feel they are being told to shoulder more responsibility for patient outcomes, even as they’re losing some control over how they treat their patients. Incomes are less assured, but the threat of lawsuits is constant.

All this anxiety combined with the everyday stress of the job can be a toxic mix — affecting quality of care and staff retention. As major changes rock the system, hospital administrators try to create stable conditions within their own four walls.

A place to catch some R&R

At the Hospital at the University of Pennsylvania, healthcare staff can take a break in a cozy center dedicated to rest and relaxation.

Cushy massage chairs in peaceful quiet rooms offer a place to take a deep breath between patients or regroup after work. The center has been open for a year, and is very popular.

Steven Sivak says across town at Einstein, physicians have no such luxury. “We don’t have a burnout center, a burnout clinic, or burnout sessions, we have other sessions that begin with a ‘b’ and sometimes that helps, that physicians blow off some steam.”

Sivak says working at Einstein is demanding; it has a poor patient population facing many health and social issues. Despite that, turnover at the hospital is low. Sivak says a strong sense ofcamaraderie among the doctors helps. What keeps him from burning out is knowing that what he does matters.

“Just the other day I ran into one of my patients in the cafeteria, and she said ‘thank you so much'” said Sivak. He had been working with this patient with her blood sugar and blood pressure. She told Sivak that she never cared about her health so much as she has since she became her patient. “I have to say that made me feel terrific,” said Sivac.

Many physicians rarely have such satisfying moments, says Guy Fried, chief medical officer at Magee Rehab in Philadelphia. “You are just a cog in the wheel, just one piece out there, you can get burned out.”

Fried says many doctors see patients during just one pit stop on their journey through the hospital — never knowing what happens in the end.

“Physicians have gone into medicine to help people to the extent that they are not seeing the fruits of their labor, that they are seeing the patients that they help, that can be a problem,” said Fried.

Fried’s approach at Magee is to create care teams where doctors see patients throughout their stay at the hospital. He also frequently talks to staff about burnout, to gauge when someone is exhausted and needs a break.

New job, less stress

Erin Lockard recently changed jobs. She works at a smaller hospital — where she is still busy. “Oh yeah, my pager is usually going off every five to ten minutes, so trying to get a consistent, streamline thought process is really hard.”

But she says her work now feels manageable, and she feels more supported.

“I am regularly being asked by the leaders of the hospital how I am doing, and how they can help me do my job better, and that’s nice. It feels really nice,” said Lockard.

A caring boss, team work, even massage chairs may help – but in the absence of major system changes, many doctors say, the threat of burnout will continue to follow them on their daily rounds.