How will this module help me?
Provides key steps to help you prevent physician burnout in your practice.
Offers strategies to construct a process to measure and improve physician well-being.
Presents examples of successful burnout prevention programs in a variety of settings.
Introduction: What Is Physician Burnout?
Burnout is a long-term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement, and a lack of empathy for patients.1 By measuring and responding to burnout you will be able to:
Recent studies show a national burnout rate of 43.9% among physicians in practice,2 including private practice, academic medical centers, and the Department of Veterans Affairs (VA). With almost half of US doctors showing signs of burnout, and numerous adverse outcomes for physicians linked to burnout, 2 it is an important issue for organizations to address. Reducing burnout can have a positive impact on your practice, including improved patient satisfaction, higher physician retention rates, better morale in the office, and improved recruitment.
Seven STEPS to Prevent Physician Burnout:
Establish wellness as a quality indicator for your practice
Start a Wellness Committee and/or Choose a Wellness Champion
Conduct an Annual Wellness Survey
Meet Regularly with Leaders and/or Team Members to Discuss Data and Interventions to Promote Well-Being
Initiate Selected Interventions
Repeat the Survey Within the Year to Reevaluate Well-Being
Seek Answers Within the Data, Refine the Interventions, and Continue to Make Improvements
STEP 1 Establish Wellness as a Quality Indicator for Your Practice
Encourage your practice or organization to recognize the impact of burnout on physicians as well as patients, the quality of care delivered, and the financial impact (eg, through turnover). Establish well-being–the inverse of burnout—as a quality indicator that you regularly measure in your practice. Consider using annual burnout scores as a sign of the health of the practitioner workforce within your organization.
“Burnout makes it nearly impossible for individuals to provide compassionate care for their patients.”
Steven Lockman, MD, Senior Medical Director, Neurosciences, Orthopedics and Rehabilitation Service Line/Chief, Physical Medicine and Rehabilitation Hennepin County Medical Center, Minneapolis, MN
STEP 2 Start a Wellness Committee and/or Choose a Wellness Champion
Wellness champions are individuals within an organization who promote the use of wellness resources, model positive behaviors such as leaving work on time, and encourage employees to complete the annual wellness survey. If you work in a solo or small practice, a wellness champion may be a better option than a committee.
A wellness committee should be made up of practitioners (eg, MDs, DOs, NPs, and PAs) from various disciplines and administrators from different departments (eg, finance, management) who can work with your practice or organizational leaders to measure burnout periodically. Committee members can then present data to practitioners and brainstorm solutions to challenges. The committee should plan to meet for about one hour each month to review current projects, plan new initiatives, discuss survey data, and respond to new opportunities or stresses.
Talking Points for Leaders (38 KB)You can use this document to help you develop talking points to encourage your organizational leadership to support wellness efforts.
STEP 3 Conduct an Annual Wellness Survey
The importance of conducting an annual wellness survey cannot be overstated. There are many benefits to conducting a wellness survey, including:
It is a great predictor of behavior. For example, asking people directly about their intention to leave an organization is more than twice as accurate than many predictive analytics models.4
It gives people the chance to feel heard. The act of completing a survey gives people a specific channel for expressing themselves, even when the results are anonymous. Anonymous surveys may yield a more accurate data set and higher response rate because it gives respondents a safe manner to express themselves. It can be a vehicle for change. Once practice and organizational leaders are aware of the results, specific interventions can be chosen to address concerns that are discovered through the survey.
With physician burnout itself attributed to organizational factors, solutions can be found—and should be made—at the organizational level. That's why it is crucial to recognize physician well-being challenges in your organization and to understand the types of solutions that can be tailored to the needs of your health system, its physicians, and its care teams. It is important to:
Select a validated assessment tool
Integrate measurement into your overall organizational strategy to improve physician well-being
Act on any significant findings that may serve to reduce burnout and increase professional satisfaction
The American Medical Association (AMA) can help you measure—and support—physician well-being. The AMA recognizes that a healthy, stable workforce translates directly to healthy care systems—and a healthier nation. Rigorous research and practice science are the foundation of the work we do to inform practice transformation efforts. Our ongoing research is advancing evidence-based solutions designed to increase Joy in Medicine™.
The AMA uses the Mini-Z burnout assessment, which is derived from work performed by Mark Linzer, MD, in the Physician Worklife Survey.5 The Mini-Z comprises 10 items and one open-ended question which assess satisfaction, stress, burnout, work control, chaos, values alignment, teamwork, documentation, time pressure, excess electronic health record (EHR) use at home, and EHR proficiency.
Our team of practice transformation experts can help you assess your workforce's well-being and offer guidance and targeted solutions that empower you to succeed in supporting their well-being and improving your bottom line.
STEP 4 Meet Regularly with Leaders and/or Team Members to Discuss Data and Interventions to Promote Well-Being
Share burnout assessment data with your organization's leaders as well as other team members. Meet regularly to discuss the data. An easy way to share the results of the assessment is to create a document with summary data for all respondents. After reviewing the data, identify the areas of greatest concern, either by practice or department, or the entire organization as a whole. Based on the problem area(s), select appropriate interventions to address them. More information can be found in the article, “10 Bold Steps to Prevent Burnout in General Internal Medicine.”6
STEP 5 Initiate Selected Interventions
Quiz Ref IDPrioritize and select interventions to address burnout where it exists. Interventions generally fall into the following categories:
Workflow redesign
Better communication between practitioners in your practice
Quality improvement (QI) projects targeted to address clinician concerns
Tactics to Reduce Burnout (39 KB)You can use this document to help identify specific strategies that your practice or organization can use to reduce the prevalence of burnout.
Your practice may also consider developing a resource list that details how individual practitioners can reduce burnout through time management, delegation, exercise, sleep, and mindfulness. You can find additional resources within the STEPS Forward™ Physician Well-Being module.
Workflow redesign
Workflow redesign to reduce burnout may include: 1) pairing nurses or medical assistants (MAs) with physicians in set teams 2) improving preparation and organization by implementing pre-visit planning with pre-visit labs, 3) sharing tasks with non-physician staff, including having MAs document patient visit information in the medical record, and 4) improving workflows between MAs and appointment coordinators. You may also consider if time allotted for daily visits, procedures, or bedside inpatient care in your practice is sufficient or if it is causing time pressure for your team.
Please see other STEPS Forward™ modules for suggestions to improve workflow in your practice.
Communication
Communication intervention projects could include: 1) co-location of key team members (eg, MAs, nurses, and practitioners), 2) daily huddles to discuss complex patients and care coordination, and 3) scheduling monthly practitioner meetings focused on work–life balance or challenging situations in patient care.
Refer to other STEPS Forward™ modules for assistance with improving communication in your practice.
Quality Improvement (QI)
Selecting quality improvement projects that directly address physician concerns reduces burnout by empowering them to create change. Projects could include: 1) a streamlined prescription renewal process, 2) screening patients for depression, 3) employing non-clinicians to perform administrative duties such as tracking forms and sending faxes, 4) presenting burnout assessment results and developing solutions, and 5) implementing new processes to manage hypertension or pre-diabetes management programs.
Table 1.
Examples of Interventions to Reduce Burnout in your Practice.A summary of interventions performed as part of the Healthy Work Place (HWP) study conducted by Mark Linzer, MD, and colleagues. Adapted with permission.
WORKFLOW | COMMUNICATION | QUALITY IMPROVEMENT (QI) | OTHER |
---|
Shift responsibilities of entering data into the EHR from the physician to an MA or other team member. | Improve interpersonal communication and teamwork. | Implement a hypertension management program. | Implement panel management. |
Learn more in team documentation. | Learn more in team meetings. | Learn more in annual prescription renewal | Learn more in addressing social determinants of health |
Better patient flow through the clinic. | Improve opportunities for informal communication among health care teams, such as a shared lounge or periodic shared meals. | Establish quality improvement projects for issues of importance to health care teams. | Dashboard of patient population measures for clinicians. |
Learn more in pre-visit planning and pre-visit laboratory testing. | Learn more in team culture. | | |
Share information to make the practice or organization more efficient. | Monthly formal discussions on patient care for clinicians to improve collegiality. | Free up time for nurses and physicians by implementing an annual prescription renewal process. | Present wellness data to prompt discussions on changing the clinic environment. |
Assess workflow between MAs and nurses to identify opportunities for change. | Informal survey of clinicians for a “wish list” of issues to be corrected. | Implement a pre-diabetes management program. | |
Learn more in expanded rooming and discharge protocols. | | | |
More time for nursing and MA team members to complete tasks. | Share organizational updates with monthly email or meeting with leaders. | Implement processes to improve medication adherence. | |
Pair one or two MAs with each physician. | Clinicians meet individually with leadership to review operations and identify concerns. | Use the PDSA method to address inefficiencies in the patient portal. | |
Learn more in expanded rooming and discharge protocols. | | | |
STEP 6 Repeat the Survey Within the Year to Reevaluate Well-Being
Compare prevalence of stress and burnout from before and after your intervention(s). Use a simple spreadsheet or graph to show changes in stress levels, burnout, satisfaction, control over work, chaos, and alignment of values over time. Develop an understanding of what worked and celebrate those successes. Examine factors that saw no change or a rise in burnout prevalence after the intervention and seek explanations and remediable solutions.
STEP 7 Seek Answers Within Data, Refine Interventions, and Continue Improvements
Use your burnout assessment results to determine which interventions are working, refocus on those interventions, and reinvigorate your team to carry them out in your practice. In areas where burnout is increasing or observed improvements are not sustained, analyze the results to guide new or modified interventions. The commitment of the wellness committee or wellness champion to the interventions may help convince your fellow practitioners that your practice is dedicated to staying on a path to reduce burnout.
Physician stress and burnout can have a significant impact on the quality of care delivered to patients, organizational productivity, morale, and costs. You can take corrective action early by identifying sources of stress and developing interventional approaches that will help your organization reduce burnout and promote the well-being of all practitioners.