Based on an American Medical Association news article published April 10, 2019 and Sara Berg's interview with Carlos Estrada, MD, Professor and Division Director of General Internal Medicine, University of Alabama at Birmingham.
Learn how the University of Alabama at Birmingham (UAB) significantly lowered its burnout rate by focusing on physician leadership development.
The general internal medicine division saw higher rates of burnout than they would like and set out to fix this problem.
“People have been asking, ‘So, what's the secret sauce?'” said Carlos Estrada, MD. The secret sauce involves physicians having autonomy and the chance to develop as educators and leaders.
Developing the Intervention
Figure 1. Three Pillars of the Intervention
Creating autonomy and purpose
As is the case for others, it is important for internists to have a sense of purpose and autonomy, which UAB accomplished by having faculty involved in developing their work goals.
“Everyone is involved in education, so our sense of purpose was very clear,” said Dr Estrada. “Autonomy is how people craft their job descriptions and how that evolves over time. Autonomy is not, ‘Hey, let me do what I want with my schedule.' It is aligning what they want to do with opportunities and passion.”
For example, shortly before being hired, a UAB internist was chosen to be the internal medicine residency program associate director—a leadership opportunity that developed soon after recruitment. The medicine department considered many faculty but this faculty member was selected because he was a recognized leader, educator, and administrator.
UAB Medicine has created several leadership development programs, which are also supported by the Department of Medicine. Through a formal structure that begins with chiefs and leaders, the programs target women, underrepresented minorities, and select faculty. It now includes coaches for personal and professional development.
Identifying physician passion
“Some [doctors] know what their passions are,” said Dr Estrada. “We have sponsored and fostered participation in professional development programs as well as advanced degrees in medical education.”
One internist expressed an early interest in point-of-care ultrasound. UAB paid for him to attend a meeting where he confirmed his interest and continuing education enhanced his knowledge of the new technology.
However, “it's not just about one person,” said Dr Estrada. “It's about the culture of the 20 to 25 people who are part of the division—everyone is supportive of each other. Sponsorship and mentoring are part of our fabric, which started with the inaugural director, Dr Bob Centor.”
It goes beyond a single individual's passion, such as women supporting other women in the department—a critical step for sponsorship and guidance through senior mentors and leaders.
Another way is by leveraging programs across the nation, such as the Association of American Medical Colleges (AAMC) for early and midcareer programs for women leaders. UAB pays for physicians to attend one of the AAMC events for women to develop leadership skills.
“When we invest in people, they discover things they did not know they had,” said Dr Estrada. “To me, the investment in the people in terms of the leadership development is critical and crucial, and we will continue to do that.”
Allowing flexibility in work
“If you're working in a group of 3 or 4 people supervising in clinic and you need to peel off and go away for an hour meeting or the child gets sick and so forth, we have the flexibility to cover for each other,” said Dr Estrada.
The Birmingham Veterans Affairs (VA) Medical Center, across from the university, is a key partner for patient care, education, and research—adding diversity and flexibility of opportunities.
“It's an extraordinary place for teaching and patient care. When we have 4 attendings supervising in clinic and the clinic slows down, then physicians can work on VA-related education or patient care projects,” he said.
The general internal medicine division at UAB has a burnout rate of 13%, which is significantly lower than the rate in other divisions.
When asked about their overall satisfaction with their job, 95% of internists at UAB strongly agreed compared with the national average of 75%.
“When the institution measured the [burnout] level across departments and divisions, it was what you see across the nation between 30% and 50%, and even higher in some areas. We are aware that our numbers were among the lowest in the nation. I don't think it was from one single intervention that we did.”
—Carlos Estrada, MD