Physician stress and burnout: The causes and potential solutions for nephrologists

By Alan H. Rosenstein M.D., M.B.A

At ASN Kidney Week in New Orleans, I presented a session on the impact of growing stress and burnout in Nephrologists and how it might affect physician attitudes and behaviors toward patient care. The main focus of the session was to highlight how important physician satisfaction and engagement are to organizational, team, and individual relationships impacting patient outcomes of care.

The main point of my talk was to recognize how serious an issue physician dissatisfaction, stress, and burnout is, the causes and the barriers, and what can be done to help our physicians (and staff) better adjust to the pressures of today’s health care environment.

Let me explain.

Causes

There have been many recent studies showing that more than 50% of the physician population suffers from the consequences of stress and burnout. All specialties are affected, with Nephrologists falling right in the middle as to percentage and severity. Common causes include changing roles and responsibilities, metric accountability, increasing administrative demands, electronic record documentation and reporting, a loss of autonomy, and a general sense of loss of purpose and loss of control. For Nephrologists, the situation is compounded by on-call schedule demands and the consequences of treating chronic disease and the resulting sense of frustration and compassion fatigue. All of these factors need to be considered when trying to develop strategies to improve the situation.

Barriers to resolution

One of the key barriers is the individual physician. Physicians have strong egos and their common sense of stoicism often impairs their sense of reality. Many physicians either don’t recognize or won’t admit that they are working under stress and if they do, feel like they have been working under stress all their lives and can handle it on their own. If they are willing to open up, they are reluctant to seek help worried about issues related to confidentiality or outside concerns about their competency. They don’t realize how the stress can be affecting their overall well-being and behaviors and the impact that this can have on staff and patient relationships that effect patient care. There are a growing number of studies linking high stress and burnout to poor judgment and decision making, impaired communication and collaboration, medical errors, patient dissatisfaction, and malpractice complaints. As an end result, many physicians have either retired prematurely or have switched careers.

A second key barrier is the organization. If we can’t leave it up to the physician to take action on their own, then we need to look to the organizations in which they are associated with to take a pro-active position in trying to help their physicians succeed. The details of these strategies are presented below.

Strategies to help physicians

  1. The first step is to raise levels of awareness and help physicians and the organization recognize how important an issue this really is. The literature refers to a “burnout epidemic”, but to get your finger on the pulse, it would be best to do your own individual organizational assessment. This could include structured surveys on physician satisfaction and morale or more in-depth surveys on the workplace environment and burnout (Maslach burnout survey as an example), or just informal opportunities for physicians to give their perspective on how things are going.
     
  2. The next step is to provide education. One focus of the education is to share the results of physician burnout and satisfaction surveys and let them know that they’re not alone out there. The next step is to provide training. Much of this training is geared toward addressing factors that can improve overall physician relationships by focusing on factors that improve communication and team collaboration. These courses might include improving didactic communication and team collaboration skills, improving overall relationship training through courses on customer satisfaction, diversity training, and/ or courses in emotional intelligence and mindfulness, palliative care, or through more theme related courses in stress, time, project, or conflict management. The goals of these offerings is to help physcian deal with the frustrations of clinical practice and improve efficiency in the overall care management process.
     
  3. The next step is to provide the necessary support and assistance in helping physicians do what they want to do – practice good medical care. This is a multifactorial process. It starts with organizational culture and commitment. Those organizations who show that they value and respect and really care about their physicians have a much greater change of improving overall physician satisfaction and engagement. The next step is to provide needed support.


Providing needed support

Support can come from three different areas.

      1. Logistical and administrative support can be provided by:

  • adjusting on-call responsibilities
  • providing support for data entry and chart documentation
  • helping with electronic medical record issues (using scribes, for example),
  • or implementing other processes or procedures to help the physician deal with the business side of medical practice.

    2. Clinical support provided by:
     
  • greater utilization of Physician Assistants or Nurse Practitioners that free up time allowing physicians to concentrate on more complex cases,
  • or using a “care manager” to help coordinate all the follow up steps of medical care.
  • the biggest gains can come from providing physicians with the appropriate emotional and behavioral support that meets their needs.

    3. Behavioral support provided by:
     
  • informal peer support or through designated channels such as a Physician Wellness Committee
  • a Physician Employee Assistance Program (EAP)
  • state sponsored Physician Health Programs (PHPs),
  • or through on-line programs offered through the AMA or National Academy of Sciences.


The goal of the above behavioral support programs is to promote work-life balance and improve overall physician well-being and resilience. Individual one-on-one coaching or counseling sessions that maintain confidentiality and are sensitive to physician schedules, have shown the greatest value in providing individualized solutions that improve physician reactions. In more complex situations more comprehensive behavioral support services can be offered through either internal programs or outsourced to agencies dealing with specific behavioral issues.

There are many avenues of support. On the basic level, just allowing and promoting physician input and giving them an opportunity to vent their concerns will open the doors for physician engagement. Responding to their concerns and showing you care will increase overall physician satisfaction.

In summary, addressing stress and burnout is a crucial component of improving physician attitudes and enthusiasm for providing medical care. We need to remind the physician of the value of what they do and keep them focused on the reasons they chose medicine as a career. Achieving this goal is a two phase process. On one side, the physician needs to recognize the importance of accepting outside assistance in helping them negotiate the pressures of medical practice. On the other side, their organizations need to be able to express empathy and understanding for the physician’s concerns and pro-actively offer service and emotional support to enhance their viability. In the end, we need to recognize that physicians are a precious, limited, overworked resource, and we need to show them that we value and respect their work and thank them for what they do.​

If you have any questions or comments on the topic, please contact Dr. Rosenstein directly at ahrosensteinmd@aol.com or the KNO staff at info@kidneynews.org.

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Alan H. Rosenstein M.D., M.B.A
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At ASN Kidney Week in New Orleans, I presented a session on the impact of growing stress and burnout in Nephrologists and how it might affect physician attitudes and behaviors toward patient care. The main focus of the session was to highlight how important physician satisfaction and engagement are to organizational, team, and individual relationships impacting patient outcomes of care.

The main point of my talk was to recognize how serious an issue physician dissatisfaction, stress, and burnout is, the causes and the barriers, and what can be done to help our physicians (and staff) better adjust to the pressures of today’s health care environment.

Let me explain.

Causes

There have been many recent studies showing that more than 50% of the physician population suffers from the consequences of stress and burnout. All specialties are affected, with Nephrologists falling right in the middle as to percentage and severity. Common causes include changing roles and responsibilities, metric accountability, increasing administrative demands, electronic record documentation and reporting, a loss of autonomy, and a general sense of loss of purpose and loss of control. For Nephrologists, the situation is compounded by on-call schedule demands and the consequences of treating chronic disease and the resulting sense of frustration and compassion fatigue. All of these factors need to be considered when trying to develop strategies to improve the situation.

Barriers to resolution

One of the key barriers is the individual physician. Physicians have strong egos and their common sense of stoicism often impairs their sense of reality. Many physicians either don’t recognize or won’t admit that they are working under stress and if they do, feel like they have been working under stress all their lives and can handle it on their own. If they are willing to open up, they are reluctant to seek help worried about issues related to confidentiality or outside concerns about their competency. They don’t realize how the stress can be affecting their overall well-being and behaviors and the impact that this can have on staff and patient relationships that effect patient care. There are a growing number of studies linking high stress and burnout to poor judgment and decision making, impaired communication and collaboration, medical errors, patient dissatisfaction, and malpractice complaints. As an end result, many physicians have either retired prematurely or have switched careers.

A second key barrier is the organization. If we can’t leave it up to the physician to take action on their own, then we need to look to the organizations in which they are associated with to take a pro-active position in trying to help their physicians succeed. The details of these strategies are presented below.

Strategies to help physicians

  1. The first step is to raise levels of awareness and help physicians and the organization recognize how important an issue this really is. The literature refers to a “burnout epidemic”, but to get your finger on the pulse, it would be best to do your own individual organizational assessment. This could include structured surveys on physician satisfaction and morale or more in-depth surveys on the workplace environment and burnout (Maslach burnout survey as an example), or just informal opportunities for physicians to give their perspective on how things are going.
     
  2. The next step is to provide education. One focus of the education is to share the results of physician burnout and satisfaction surveys and let them know that they’re not alone out there. The next step is to provide training. Much of this training is geared toward addressing factors that can improve overall physician relationships by focusing on factors that improve communication and team collaboration. These courses might include improving didactic communication and team collaboration skills, improving overall relationship training through courses on customer satisfaction, diversity training, and/ or courses in emotional intelligence and mindfulness, palliative care, or through more theme related courses in stress, time, project, or conflict management. The goals of these offerings is to help physcian deal with the frustrations of clinical practice and improve efficiency in the overall care management process.
     
  3. The next step is to provide the necessary support and assistance in helping physicians do what they want to do – practice good medical care. This is a multifactorial process. It starts with organizational culture and commitment. Those organizations who show that they value and respect and really care about their physicians have a much greater change of improving overall physician satisfaction and engagement. The next step is to provide needed support.


Providing needed support

Support can come from three different areas.

      1. Logistical and administrative support can be provided by:

  • adjusting on-call responsibilities
  • providing support for data entry and chart documentation
  • helping with electronic medical record issues (using scribes, for example),
  • or implementing other processes or procedures to help the physician deal with the business side of medical practice.

    2. Clinical support provided by:
     
  • greater utilization of Physician Assistants or Nurse Practitioners that free up time allowing physicians to concentrate on more complex cases,
  • or using a “care manager” to help coordinate all the follow up steps of medical care.
  • the biggest gains can come from providing physicians with the appropriate emotional and behavioral support that meets their needs.

    3. Behavioral support provided by:
     
  • informal peer support or through designated channels such as a Physician Wellness Committee
  • a Physician Employee Assistance Program (EAP)
  • state sponsored Physician Health Programs (PHPs),
  • or through on-line programs offered through the AMA or National Academy of Sciences.


The goal of the above behavioral support programs is to promote work-life balance and improve overall physician well-being and resilience. Individual one-on-one coaching or counseling sessions that maintain confidentiality and are sensitive to physician schedules, have shown the greatest value in providing individualized solutions that improve physician reactions. In more complex situations more comprehensive behavioral support services can be offered through either internal programs or outsourced to agencies dealing with specific behavioral issues.

There are many avenues of support. On the basic level, just allowing and promoting physician input and giving them an opportunity to vent their concerns will open the doors for physician engagement. Responding to their concerns and showing you care will increase overall physician satisfaction.

In summary, addressing stress and burnout is a crucial component of improving physician attitudes and enthusiasm for providing medical care. We need to remind the physician of the value of what they do and keep them focused on the reasons they chose medicine as a career. Achieving this goal is a two phase process. On one side, the physician needs to recognize the importance of accepting outside assistance in helping them negotiate the pressures of medical practice. On the other side, their organizations need to be able to express empathy and understanding for the physician’s concerns and pro-actively offer service and emotional support to enhance their viability. In the end, we need to recognize that physicians are a precious, limited, overworked resource, and we need to show them that we value and respect their work and thank them for what they do.​

If you have any questions or comments on the topic, please contact Dr. Rosenstein directly at ahrosensteinmd@aol.com or the KNO staff at info@kidneynews.org.

Date:
Tuesday, November 14, 2017