Joseph Campbell said, “Follow your bliss.” I am sure blissful is not how I would describe the state of my fellow physicians and other healthcare professionals. You would have to live in a cave to miss the plethora of articles and discussions about “physician burnout.” Too numerous to recite, I will mention two.

The first is from the Archives of Internal Medicine, August 20, 2012, titled “Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population.” As this article states, burnout is not a recognized psychological disorder but an “experience.” The ICD-10 code describes it as “a problem related to life-management difficulty.” Burnout among nearly 7,000 doctors was measured using the Maslach Burnout Inventory (MBI).

Authors describe it as “a syndrome characterized by a loss of enthusiasm for work (emotional exhaustion), feelings of cynicism (depersonalization) and a low sense of personal accomplishment.” Emergency medicine, internal medicine, neurology and family medicine had the highest rates of burnout. Among their conclusions was the fact that almost one in two (45.8 percent) U.S. physicians has symptoms of burnout implies that the origins of this problem are rooted in the environment and care delivery system rather than in the personal characteristics of a few susceptible individuals.

The second article is from the 2013 Medscape Physician Lifestyle Report1. It includes some fascinating statistics and suggestions for individuals to consider about burnout. Two observations are particularly pertinent for dealing with the larger “system” issue. In his Medscape interview, Paul Griner, MD, said “Physicians should participate actively in health reforms that return a greater level of control to their patients and themselves. Embracing the concept of team care is important. Moving from a philosophy of ‘I am responsible’ or ‘I am in charge’ to ‘we are responsible’ or ‘we are in charge’ is an important step.”

In the Medscape Primary Roundtable on burnout interventions, Roy Poses, MD, made the following observation: “Although extensive literature suggests that contributors (to burnout) include excessive workload, loss of autonomy, inefficiency due to excessive administrative burdens, a decline in the sense of meaning that physicians derive from work, and difficulty integrating personal and professional life, few interventions have been tested. Most of the available literature focuses on individual interventions centered on stress reduction training rather than organizational interventions designed to address the system factors that result in high burnout rates. Most interventions meant to improve burnout have treated it like a psychiatric illness, not a rational response to a badly led, dysfunctional healthcare system.”

So, this is my plea to everyone (physicians, CEOs, politicians, healthcare companies, medical education organizations and anyone else in between) to advocate for an improved healthcare system for all of us — physicians, other healthcare professionals and patients alike.

What do we do while we fix the system?
As Warren Pendergast, MD, medical director of the North Carolina Physicians Health Program (NCPHP) said in his article “Whither Physician Wellness” in NCPHP Metamorphosis (Fall-Winter 2012), “We have not ‘gotten around to’the concept of physician wellness. It’s often difficult to get patients to take care of themselves in all the ways they need to … and it may be even more difficult to think about holding ourselves accountable to an abstract standard of wellness.” But things are finally changing. Medical schools and residency programs are developing “wellness” and “resiliency” curriculums. Skills include mindfulness meditation, guided imagery, creative expression, journaling, laughter yoga, biofeedback, social support and others. Employers and healthcare organizations are starting to realize the value of “physician wellness” to prevent compassion fatigue and decreased productivity and to help retain the physicians in whom they have invested time and energy.

Fortunately, there are many resources available to healthcare professionals across North Carolina. While we all need to work to “fix the system,” there is help now for you and your colleagues/friends. Remember, sometimes we (or they) are the last to know there is something wrong. Don’t be afraid to ask for help or ask someone else if they need help.

(Does MD have to stand for malignant denial?) Take the Maslach Burnout Inventory or the Adult Apgar (S.S. Bintliff, Wellness Book for Emergency Physicians, ACEP, 2004). Other excellent reading materials and resources are listed at the end of this article. The North Carolina Medical Board (NCMB) Forum, July 2012 articles, “Preserving a Scarce Human Resource: Healthy Physicians” by John-Henry Pfifferling, PhD, from the Center for Professional Well-Being in Durham, and “Practicing Self-Care: Resources for Physician Well-Being” by Christopher Snyder, MD, are a good place to start. The NCMB site, www.ncmedboard.org, has many other references, as well (under Professional Resources to Links and then Physician Well-Being).

Many employers have Employee Assistance Programs (EAP) that are confidential and inexpensive. CMC-Charlotte Metro facilities, has a Physician Health Committee chaired by William Bockenek, MD. This is a committee of the joint medical staff from CMC-Main/Pineville/Mercy/University/CR and is available to all physicians credentialed at any of these facilities regardless of their employer. All medical directors in the Carolinas HealthCare System Medical Group know what resources are available to help any of their physicians/PAs/NPs who would like any help with substance abuse/mental health issues/burnout, and should be contacted directly. Anyone with access to CHS Physician Connect can check the Medical Staff Resources: Work/Life Balance page, as well. Novant Health Medical Group has the Physicians Health and Effectiveness Committee, chaired by Stephen Ezzo, MD. Novant Health hospital system has a Practitioner Health and Effectiveness Committee, which can be accessed by contacting each department chair or chief of staff. The NCPHP, whose mission is “improving the health and wellness of medical professionals with compassion, support, accountability and advocacy,” is available to help all physicians and physician assistants licensed in North Carolina.

Beyond its traditional role in secondary and tertiary prevention and treatment, NCPHP is interested in helping physicians and others proactively take better care of themselves, and would partner with any organization toward that goal. This may be trite, but as a family physician, I am going to say it anyway, “An ounce of prevention is worth a pound of cure!”

What can I do?
As individuals, there are many things we can do to “be well.” We should practice what we preach to our patients and develop a sense of balance in all areas, including physical, emotional, spiritual, relationships, community and work/career. Consider one thing daily you are grateful for, or one person you love, or one thing you did that helped someone else. Take advantage of physician wellness activities offered by your employer, specialty societies and community organizations. Educate yourself about the causes of burnout and the opportunities for wellness. Do something nice for yourself — it is okay! It doesn’t always have to be about someone else. I thought about this recently on a trip we took to Yellowstone National Park. The Mecklenburg County Medical Society has an initiative to “get kids outdoors and into nature” and that certainly applies to adults, as well. Out in nature, it really is possible to forget about EHR inboxes, meetings, texts (especially when there are no satellite towers) and the Affordable Care Act. You realize your partners really can take care of your patients just fine. President Teddy Roosevelt and John Muir had great insight about the benefits, beauty and inspirations of nature, so I will close with this one by Muir (and you don’t even have to go to Yellowstone — Our state has many parks, greenways and great neighborhoods to enjoy). “Everybody needs beauty as well as bread, places to play in and pray in, where nature may heal and give strength to body and soul.”

Would a seminar on physician burnout or wellness be beneficial?
Comment on this article, send an email or reach out to your local medical society and ask them to plan an event.

Footnotes:
1. Carol Peckham, Lifestyle and Burnout: A Bad Marriage. Medscape. March 27, 2013.

Resources:

• Maslach C. and Leiter M. The Truth about Burnout: How Organizations Cause Personal Stress and What to Do About It. Jossey-Bass Publishers; 1997.


• Lipsenthal L. Finding Balance in a Medical Life. California: Finding Balance, Inc., 2007


• Lipsenthal L. Enjoy Every Sandwich: Living Each Day as If It Were Your Last. New York: Crown Archetype, 2011.


• Remen R. Kitchen Table Wisdom. New York: Riverhead Books, 2007.


• Nedrow A., Steckler N., Hardman J. Physician Resilience and Burnout: Can you Make the Switch? Family Practice Management, Jan/Feb 2013.


• Germer C. The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. New York: Guildford Press, 2009.


• Rock D. Your Brain at Work: Strategies for Overcoming Distraction, Regaining Focus, and Working Smarter All Day Long. New York: Harper Business, 2009. www.thehappyMD.com


• Center for Professional Well-Being: 919-489-9167, www.cpwb.org


• NCPhysicians Health Program: 919-870-4480, www.ncphp.org


• Mecklenburg County Park and Recreation