Fix the system to reduce physician burnout says wellness expert

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Physician burnout is taking a heavy toll on patient care around the world. It was a problem before the pandemic, and it is an even greater issue today. So says Dr. Tait Shanafelt, Chief Wellness Officer, Stanford Medicine, Director of the WellMD Centre at Stanford Medicine, and Associate Dean for the Stanford School of Medicine. In his recent VPSA-sponsored talk, the international thought leader and top researcher in the field of physician wellbeing described physician burnout as a threat to the survival of health care. VPSA hosted the talk to draw attention to the work of the VCH-VPSA Physician Wellness Steering Committee.

“The personal consequences of burnout include broken relationships, alcohol and substance use, depression, and suicide,” said Dr. Shanafelt. “The professional fallout is decreased quality of care with increased medical errors, reduced patient satisfaction, less productivity, and higher turnover.”

To reduce burnout, physicians require more professional fulfillment. And, while personal resilience (self care, compassion, meaning in work, work-life integration, social support, and cognitive and emotional flexibility) is an important component of that, it is not enough to ask physicians to simply become more resilient.

“What we need to do is improve broken work environments, rather than teach physicians to tolerate a broken work environment,” he added.

To achieve the goal of professional fulfillment, Dr. Shanafelt advocates for a culture of wellness as well as efficiency of practice.

A culture of wellness is possible when there is leadership, an alignment of values, and physicians believe they have input and find meaning in their work. They feel a sense of community and collegiality and have peer support. Physicians need to feel appreciated along with flexibility and a culture of compassion.

To assist with efficiency of practice, Dr. Shanafelt lists EHR usability, triage, scheduling, patient portals, documentation methods, team-based care, OR turnaround times, and staffing as key.

The same things that can trigger burnout under certain circumstances can also create engagement when they are delivered meaningfully. The solution, according to Dr. Shanafelt, is to focus on the organization and its leadership.

“Health-care professional wellbeing needs to be an organizational priority,” he said. “We need leaders who advance professional fulfillment, and we need to develop system-level strategies. The focus must be on improving the environment, as well as creating infrastructure and improvement teams. Tactics need to be developed to advance the strategies and we need to execute those and measure their efficacy.”

Dr. Shanafelt spoke of the high number of physicians who view their career choice as a calling rather than as a career. They are motivated by meaning, purpose, and opportunities for growth and to make a difference. When employers offer extrinsic motivators (salary, benefits, title, awards), there is a high risk of unintended consequences including the view that leaders are out of touch with what matters.

“We’ve found that when physicians spend less than 20 per cent of their time on whatever their most meaningful activity is there is a greater risk of burnout,” added Dr. Shanafelt. He also noted the importance of community and support from colleagues and worries that physicians are becoming more isolated.

“Culture is hard to change. It can also be a source of strength… the things you need to change are only part of your culture. The rest of the culture can help you make the changes that need to happen. It’s a question of balancing forces between the status quo and positive change.”

Dr. Shanafelt is encouraged that VCH and VPSA are currently undertaking a physician wellness survey and urges participation. The survey leverages the tool used at Stanford Medicine.

“You need local data to counter denial and provide context and benchmarking. Surveys can also identify hotspots.”

“We were pleased to host such a prominent speaker and are excited that the approach we’re advancing aligns with best practice,” said Dr. Lucy Lyons, co-chair of the Physician Wellness Steering Committee. “Dr. Shanafelt provided us with a blueprint to work towards that feels doable.”

The deadline to take the VCH/VPSA wellness survey is November 23. Have your voice heard! Click here to take the survey now. You are also welcome to review the slides from Dr. Shanafelt’s presentation here.

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