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Programs to Help Physicians With Burnout
Glossary
 

Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.

Knowing When You Need Help

Preventing burnout is not something you need to do entirely on your own. It helps to seek out colleagues and discuss the things that are stressing you out. If you do not have resources at your worksite, identify a physician who seems empathetic and set up a meeting with him or her.

In large organizations, the administration often identifies these go-to physicians so that they can set aside time for this work, and so that doctors can have a clear idea of who they can seek help from.

Several years ago, I started to lead a discussion group on these issues that meets monthly for an hour in the morning. Ten to 20 people show up. Most of them are nurses, although there are always a few doctors. Usually, one or two people share a story about a situation that was emotionally challenging. The focus is on emotional issues, and we don't bring in medical issues.

Then we start discussing the case. The discussion takes us to amazing places as we are exploring our emotions deeper and deeper. A lot of sharing occurs, and it becomes a healing experience.

Many of the attendees are nurses on the oncology floor where I work. Since the meetings started, these nurses have become much more responsive to patients, and their coping power with various stressors has improved dramatically.

Hospital Programs

Some other hospitals have more formal programs to help physicians deal with stress. Brigham and Women's Hospital in Boston has a Center for Professionalism and Peer Support, where physicians can attend sessions and interactive workshops that focus on professionalism training, concerns, assessment, remediation, and research.

The peer support program consists of a network of trained clinicians who reach out to colleagues who are experiencing stress. "They are available anytime you are experiencing stress from any cause," the hospital says. "This is not therapy. It is for the support and collegiality that comes from talking to someone who has 'been there.'"

Some Minnesota hospitals have introduced programs to address provider stress. At the Mayo Clinic in Rochester, for example, doctors meet over company-sponsored dinners to talk shop and swap ideas for coping with the mounting strain of the job.

At Hennepin County Medical Center in Minneapolis, a former dining room for physicians has been remodeled into an onsite wellness center. "I think people have recognized that if you start measuring burnout, start talking about it, and develop some kind of modest infrastructure to oversee it, you can begin to make a dent in it," says Mark Linzer, MD, director of internal medicine.

What we are attempting to do is help physicians continue to thrive in what is an imperfect environment.

A voluntary program that's catching on in Colorado hospitals helps physicians build resilience and recapture the sense of fulfillment that led them to medicine in the first place. "What we are attempting to do is help physicians continue to thrive in what is an imperfect environment," says Doug Wysockey-Johnson, executive director of an organization called Lumunos, which runs the program.

Multihospital Programs

Six hospitals in the Denver area have implemented various elements of the program. Some 350 physicians have signed up to receive instructive emails on specific subjects, such as how to say "no" to patients with compassion and clarity. There are also periodic 45-minute meetings led by a trained facilitator.

Some participating hospitals host occasional dinner meetings based on a model called "Finding Meaning in Medicine." It was developed by Rachel Naomi Remen, MD, clinical professor of family and community medicine at the University of California, San Francisco.

Dr Remen is a pioneer of integrative medicine. The focus is on the whole person, including the physical, emotional, mental, social, spiritual, and environmental influences that affect an individual's health.

The Boston-based Schwartz Center for Compassionate Healthcare offers the Schwartz Rounds program, in which 450 healthcare organizations participate.

Schwartz Rounds are educational sessions held in hospitals that include a trained facilitator and several panelists who have a focused discussion on a single topic. One session, held at a large academic medical center in Michigan, was titled "Hangry: The Things I Do When I'm Hungry, Tired, and Don't Take Care of Myself."

Private Programs

For physicians who don't have access to a hospital group, or who are leery of joining one for fear that colleagues will see them attending meetings and put two and two together, there are nonhospital groups across the country that offer a greater degree of privacy.

In 15 states, the American Balint Society sponsors facilitator-led gathering of clinicians who meet regularly to present clinical cases. The goal is to improve and better understand the clinician/patient relationship.

The organization also sponsors Balint Online, where virtual groups meet online via videoconferencing, with the aim of "decreasing isolation through peer consultation."

Virtual groups meet online via videoconferencing, with the aim of "decreasing isolation through peer consultation."

The Remen Institute for the Study of Health & Illness at Wright State University's Boonshoft School of Medicine in Dayton, Ohio, sponsors Finding Meaning in Medicine discussion groups throughout the country. Meeting monthly, physician groups choose such topics as grief, grace, healing, courage, mystery, and intimacy, and each attendee contributes a personal story on that topic.

Programs From Organized Medicine

Medical associations are beginning to create online programs to help physicians deal with stress and ward off burnout.

The American Academy of Family Practice had Dr Drummond put together a set of tools to reduce burnout. [1] The American College of Surgeons offers a physician well-being index and a variety of articles to read. [2]

The American Medical Association offers a free suite of online modules for improving medical practice as part of its STEPS Forward program for improving medical practice. Under the direction of Dr Sinsky, the association has put together four modules dealing with "professional well-being." They focus physician wellness, improving physician resiliency, preventing physician burnout, and suicide prevention. [3]

Coaching

If you can't find any resources at your medical association or hospital, or you want to be anonymous, you can always hire a coach. You can find them from coast to coast. Many coaches focus on physicians, and some are physicians themselves.

Physician coaches work with stressed or burned-out doctors in person or over the phone. They tend to deal with four areas: leadership skills, major life decisions, disruptive physicians, and physician burnout. Many of them conduct workshops as well.

Physician coaches work with stressed or burned-out doctors in person or over the phone.

Dr Moskowitz, a radiologist, runs the Center for Professional and Personal Renewal in northern California. Dr Drummond, whose coaching firm is called The Happy MD, is a family physician based in Seattle, Washington. He has six coaches working for him, all of whom are physicians.

Francine R. Gaillour, MD, an internist, is executive director of the Physician Coaching Institute in Bellevue, Washington. Helane Fronek, MD, another internist, runs Doctors Coaching Doctors, another California-based firm.

Heather Fork, MD, whose Doctors' Crossing coaching firm is in the Austin, Texas, area, is a dermatologist. Gail Gazelle, MD, a palliative care specialist, operates The Successful MD in Boston and runs the burnout program at Brigham and Women's Hospital.

Coaching is all about enhancing self-awareness. The physician helps create the agenda, which could cover such issues as where they get stuck, or what motivates them.

One caveat: Coaching is meant for high-functioning individuals who are willing to look at and examine their feelings and motives. It typically won't work very successfully for people who are active substance abusers.

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Welcome! This article is part of a Medscape Physician Business Academy course, . Visit the Course Page to take the full course and receive a certificate.

 

Gabriel A. Sara, MD

| Disclosures | January 01, 2017

Authors and Disclosures

Author(s)

Gabriel A. Sara, MD

Assistant Professor of Medicine, Departments of Medicine, Hematology, and Oncology, Icahn School of Medicine at Mount Sinai; Medical Director, Infusion Suite, Division of Hematology/Oncology, Mount Sinai West, New York, New York

Disclosure: Gabriel A. Sara, MD, has disclosed no relevant financial relationships.