Leaders Move to Tackle Burnout in Neurology, Psychiatry

Megan Brooks

September 19, 2017

Burnout and emotional exhaustion are a national problem among all US physicians. But the issue is receiving increasing attention from national stakeholders and the federal government.

This past spring, psychiatry and neurology organizations came together over 2 days in Chicago to discuss physician wellness and burnout at the 2017 Crucial Issues Forum, convened by the American Board of Psychiatry and Neurology (ABPN).

"The Critical Issues Forum has been annual for the last 4 years. This year the topic was burnout and wellness in psychiatrists and neurologists," ABPN chair Kerry Levin, MD, from the Cleveland Clinic in Ohio, noted in an interview with Medscape Medical News.

The forum brought together national stakeholders in psychiatry and neurology to discuss factors contributing to physician wellness and burnout, and what can be done to promote physician wellness and decrease burnout by medical schools, residencies, specialty boards, and professional societies.

Representatives from the Accreditation Council for Graduate Medical Education (ACGME), the American Board of Medical Specialties, and the Association of American Medical Colleges (AAMC) attended the forum.

In his keynote address, Tait Shanafelt, MD, formerly at Mayo Clinic and now at Stanford University School of Medicine, noted that physician burnout is a widespread health systems problem that decreases quality of care, increases medical errors, decreases professional productivity and effort, promotes physician turnover, limits patient access to care, and erodes patient satisfaction.

Dr Shanafelt added his support to that of others who have called for a modification of the healthcare "triple aim" of enhancing patient experience, improving population health, and cutting costs of care into a "quadruple aim" through the addition of improving the work-life balance of healthcare providers.

Key Causes of Burnout

He noted that key causes of burnout include increased clinical demands, decreased staffing, decreased autonomy, government/reimbursement issues, decreased time with patients, difficulty balancing personal and professional lives, inefficiency and intrusion of electronic health records, and a sense of isolation.

But he also noted that physicians are at increased risk for burnout because of inherent personality characteristics that are often adaptive in some professional settings (perfectionism, attention to detail) but may become maladaptive in other contexts, such as integrating personal and professional life.

Ultimately, however, Dr Shanafelt said it's his view that problems in health systems are the biggest culprits in physician burnout. He offered the following specific organizational strategies to reduce physician burnout and promote physician engagement:

  • Acknowledge and assess the problem

  • Harness the power of leadership

  • Target interventions to improve efficiency

  • Cultivate community at work

  • Use rewards and incentives

  • Align values and culture

  • Promote flexibility and work-life integration

  • Promote resilience and self-care

  • Employ organizational science

Making Progress

In a keynote panel discussion, Darrell Kirch, MD, AAMC president and CEO, noted that many medical organizations are still in the early stages of awareness about the issue of trainee and physician burnout, but that fortunately, most organizations are past the point of denial.

Dr Kirch called for all medical specialty boards to partner with the National Academy of Medicine to focus attention on the negative effect of physician burnout on medical education and the quality of patient care.

Dr Levin told Medscape Medical News that burnout is a "multifactorial problem among all medical specialties in the United States. It has to do with increasing patient care burdens and decreasing support, but also the increasing burden that is put on physicians at the institutional and national levels in terms of metrics and measurements, both from federal payers and other organizations.

"These organizations ensure quality practice, and, of course, that is all very good, but it takes a toll on physicians who already are overwhelmed by their patients."

It's imperative to address burnout, wellness, and work-life balance to continue to attract young talent to the field of medicine, Dr Levin noted.

"That's why we asked the AAMC, the ACGME, and others to the forum. These organizations have an important role to play in addressing burnout in trainees and also in medical students, because there is burnout in those groups as well. This is not just an ailment of physicians but it also involves physicians in training and medical students."

Dr Levin said he is optimistic about overcoming physician burnout. "The problem is now recognized at the national level and at the federal level. Now finally all levels in the chain of command overseeing physicians are beginning to understand the threat burnout poses to the health of physicians, and as a result, the health of our patients.

"I am a neurologist," Dr Levin added. "We have among the highest burnout rates among all specialties of medicine, and we have one of the lowest satisfaction rates with work-life balance, but neurology is making progress."

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