The notion that physician burnout can be eliminated may seem like an idealized vision, but it is coming true.
We are committed to changing the sobering statistics: physicians in the United States commit suicide at nearly twice the rate of all other professions. For every suicide, there are thirty unsuccessful attempts. If recovery involves leaving medicine for a period of time, most will not return to the profession if they are out for more than ninety days. For those that do return to the profession, approximately ten percent will continue to struggle with some form of post-traumatic stress for the rest of their lives.
Burnout is a consequence of many factors. It begins with life events, both good and bad, and progresses until stress wears the sufferer down. Eventually, those impacted walk through every day with a negative mindset, growing more helpless and hopeless and feeling worthless. Neurologically, the victim is no longer thinking rationally about the situation and lacks the energy and motivation to make changes. Ultimately, a crisis occurs that leaves the individual physiologically and psychologically wounded. This is a moral injury that destroys one’s image of self and worldview.
Fortunately, there is hope for breaking this cycle. Ten years ago, I became personally aware of the issue of physician burnout as a hospital administrator. A friend who was a physician went “off the deep end,” losing his job and family, before moving on to another career. I am grateful he didn't take his life. As a result, I began to focus more on the issue of burnout, especially in what I call the “helping professions.” In my private practice, I began to recognize patterns showing up in my clients. These were patterns we could actually address.
However, the work I did with dual diagnosis addicts in a mental health and substance abuse treatment center didn’t provide the opportunities professionally to address this issue head-on with the help and resources of like-minded colleagues. It wasn’t until five years later, when I moved to another role in healthcare, I discovered other professionals concerned with and committed to addressing the issue of physician burnout. Now, a number of my colleagues work together, bringing a wide range of medical, psychiatric, psychological, and wellness expertise to bear. In the last five years, we have seen remarkable progress with some startling outcomes. This is the good news about physician burnout.
We discovered holistic physician well-being programs succeeded in reducing and eliminating burnout and suicide. These programs deal with the external environment in which the physicians live and work, as well as the physicians themselves. We address all stages of peri-burnout. There are specific conditions that should be met in order to have a confident expectation of success. For example, the well-being program must be holistic and, in addition to addressing environmental factors, must provide strategies involving prevention, maintenance, and intervention. Additionally, it must be consistently functioning in this manner for three years.
Clinical and financial measures had to be developed to satisfy leaders sponsoring programs. We demonstrated results using evidence-based medicine, relevant financial measures and improved quality, engagement, and satisfaction measures, including lower turnover and replacement costs. A new coaching role was created to help minimize the impact of more cost-sensitive crisis interventions. This coach was able to confidentially help a physician improve their practice of medicine, find ways to lessen the impact of the workload created by new technology, and help the physician be a better business person.
We had to be creative in developing models for hospitals, physician groups, and health systems that enabled them to navigate the complex world of regulatory compliance issues, confidentiality issues, and interface with statewide programs where they exist. These models need to work equally well with employed, contracted, and community-based physicians. There is also the matter of comparative performance: how is one institution doing compared to another? This meant working with partners to develop a national database. Additionally, we needed to make such programs budget-friendly and explore alternative means of funding in order to have a three-year return on investment.
These programs are currently in operation to varying degrees across the country. Some elements have been put in place, tested and proven, while others are still being tested. Regardless, the results have encouraged us enough that we’ve extrapolated and exported internationally the lessons learned to address issues of burnout with veterans, first-responders, and refugees. There is still a great deal of work to do. We are grateful for the small progress that has been made and the privilege of serving leaders in our profession.
About the Author: Jeff Jernigan, PhD, LPC, BCPPC (jjernigan@fspleaders.com)
Jeff is an ordained pastor and board certified psychologist. As a missionary, minister, and healthcare professional, Jeff has served in faith-based ministry including churches, para-church organizations, hospitals and health systems since 1983. He is recognized nationally and internationally for leading-edge programming focused on the prevention of burnout and self-directed violence associated with the helping professions.
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