A week ago, I saw Jeremy for our monthly check-in. He told me he was ready to try psychotherapy. This was a major breakthrough!
Unfortunately, his insurance didn't cover therapy. Even if it did, none of the clinic's social workers had openings in their schedule, and we just lost two great employees last month.
When I explained the situation to Jeremy, he first seemed confused, then angry. He wasn't angry at me, exactly, but his emotions filled the tiny, windowless office with tension. He, in turn, requested more medication for his nerves. This seemed logical, but we both knew it wasn't the best solution. Instead, I attempted to summarize relaxation techniques.
I glanced at the clock. Jeremy noticed and realized his 15 minutes with me were almost over. He stood up and leaned over my desk, desperate now, begging for an extra prescription. He quickly iterated through the tremulous story of his past. I listened empathetically, but explained again why more medication wasn't the answer. He left.
For a moment, I sat alone at my desk. My heart raced. I felt sick and tired. I felt like a failure. I knew what Jeremy needed to get better — and more importantly, he knew what he needed to get better — but we were both stuck. We needed more time, more resources, more support.
I skimmed my schedule. Twenty-one more patients to "help" today, and the next two were already in the waiting room.
A Brief Background on Burnout
Because of the challenges facing modern medicine, healthcare clinicians such as nurse practitioners, physician assistants, and physicians are more likely than ever to experience the effects of professional burnout. They are far-reaching, affecting not only the individual clinician, but also their patients' lives and the healthcare system as a whole.
In 2007, the U.S. Department of Health and Human Services described professional burnout as an occupational hazard, resulting in high-quality healthcare professionals leaving medicine altogether. Preventing and addressing clinician burnout is not longer an option; it is essential to improving outcomes, attracting talented professionals, and reducing the clinician shortage.
Compounding the problem is the fact that clinician burnout is on the rise. In 2013, 40 percent of healthcare professionals reported experiencing symptoms; by 2015, this number had increased by 6 percent. Primary care providers and those practicing in emergency rooms or intensive care units experienced the highest rates.
Professional burnout results when you combine compassion fatigue with time pressures, a chaotic workplace, misalignment of values, and a lack of autonomy. Symptoms fall into three categories: emotional exhaustion, depersonalization, and reduced personal accomplishment. If not managed properly, burnout can lead to alcohol abuse, relationship problems, and suicidal thoughts.
Not only does burnout hurt clinicians, but it hurts patients, too. A 2009 study published in the Annals of Internal Medicine found that clinicians with symptoms of burnout are more likely to make a medical error and experience malpractice litigation. Their patients are less satisfied and less adherent to treatment plans, resulting in poorer outcomes.
Burnout also costs a lot of money. Estimates suggest that it runs up a bill of $213.1 million annually: $185.2 million because of early retirement and $27.9 million because of reduced clinical hours. Burned-out clinicians take more sick time, are less productive, and retire at a younger age.
Clinicians have been and always will be exposed to distressed patients. This won't change. What can change is the system surrounding and supporting these providers.
How to Prevent and Address Provider Burnout
Here are five methods to try:
1. Help Patients Help Themselves
Ensure that patients can access the resources they need to care for themselves. Explore innovative means for patients to engage in their own wellness. Consider offering health coaches to guide patients through both the complexity of the healthcare system and their own illnesses. Evaluate technology solutions such as apps, fitness bands, and patient portals that effectively engage patients in their own care.
2. Shift to Value-Based Care
Moving away from the fee-for-service model allows clinicians to practice medicine more autonomously. It doesn't make much sense to assume every patient should be seen for a mere 15 minutes. Based on their situations, maybe one needs 20 minutes while another needs 10. Transitioning to value-based care will empower clinicians to do what's best for patients in order to achieve the optimum outcome and highest reimbursement. These newly empowered providers will be less likely to experience burnout and more productive in the long run.
3. Invest in Clinician Wellness
Start by creating an anti-burnout committee and electing a champion from every department. Distribute the Mini Z Survey developed by the Medical Group Management Association to assess providers' current burnout levels. Based on these results, plan anti-burnout initiatives. Consider exploring employee perks already used by the high-tech industry to attract top talent: unlimited vacation, free child care, pet insurance, subsidized lunches/snacks/drinks/coffee, daily yoga breaks, gym membership, oil changes and car washes, on-site massages, and paid volunteer time and parental leave.
4. Provide Extra Support
Develop a culture that supports clinicians when they need it most. Consider evaluating when and where a healthcare system needs more providers. Would your clinic benefit from one extra primary care nurse practitioner during the flu season? Maybe the emergency room needs one extra physician over the summer. Seek out creative and cost-saving solutions to these problems, such as analyzing big data and recruiting through a locum tenens agency.
5. Implement Team-Based Care
Engage other members of the healthcare team in patient care. A 2015 study published in the Journal of Family Practice found that team-based care improves patient outcomes, increases access to care, decreases costs, and drastically enhances provider job satisfaction. Remember to involve all clinicians in decision-making, and to appreciate everyone's expertise, regardless of background or education. Create a culture that celebrates diversity, respects all ideas, and discourages arcane notions of patriarchy.
Bio: Dr. Melissa DeCapua is a board-certified psychiatric nurse practitioner who graduated from Vanderbilt University. Her background is in child and adolescent psychiatry as well as psychosomatic medicine, and she currently works as a design researcher in the technology industry. She is a strong advocate for empowering nurses, and she fiercely believes that nurses should play a pivotal role in shaping modern healthcare. For more information, visit melissadecapua.com and follow her on Twitter @melissadecapua.