Centura's Solutions to Physician Burnout

Introduction: Physician burnout has been recognized as a national concern for over 40 years, even prior to COVID hitting in 2020. A 2015 study found over 50 percent of physicians report symptoms of burnout (1) 

In 1981 the Maslach Burnout Inventory (MBI) was introduced and has become the gold standard for assessing physician burnout (2). The MBI scales assess how frequently members of the group feel Emotional Exhaustion, Depersonalization, and Personal Accomplishment. Examples of survey statements in the 3 areas include: 

• “I feel drained from my work” (Emotional Exhaustion).
• “I don’t really care what happens to some patients” (Depersonalization). 
• “I have accomplished many worthwhile things in this job” (Personal Accomplishment).

On May 23, 2022, The Surgeon General declared that burnout in healthcare workers is a crisis and physician wellbeing must be a priority.  During the pandemic, rates of burnout have reached their highest levels and do not appear to be decreasing.  Peer coaching is a useful mechanism to support physicians. A study by the Cleveland Clinic demonstrates that physicians in a system with a peer coaching program are more likely to stay at an organization (3). Furthermore, in VITAL Worklife’s 2022 pre/post survey results of physician peer coaching cases, 92% stated, “their coaching experience made it more likely they would stay in their current role and/or medical profession and 97% stated, “they would recommend peer coaching to others” (4). While it is broadly accepted that peer coaching is a great source of support for physicians, there is little published data on specific benefits (5).

The Wellbeing program at Centura Health was initiated in 2015 and expanded in 2019. Between 2015 and 2022, over 150 peer coach physicians have been trained at 11 of our 20 hospitals. Our data supports the effectiveness of the peer coaching program for both the trained coaches and those that they support.  

This article will describe four areas of physician peer coach training successes:

• Lower MBI burnout scores in medical staff in hospitals with the most coaches.

• Lower MBI burnout scores in hospitals with the longest peer coaching programs

• Lower MBI burnout scores in coaches versus general medical staff

• Higher engagement scores in coaches versus general medical staff.

The Centura Health Physician and Advanced Practice Provider Wellbeing Program includes an Enterprise Wellbeing Committee and an Enterprise Medical Director with a specialty in psychiatry and expertise in physician wellbeing since 2009 (6). 

The program began when a group of Centura Health physicians met in 2015 to create an action plan to address burnout.  The physicians requested training to help them recognize the symptoms of burnout and address the burnout; they specifically asked for training so that they could provide colleagues with one: one support.  There was overwhelming agreement within this group that a physician was much more willing to accept support from a colleague than from a mental health expert, family, or non-medical friends. This sentiment is repeatedly voiced by the physicians that go through our peer coach program.   Other programs similarly describe the importance of talking with a peer and have noted that almost 90% of physicians queried would opt to talk to a colleague in contrast to seeking other forms of support (7).

Other facets of the Wellbeing Program include a 24-hour support line specifically for medical staff, 1:1 confidential coaching and support from the Wellbeing Medical Director, group support for physician practices, an annual Wellbeing Conference and activities at individual hospitals including dinners, social activities with families and book clubs.  

For the past two years we have asked the physicians on medical staff to complete the MBI and associated Areas of Work-Life Survey . Our results are similar to the national averages of MBI scores based on the Mindgarden data; however, the most recent Mindgarden data is primarily pre-pandemic and spans 2017-2020. (8) The most robust MBI data available for 2022 was collected by Shanafelt; rates of emotional exhaustion and depersonalization have significantly increased nationwide in late 2021 and early 2022. In a sample of over 4300 physicians nationwide, rates of emotional exhaustion increased by 30% and depersonalization increased by 60% (9). 

Our MBI data remained stable with no significant increases between February 2021 and July 2022. There may be multiple factors that influenced our stable scores; however, we feel that our peer physician coach training program had a positive influence on the wellbeing of our physicians.

Findings at individual hospitals offer insights into a relationship between peer coach training and wellbeing. Three hospitals stood out due to their low levels of burnout: 1) St. Anthony North, 2) Penrose-St. Francis and 3) St. Thomas More)

• Penrose-St. Francis has had the longest running, trained and tenured physician coaches 
• The “big 3” hospitals have more physician coaches than the other seven hospitals. 
• St. Anthony North and Penrose-St Francis had significantly lower rates of emotional exhaustion than the other hospitals. 
• St. Thomas More had the lowest rate of depersonalization
• All three hospitals had the highest scores on the personal accomplishment questions indicating a high level of personal satisfaction related to their work.  

In addition to providing support to others, the benefits of going through coach training program appears to have a positive effect on the coaches.  Emotional exhaustion and Depersonalization scores were significantly lower for physicians that had completed the training. 

The “trained” physician coaches reported at least three intrinsic benefits:  

1. They feel secure and more confident when approaching and supporting a struggling colleague, 
2. They report a pleasure in connecting and forming new friendships with the physician in their coaching cohort
3. They acknowledge the altruistic reward of coaching a peer.

Quotes from “trained” physician’s and advance care practioners who completed the program stated:

• This was a great discussion, good connections, and topics. I feel more confident coaching now. 
• Being more aware of what my colleagues are going through and how I may be able to help them thoroughly. 
• Increases our awareness of the people around us
• I will be more likely to listen without trying to solve problems. Make sure I always offer to follow up with colleagues who are struggling
• Just listening is powerful for our peers – not just our patients
• A good amount of brainstorming and learning. Not overwhelming- gave a sense of “I can do this”
• Improved empathy, better listening, ability to help my peers
• Rearrange how I approach coaching situations as compared to medicine. I could see this being useful at work as well as in my personal life. 
• I felt like the training alone made my stressors diminish
• I will be better lister, I will reach out more to my peers

In conclusion, the ongoing physician burnout “epidemic” continues to be a major challenge facing healthcare. The “Centura Health Physician and Advanced Practice Provider Wellbeing Program” continues to find ways to support Physicians and APPs through innovative, targeted programs. The trainings not only help them to be better supports for their fellow colleagues, but better physicians with their patients and better family members at home.  

These programs have showed positive outcomes that are trending in the right direction for our healthcare workers and will only increase retention, improved health and ultimately will provide a more positive bottom line for Centura Health. 

References:

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clinic Proceedings. 2015 Dec; 90(12): 1600-1613.
2. Leiter, M. P., & Maslach, C. (2003). Areas of worklife: A structured approach to organizational predictors of job burnout. In Emotional and physiological processes and positive intervention strategies. Emerald Group Publishing Limited.
3. https://healthcareexecutive.org/archives/may-june-2022/cleveland-clinics-coaching-approach-is-improving-retention
4. Vital Work-Life, “2022 Well-Being in Healthcare: Trends & Insights” 2023. 
5. Author: Kelly Williamson, Patrick M. Lank, Navneet Cheema, Nicholas Hartman, Elise    O. Lovell, Publish Year: 2018; Authors: Kelly Williamson, DOI: 10.4300/JGME-D-18-00155.1, Publication: J Grad Med Educ. 2018 Oct; 10(5): 532-536.
6. Goebert D, Thompson D, Takeshita J, Beach C, Bryson P, Ephgrave K, Kent A, Kunkel M, Schechter J, Tate J. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009 Feb;84(2):236-41. doi: 10.1097/ACM.0b013e31819391bb. PMID: 19174678.

• Higham A, Behrman S, Vlachos H, Lightfoot H, Stevens R, Stegen G. Let's embed peer-support groups into the medical curriculum for all. Future Healthcare J. 2021 Nov;8(3):e692-e694. doi: 10.7861/fhj.2021-0041. PMID: 34888468; PMCID: PMC8651315.

1. Copyright © 2012, 2016, 2018 by Christina Maslach and Susan E. Jackson. Allrights reserved. Published by Mindgarden, inc. www.mindgarden.com [v4.1CF-1085]
2. Shanafelt TD et al. Changes in Burnout and Satisfaction with Work-Life Integration in Physicians During the First 2 Years of the Covid-19 Pandemic. Open Access Published September 13, 2022 DOI;

Authors:

Di Thompson, MD, Enterprise Medical Director of Well-being,Centura Health

Brock Bordelon, MD.

Calvin Paries, DrPH.

Sunmee Lee, MD.