Physicians call it “Pajama Time.” But it has nothing to do with curling up with a good book before heading off to bed.
In medical parlance, Pajama Time refers to the several hours at night that many physicians must set aside to catch up on completing notes, tasks and orders that they simply don’t have a time to manage during the workday.
However, Pajama Time is symptomatic of a larger and growing problem throughout the medical profession: physician burnout.
Dealing with a flood of medical data is a major cause of physician burnout. But it’s not the only one.
Physicians now find themselves under more stress and pressure from a variety of sources beyond their control.
For example, stress is sparked by increased patient volume, wrestling with complex and time-consuming electronic health records, merging practices that result in a loss of autonomy and peer-to-peer interactions, and a sharper emphasis on outcome metrics and benchmarks.
Although many of these changes are necessary as medicine moves away from fee-for-service and towards fee-for-value, the triple aim that is meant to fix the U.S. health care system only magnifies and perpetuates the stress experienced among the nation’s physicians.
Often difficult to detect, physician burnout takes on many forms. Chief among them is emotional exhaustion, detachment and insensitivity toward patients and a lack of feeling successful and accomplished in their work.
The severity of physician burnout often depends on the type of medical specialty being practiced.
Tait Shanafelt, MD, a nationally recognized expert in physician wellness, in 2014 administered the Maslach Burnout Inventory to a large national physician sample showing that approximately 50% of U.S. physicians were experiencing at least one symptom of burnout.
In 2013, the first year of the “Medscape Lifestyle Report,” showed that emergency medicine had the highest rates of burnout, just above 50 percent. That jumped to close to 60 percent in 2017. It also showed that physicians working in primary care tended to struggle most with burnout.
The consequences of physician burnout run far and wide.
Picture a Venn diagram, with burnout overlapping the personal and the professional effects.
Personal consequences include anxiety, depression, alcohol and substance abuse, family conflict and an increased risk of suicide, according to the Mayo Clinic.
Professional consequences range from decreased quality of care to increased medical errors to decreased patient satisfaction.
The rising level of physician burnout is simply unsustainable, with repercussions negatively affecting nearly every facet of the health care system.
Summit Medical Group, the nation’s largest independent multispecialty physician group, recognized the concerning trend of burnout among doctors even before it was talked about openly, and is at the forefront of this issue. The group is combating physician burnout on multiple fronts:
1. Improve communications. One way to help physician burnout is to give physicians an avenue to express what they see as causing their stress and have someone take it seriously. Summit Medical Group (SMG) has made this a top priority by having its board of directors, who are practicing physicians, meet with the group’s physicians to obtain their feedback, thoughts and suggestions. By having regular small group meetings with physicians these leaders gain a keener sense of the possible remedies that SMG can adopt to reduce burnout. Also, most of the interventions that the group has adopted to address burnout has come from these meetings. To further help with communication, SMG assigned lead physicians to geographic regions to ensure that accurate and timely information gets down to the individual physician and their feedback gets up to leadership. Another way SMG has strengthened overall communication is through various electronic newsletters that keep its physicians informed and engaged about the medical group and their colleagues. They have also created a dedicated email address and voicemail allowing their physicians to leave confidential feedback at any time.
2. Bolster physician support services. It is well known that physicians are excellent at helping others, but not very good at asking for help themselves. It’s not in their DNA. That’s why it’s incumbent upon medical groups to proactively offer support services to their physicians with minimal barriers. For example, SMG has trained 14 volunteer physicians from different specialties to speak with their colleagues during times of acute stress, unexpected outcomes or when dealing with a medical malpractice lawsuit. These volunteer physicians often have been though similar situations, making it easier for them to offer support and advice. SMG also does not wait for their physicians to ask for help but will reach out to them to offer support whenever one has had a stressful event or appears in need. SMG further understands that at times medical providers need more than a peer to speak to and does have professional psychological services available to them. There are also other support services that SMG has implemented, including ways to help physicians unplug when they are on vacation. Because many physicians receive hundreds of patient orders and tasks per week it is no wonder that many feel compelled to log on to the Electronic Health Record (EHR) when they’re supposed to be recharging their batteries. And if they choose not to log-on many experience anxiety on vacation knowing what they are going to return to when they head back to the office. To help, SMG has hired Advanced Practicing Nurses and Physician Assistants to manage their doctors’ EMR inboxes when they are on vacation. This not only helps the vacationing physician but also reduces the burden on the office staff who are often managing their own work along with that of the vacationing doctor.
3. Foster a sense of community. The ‘Physician Lounge,’ a physical space where doctors could unwind and exchange professional information and give each other support, used to be a staple of the medical profession. No longer. Physicians simply do not have the time to go to the lounge during busy work hours and many medical systems have eliminated them in favor of more clinical space. However, medical groups do need to find alternative means for their physicians to interact with each other to avoid having them feel isolated and siloed. For example, this summer SMG adopted a social media platform called Yammer. Yammer has been described as an on-line “Physician Lounge” where doctors can exchange medical information, consult on general medical cases, share social pleasantries and provider each other support. Similar to Facebook, Yammer is set up for each medical department throughout SMG as well as for the larger physician group. Perhaps most important, Yammer offers physicians a sense of community—a place where they can share ideas, frustrations and solutions to the stresses they face. In addition, SMG holds regular networking events which give providers who may feel isolated in their work the opportunity to interact with colleagues both professionally and socially.
The old-school thinking needs to take a dramatic turn. As a previous Associate Director of a Family Medicine residency program, I’ve seen the toll that burnout can take on even the freshest generation of physicians. There’s a growing onus on the medical profession to reduce the rate of physician burnout. The industry’s future wellbeing depends on it.
James Korman, PSYD, FACT, is Director of Behavioral Health and Provider Engagement at Summit Medical Group.