January 20, 2017
Area(s) of Interest: Anesthesiology Physician Leadership
||Bryan Bohman, M.D.
This is an infographic adapted from a presentation by Bryan Bohman, M.D., that drives home the mental, physical and fiscal costs of physician burnout:
Burnout is an insidious psychological phenomenon consisting of two main elements: depersonalization and emotional exhaustion, says Dr. Bohman, who is Associate Chief Medical Officer at Stanford Hospital and Clinics and Interim Director of Stanford's new WellMD Center.
Burnout impairs not only the physician's ability to provide optimum care for patients, but it also can have a devastating impact on the physician's personal life, as evidenced by physician suicide rates that are twice the national average. “We have unfortunately had tragic experiences with this among our own Stanford trainees and faculty colleagues over the past several years,” he says.
Physicians are in many ways a highly privileged group, he said, but surely this does not justify exposing them to this shockingly high risk of burnout. Burnout is not a minor consideration and does not simply reflect a sense of being “overworked and underpaid.”
One of Dr. Bohman's primary areas of interest is the relationship between physician wellness and health care system performance. While serving as Chief of Staff at Stanford Hospital and Clinics he established a medical staff wellness committee to advocate for appropriate attention to physician wellness across Stanford. As chair of this committee for its first four years, he led the charge to measure and address Stanford physicians’ burnout levels as well as their professional fulfillment.
The result was the 2015 launch of the Stanford WellMD Center, aimed at improving the health and professional fulfillment of physicians. The program has been funded for five years by the Stanford School of Medicine, Stanford Health Care and Stanford Children’s Health.
It is Stanford’s goal to better equip the faculty, students and researchers to meet the challenges of clinical practice for physicians where increased productivity, lower costs, improved patient experience and better population health outcomes are now the norm, says Dr. Bohman.
Statistics show that the professional well-being of U.S. physician workforce is threatened, with as many as 50 percent of academic physicians, and over 75 percent of trainees, showing symptoms of burnout in recent surveys, he said. “This extraordinary level of physician stress and burnout takes a toll not just on the affected individuals, but also has serious effects on the health of both patients and the entire organization.”
A 2013 survey of Stanford physicians found a significant portion (26 percent) reported one or more symptoms of burnout. The survey found that clinically focused faculty had higher burnout rates and lower professional fulfillment than research faculty or community physicians/adjunct faculty.
Another key finding from the Stanford survey was that burned out physicians leave Stanford at a rate twice that of those who do not suffer from burnout. "We need these physicians to stay at Stanford," he said. "So it’s really important that we build a culture and a clinical practice environment that supports work life balance and the professional fulfillment of our people. That’s what will alleviate their burnout and keep them here despite the crazy housing prices on the Peninsula."
The financial impact of attrition on Stanford Medicine is also steep— the combination of direct recruiting costs along with lost clinical revenue can easily exceed $1,000,000. That is in addition to the costs of reduced productivity and clinical quality associated with burnout.
EMRs driving up burnout rates
EMRs have become a crushing burden. Instead of just collecting clinical data, they have become billing tools, quality tools and the required data capture can impair physicians from connecting with their patients, he said.
“Connecting with patients is where physician satisfaction comes from. We cannot do a good job if we spend most of our time checking boxes. Improving our physicians’ experience with the EMR is a key goal.”
Accordingly, the WellMD program has allied with the Chief Medical Information Officer to search for solutions. They are also working with administrative leadership in the two Stanford hospitals to build care processes that are more efficient and reliable. "We believe that physician wellness should be an explicit consideration in strategic and operational decision-making across Stanford Medicine," said Dr. Bohman.
Studies show when physician wellness is ignored, there are also consequences for patients – medical errors are one such consequence. Depressed resident physicians made medication errors at six times the rate of residents who were not depressed and sleep-related impairment has also been shown to have direct impact on the quality of patient care in addition to being harmful to the affected physician’s psychological and physical well-being, said Dr. Bohman.
"We want to encourage a culture where the effects of the academic and clinical environment on physician health and professional fulfillment are seen by all as an essential consideration in creating the highest quality academic health care system," he said.
As part of that effort, the WellMD program has ambitious goals:
- Embed wellness education and initiatives in medical student and trainee curricula;
- Integrate support for physician wellness in leadership roles and responsibilities
- Provide access to child care and affordable housing for trainees and early career physicians;
- Find ways to make it more practical for physicians to participate in paternity leave, maternity leave, elder care and family leave; and
- Establish space and venues to encourage professional interaction and wellness (including physician lounges, exercise opportunities and healthy food options).
These are just a few of the initiatives that the program plans to enact in its efforts to slow physician burnout at Stanford.
Plenty of changes to the program are coming, Dr. Bohman said. In 2017 the program will hire a new director and a new burnout survey of the school’s physicians has just been completed. “Based on national trends showing worsening of epidemic levels of physician burnout, and considering that our center is just starting its real work, I don’t expect to see our Stanford burnout levels improved from 2013. If it holds steady this time around, I would be very happy. But the status quo is truly unacceptable, and our longer term goal is to make a large dent in these numbers and to have a large impact on the lives of our physicians, our patients and all the members of our health care teams.”
Learn more about the Stanford WellMD program at http://wellmd.stanford.edu.
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