Health professionals in the U.S. are facing a public health crisis: More than half of doctors are affected by burnout, and it’s having negative effects on their health and the health of their patients.
Burnout is caused by a variety of factors, but for the most part, “being a physician is inherently stressful. It just is,” says Samantha Meltzer-Brody, MD, director of the UNC Perinatal Psychiatry Program and associate professor in the UNC Department of Psychiatry. Dr. Meltzer-Brody is the director of UNC’s Taking Care of Our Own Program, which provides mental and physical health education, support, advice and referrals for physicians in the hopes of preventing or mitigating burnout.
“UNC has had a physician mental health program for much longer than many other institutions,” she says. “I think we are doing a very good job of saying this is an important issue and something that needs to be actively addressed.”
Symptoms of Physician Burnout
The symptoms of burnout are serious and shouldn’t be ignored. They include:
- Emotional exhaustion
- Sense of loss of meaning in work
- Reduced sense of accomplishment
If untreated, these symptoms can lead to depression and, in severe cases, suicide. Physicians and physicians in training historically have a higher rate of suicide than the general population. A 2015 study by the Mayo Clinic found that out of 7,000 doctors, 7 percent had considered suicide within the past 12 months, compared with 4 percent of other workers.
How UNC Addresses Physician Burnout
Taking Care of Our Own started in 2012 and has picked up support as the national dialogue about physician burnout has grown louder. The program acknowledges the struggle of balancing medical school, residency and work with a personal life, and it aims to intervene when the balance becomes unstable. In 2016, UNC went a step further by integrating a “Quadruple Aim” approach in hopes of not only assessing burnout, but also enacting institutional change to prevent it.
The Quadruple Aim takes the widely adopted “Triple Aim” of improving health system performance—enhancing patient experience, improving population health and reducing costs—and adds a fourth item: improved professional satisfaction.
The new focus is institutionwide, Dr. Meltzer-Brody says.
“We are working together now across the system with all the different components to effect change. Burnout is now something that leadership, department chairs and residency training directors recognize.”
With the adoption of the Quadruple Aim, physician wellness is now an important measurement of the health care system’s overall performance. Programs like the Integrated Emotional Support Program, which includes peer support and critical incident stress management, provide opportunities for physicians and providers to seek guidance.
“We recognize that this is a complex problem and there is not a simple fix, so we need to have a multifaceted approach,” Dr. Meltzer-Brody says.
While UNC is taking initiative to decrease the prevalence of physician burnout, other changes have landed in the form of guidelines and policies from oversight agencies. The American Medical Association adopted a policy in June that is aligned with the Quadruple Aim approach and would allow doctors and residents better access to mental health care and reduce the stigma of mental health illness in the medical community.
Physicians have been afraid to talk about burnout or mental health troubles for fear it might impact their ability to practice. The AMA’s new policy calls on state medical boards to evaluate the mental health of physicians as they would physical health, while not automatically considering a previous mental health diagnosis as an impairment to practice. The policy also aims to reduce the stigma of seeking help by making care more accessible in medical schools, residencies and hospitals.
Dr. Meltzer-Brody says prevention will be UNC’s focus in 2018. It is critical that the UNC School of Medicine and health care system work together to address this issue for physicians and providers by focusing on things that will decrease the drivers of burnout. This will include an active assessment of how electronic medical records contribute to burnout and ways to improve the workflow. However, she adds that physicians also need to be vigilant in protecting their own well-being by making choices that allow them time to recharge.
“It’s imperative that physicians make this a top priority,” she says. “Make sure you reach out and access the resources that are there. We need to move beyond the concern that taking care of ourselves is stigmatizing and take a pragmatic approach to our own health.”