Submitted by Mario Pistilli, Chair, CHEF Chapter Communications Committee
The event was a panel discussion moderated by Anita Halverson, FACHE. The panel was composed of Dr. Patrick Godwin, Section Chief of Hospital Medicine at Jesse Brown VA Medical Center; Dr. Barbara Loeb, Chief Medical Officer, Tenet Healthcare; Dr. Carlotta Rinke, Senior Medical Director, Aetna Accountable Care Solutions. We also had the privilege of being joined by Mr. Richard Cordova, FACHE, past Chairman of ACHE and President Emeritus of Children?s Hospital Los Angeles. The audience was a great mix of both experienced and younger physicians as well as hospital administrators. The issue of physician burnout has a wide ranging effect on everyone in the healthcare industry.
Anita gave a wonderful overview of the scope of physician burnout and the linkage between physician burnout and lower quality of care. Anita pointed out that up to 11% of surgical errors are attributed directly to physician burnout. Physician dissatisfaction has been on the rise with up to half of physicians reporting some sort of burnout. The most effected group of physicians were mid-careerists of between 11-20 years in practice.
Dr. Godwin discussed the issue of burnout from the perspective of the hospitalist. The main stressor that Dr. Godwin has seen in practice is the physician being torn between work and family. This work-life balance can be very difficult to achieve for a hospital based physician. Dr. Godwin defined burnout as ?being unable to recover during your time off?. I found this to be an interesting perspective on burnout. Dr. Godwin had some concrete advice for the audience in dealing with burnout. Dr. Godwin advised the creation of boundaries to preserve your outside activities. He emphasized that it is not selfish to create these boundaries, but it makes you a better more productive physician. Dr. Godwin shared that one way to maintain these boundaries is to learn to be comfortable in delegating. Dr. Godwin suggested that physicians evaluate closely the tasks that they perform each day and which of those can be performed by others. Dr. Godwin pointed out that you need to learn when to say ?no?.
Dr. Rinke had a completely different focus on the topic and approached it more from the perspective of a typical physician?s personality type and the realities of medical practice. Dr. Rinke described that a typical physician is a highly competitive and driven individual. In order to get accepted to medical school and succeed, the person is typically at the top of their high school and college class. These individuals are typically people that embrace learning and overcoming challenges. The fact that there is little path for advancement for mid-career physicians can be a significant source of stress for highly competitive personalities. Primary care medicine can get very repetitive and for people used to overcoming challenges and moving forward this can be very stifling. Dr. Rinke suggested that physicians get more involved in hospital or community projects in which they can fulfill those needs to learn, grow, and advance.
Dr. Loeb gave a very surprising and sobering view of how serious this issue can become. Dr. Loeb shared the shocking statistic that over 400 physicians commit suicide each year. In fact, physician is the top profession for suicide risk at 1.87 times the general population. Dr. Loeb also stated that there is a high rate of physicians that suffer from post-traumatic stress disorder. Dr. Loeb revealed that a survey of 8000 surgeons showed that 6.3% of them had contemplated suicide. One of the major stressors that Dr. Loeb mentioned was the lack of autonomy that physicians experience. Physicians are increasingly losing their decision making power to insurance companies, medical practice managers, government regulations, and hospital management. Dr. Loeb felt that typical physicians like efficiency, having input, quality, competent nursing, and appreciation. The lack of these at sufficient levels all contribute to physician stress.
Mr. Cordova then gave a completely different perspective from his role as a hospital CEO. He brought his wealth of experience to the issue. Mr. Cordova spoke about the significant financial pressure that young physicians are under most of whom have significant student loan debt. He spoke about his experience in recruiting physicians and that housing and compensation are major concerns. Mr. Cordova also pointed out that professional reputation both in the community and inter-professionally are significant stressors. Mr. Cordova gave a lengthy discussion on how medical schools have not kept pace with the changing world and have failed to adapt the way they train physicians. They graduate ill prepared to deal with the stressors they will face and lacking the leadership skills and emotional intelligence to thrive.
The panel discussion was a revealing look at the seriousness and pervasiveness of physician burnout. The point was emphasized that the healthcare industry needs to consider physician well being as an investment. There were many similarities between the stressors that the panel discussed and those that I have experienced in my career. I think that all of us in the healthcare industry have struggled with some aspect of these issues and the strategies presented would benefit all of us. It was refreshing to have the participation of physicians in an ACHE event. I feel that more involvement by physicians in ACHE and in healthcare leadership roles will be an increasingly beneficial partnership. It is important that physicians and other healthcare professionals reconnect to their purpose and make taking care of themselves as high a priority as taking care of others.