Research has shown that physician burnout is a growing epidemic throughout the United States. “In medicine, high levels of burnout have been found among both physicians and nurses in many studies spanning a wide range of specialties,” says Lillian L. Emlet, MD, MS, FACEP, FCCM. The ramifications of burnout are significant and can include decreased patient satisfaction with care from their physicians, increased risks for medical errors and litigation, and reduced quality of life for clinicians, among others.
A recent study in JAMA Internal Medicine tested an intervention involving a facilitated physician small-group curriculum to see if it improved well-being. The intervention involved a small group curriculum for physicians that met for 19 sessions. The sessions lasted 1 hour and were conducted on a biweekly basis for 9 months. The hypothesis is that the intervention would improve physician well-being when compared with giving physicians 1 hour of protected time biweekly. In each of the sessions, physicians discussed topics such as meaning in work, empowerment and engagement in work, burnout, symptoms of depression, quality of life, and job satisfaction.
The analysis concluded that the intervention led to improvements on meaning and engagement in work and reduced depersonalization, findings that were sustained when assessed at 12 months. However, the authors observed no statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction among participating physicians.
A Thorough Critique
In an issue of Critical Care, Dr. Emlet and Matthew Siedsma, MD, critiqued the aforementioned study and described its pros and cons. “The study was well designed and provided 12 months of follow-up to ensure there was a lasting effect from the intervention,” Dr. Emlet says. “The design was also randomized control trial rather than observational or descriptive in nature. However, only two aspects of physician well-being were improved, and many aspects were improved with giving 1 hour of protected time in the control group.”
According to Dr. Emlet, findings of the JAMA Internal Medicine study show that there is no single panacea for physician burnout, but there may be opportunities to improve physician well-being. She notes that since some physicians benefitted from an additional hour of protected non-clinical time, there is an impact of workload and time allocation with an increasingly highly digital electronic medical record and compliance requirements for billing and reimbursement. Some physicians will benefit from a shared community, time, and curriculum to promote wellness. More research is needed to determine which groups of physicians will benefit from the different interventions described in previous studies.
“Given the continuously increasing workload for physicians, it’s important to consider interventions that concentrate on enhancing physician and nurse well-being to reduce risks of burnout,” says Dr. Emlet. “Institutional leadership needs to have open lines of communication with personnel so that burnout can be addressed and managed in EDs and inpatient settings as well as other hospital environments. There also needs to be awareness of the group’s morale. Efforts to prevent burnout are critical to enhancing the quality of life for physicians, nurses, and other hospital staff and for reducing the risks associated with the repercussions of burnout.”
Siedsma M, Emlet L. Physician burnout: can we make a difference together? Crit Care. 2015;19: 273. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489124/.
West CP, Dyrbye LN, Rabatin JT, et al. Intervention to promote physician well-being, job satisfaction, and professionalism: a randomized clinical trial. JAMA Intern Med. 2014;174:527-533.
Shanafelt TD. Enhancing meaning in work: a prescription for preventing physician burnout and promoting patient centered care. JAMA. 2009;302:1338-1340.
Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al. Burnout and suicidal ideation among US medical students. Ann Intern Med. 2008;149:334-341.