What do you do if your physicians are experiencing burnout?

One of the most common things I hear from physicians I coach that are experiencing burnout is that they feel stuck or trapped. Many physicians feel overwhelmed, irritable, unmotivated, or even outright dread going to work. They may have insomnia and headaches. They often fantasize about quitting or escaping medicine, but don't know how to replace their income or what they would be able to do besides medicine. These feelings can lead to unhealthy habits such as excessive drinking, binge eating, and drug use, all to avoid the feelings of frustration and unhappiness. If left unchecked, severe burnout can lead to thoughts of harming oneself, desperation and loss of hope. Recognizing and treating early burnout is key to physician wellbeing.

Recognizing burnout symptoms in physicians through traditional methods like observing or asking about physical, emotional, cognitive, behavioral, or dietary signs can often be impractical. Heart Rate Variability (HRV) diagnostics stand out as they offer a scientific measure of allostatic load, providing an objective indicator of the extent of burnout progression. Utilizing HRV not only facilitates a more accurate assessment but also ensures timely interventions, helping to safeguard our healthcare providers' well-being. Embrace HRV diagnostics for a clearer insight into physician health.

Burnout is like dying from 10,000 paper cuts. It's never due to just one thing. It's the cumulative effect of dozens if not hundreds of obstacles, inconveniences, and bureaucracy. A multi-pronged approach is necessary to identify the many causes of burnout in a given medical setting. Ask the doctors and for starters look at unrealistic expectations for patient volumes; ascribing too much importance to patient satisfaction surveys (or outcome surveys without accounting for risk); insurance bureaucracy, lack of autonomy when treating patients, being referred to as a 'provider' or equating physician and mid-level expertise, changing compensation rules & more - all while shouldering the emotional demands of taking care of sick patients.

Burnout is defined as a state where the body cannot supply energy via the mitochondria. The path to burnout is a process involving neuro-psycho-endocrino-immuno-metabolic dysregulations, leading to oxidative and nitrosative stress. In addition to consciously perceived stressors, it is crucial to identify hidden stressors and disturbances. Objective diagnostics, such as lab tests and heart rate variability (HRV), supported by anamnesis and questionnaire tools, enable differential diagnostic cause investigation. This comprehensive approach ensures a thorough understanding of the underlying issues contributing to burnout, facilitating targeted interventions and effective management.

The question ought to be what are you doing to prevent burnout and moral injury among physicians? Engage physicians in meaningful discussions about what gets in the way of doing what’s best for our patients. Listen to what we need. Make space and time for us to listen to our patients. Invest in primary care. Provide support to manage the bureaucratic obstacles to good patient care. Provide reliable coverage so we can really leave work at work. Eliminate unnecessary tasks. Get rid of work-after-work aka “pajama time”. Show physicians that you really care about making things better for patients and physicians.

In my experience, participating with insurance had me seeing 50 patients daily, leaving no patient enough time with me and feeling burned out and financially strapped due to high expenses. I went direct-pay 24 years ago when I decided I wasn’t participating, but rather cooperating with the madness. Best decision of my life. It has changed so many things in a positive way for me. No stress, low volume/high value patients, low expenses, very potent doctor-patient relationships, pleasant days, none of the hassles insurance imposes on doctors, $0 accounts receivable and I’m a very happy doctor.

Physicians are experiencing burnout and leaving medicine at record levels. Loss of autonomy, tedious administrative tasks, and corporatization of medicine, are some of the many reasons. Implementing real solutions starts with asking physicians what they need and then doing it. There's no one-size-fits-all approach. Ask a physician what they need, they'll tell you, and it's not free pizzas on Fridays. They need additional support staff, less bureaucracy, and reasonable patient schedule expectations. Physicians need access to wellbeing programs, as well as time built into their schedules to actually utilize those resources. Taking care of patients is challenging enough. The many non-medical headaches should not be part of the problem.

An intervention must align with real-world conditions and constraints. Complex work processes, organizational and legal frameworks, and the unpredictable stress load caused by patient volume are challenging to influence. Instead, the focus should be on promoting health-protective resources and resilience. This includes not only behavior and lifestyle but also social resources. By fostering these elements, individuals can better manage stress and maintain well-being despite the demanding and often unpredictable nature of their work environments.

As a professional patient advocate I also made a huge effort to be a provider advocate. I continuously provided positive affirmations and share patient compliments with providers. It’s important to remember our purpose in caring for humanity which includes providers and staff.

Burnout is what prompted me to first try working with a life coach because I was unhappy, felt "stuck" and was ready to leave medicine. I decided to work with a coach for the sole reason that I would then be able to say I had "done everything I could" to stay in medicine and not feel guilty when I left. To my surprise, after just a few weeks of working with a coach, I began to experience a significant mind shift in how I viewed and experienced the various issues I had with my job at the time. Although the problems didn't change, how I experienced them changed significantly, and that made a big difference for me. Coaching is just one example of the types of external support sources that are available for physicians to help combat burnout.

Burnout describes a process from homeostasis to allostasis to allostatic load or overload, leading to symptom development and disease manifestation. A deep understanding of the complexity of systems involved in stress regulation and their interactions requires interdisciplinary knowledge. Particularly in functional medicine, there has been significant growth in understanding autonomous regulatory processes in recent years. This knowledge emphasizes the necessity of continuous learning to keep pace with evolving insights and approaches. By integrating this knowledge, we can better address and mitigate the multifaceted nature of burnout.

Here's something else to consider. The number of physicians in the United States grew 150% between 1975 and 2010, roughly in keeping with population growth, yet the number of healthcare administrators increased 3,200% for the same time period. Also, healthcare costs have risen 3,100% or on a per-person basis, from $353 in 1970 to $11,582 in 2019 (amounts adjusted for inflation). In the meantime, burnout among physicians is at an all-time high. These trends are unsustainable and ultimately detrimental to medicine and patient care. Medicine is headed for a reckoning. If we want state of the art medicine and physicians in our future, now is the time to start overhauling the system.