Rising concerns over physician burnout are prompting new steps by medical centers to help doctors cope with the constant stress brought on by cost pressures and a changing system that many feel is beyond their control.
At the Mayo Clinic in Rochester, doctors meet over company-sponsored dinners to talk shop and swap ideas for coping with the mounting strain of the job. Buffalo Hospital in the western suburbs of the Twin Cities sponsors a series of programs aimed at helping health care providers and the broader community thrive despite stress.
And Hennepin County Medical Center remodeled a former dining room for physicians into a wellness center for caregivers, complete with yoga mats and exercise space. It complements a “reset room” HCMC created last year that gives caregivers a place for reflection away from the hospital’s hectic halls.
“The system that burns out doctors doesn’t perform as well when it comes to patient care,” said Dr. Mark Linzer, director of internal medicine at HCMC in Minneapolis. “I think people have recognized that if you start measuring [burnout], start talking about it and develop some kind of modest infrastructure to oversee it, you can begin to make a dent in it.”
Professional burnout includes emotional exhaustion, an inability to connect with other people and a low sense of meaning in work. Research has shown it can contribute to medical errors and increase job turnover.
In December 2015, a Mayo Clinic survey showed the share of doctors reporting at least one symptom of burnout increased from 46 percent in 2011 to 54 percent in 2014. Satisfaction with work-life balance declined from 49 percent to 41 percent.
The report also surveyed non-physicians and found an increasing disparity in burnout and work-life balance between physicians and other workers. An earlier Mayo Clinic study showed that physicians had worse scores on both measures.
In 2007, Mayo Clinic launched a program to study and address physician well-being. Work over the years has shown that many physicians feel isolated in dealing with the stress of the job, said Dr. Colin West, a Mayo Clinic physician who helped develop the dinner groups.
Researchers were looking for a way to promote a sense of meaning and reduce isolation by getting physicians in a group to share experiences, West said. Groups receive a brief list of topics to guide their conversations — things like stress and medical mistakes — and spend at least the first 15 minutes of each meeting in discussion.
More than 1,000 physicians and research scientists at Mayo — more than one quarter of all those eligible — have signed up for the program since it launched in 2015, West said.
“It’s not just about making physicians happy,” West said. “There are other downstream ramifications to this about being able to meet the needs of our patients.”
Helping the healers
At Buffalo Hospital, physicians and administrators launched programs to promote “resiliency” — the ability to bounce back after stress, and thrive despite it — following back-to-back tragedies involving physicians in 2014.
The first involved the death of a doctor in a motorcycle accident. Three months later, a physician killed himself inside the hospital. For Dr. Corey Martin, a physician at the hospital, a third shock came immediately after the suicide, when a colleague told him: “When I heard a doctor had taken his life … I thought it could have been you.”
Martin thought to himself: “Oh, my gosh, am I this burned out? Are we all this burned out that people think we could do this to ourselves?”
The hospital sponsored training for a group of physicians on handling stress. Those physicians, in turn, have led sessions for both health care professionals and the broader community through a program called the Bounce Back Project.
HCMC developed a provider wellness committee three years ago, and the hospital regularly conducts wellness surveys that look at stress and burnout. The new wellness center could host the sort of discussions that Mayo physicians are having over dinner, said Linzer, who is director of HCMC’s office of professional worklife.
Hospitals beyond Minnesota are responding to the burnout threat.
Robbinsdale-based North Memorial Medical Center has joined a Boston program that encourages doctors, nurses and other health care workers to meet regularly to discuss the emotional side of caregiving.
In California, Stanford Medicine rewards physicians who take on extra work for colleagues by providing extra help in their personal lives — whether it’s a meal delivery at home, housecleaning or laundry services.
The program promotes the importance of caregiving teams — not the antiquated “iron man” vision of doctoring that can lead to burnout, said Dr. Bryan Bohman, an anesthesiologist with Stanford Medicine.
“No matter how brilliant and great you are as an individual physician, if your team is not functioning well … your patient is not going to get outstanding care,” Bohman said. “You can’t know everything anymore, and you can’t do everything.”
“It’s very ego-stroking, and people don’t want to give it up in some ways, because it makes you feel powerful,” he said. “But it’s maladaptive in modern medicine.”
At most hospitals, the anti-burnout efforts go beyond physicians to include other health care providers, said Dr. Rahul Koranne, chief medical officer at the Minnesota Hospital Association. The hospital association expects to release the results this summer from its first statewide survey looking at burnout among health care professionals. The Minnesota Medical Association is paying more attention to burnout, too, but the drivers are huge, said Dr. David Thorson, the group’s president.
Financial, technical stress
Burnout has spiked with the adoption of computerized medical records, Thorson said, because many doctors believe the systems interfere with patient relationships. More cost-sharing for patients has stressed doctors, too, as physicians try to help patients get care with fewer out-of-pocket costs. And as more physicians become employees of large systems, some complain of a lack of control.
If the big drivers aren’t going away, can yoga mats and dinner groups solve the problem? Maybe not, Thorson said, but it’s worth a try.
“If [burnout] is a cumulative thing, then taking a few little things might get you below the threshold,” he said. “We have to keep trying, because if we don’t — it’s not going to be very pretty.”