Contributor: Z. Colette Edwards WG'84, MD'85
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As Burn-Out and Stress Mounts in Healthcare Professions, How Can We Heal the System and Those Who Work in It?
“The only thing that is constant is change.”
Heraclitus, Greek philosopher
The past two decades have brought about rapid, seismic changes in nearly every aspect of practicing medicine and managing health practices, facilities, professionals and patients. We can recall years past when hospitals were the primary go-to setting, stays were lengthy, preventive measures were limited, and patients were “treated” as opposed to “engaged” in care.
Today, the traditional hospital setting is no longer the de-facto hub for medical care and after-care – that function is carried out on large medical campuses, in clinics, urgent care facilities, and at home. Patients are now incentivized and encouraged to prevent disease and improve outcomes through wellness-centric programs, and each of us is able to self-diagnose through on-line medical sites, monitor calorie and steps per day on wearable devices, and access the latest – sometimes contradictory – research that promises the five “easy” steps to take to get in the best shape of one's life. In short, patients are empowered to manage their own health as best they can, and the role of medical professionals has evolved to be one of information concierge, care manager, advocate and medical expert – while accountability and expectations on the business side of medicine continue to reshape themselves almost daily.
Driven by forces as disparate as cultural norms and values, technological advancements, political and regulatory shifts, and overwhelming economic factors, the business plan that drives everything in healthcare continues to shift. While the focus in this new landscape is on improving outcomes, increasing patient engagement, and aligning incentives grounded in behavioral economics to reward coordinated care delivery, much of the national dialogue focuses on the “system” and the “patient.” With this constant shifting, however, more and more healthcare professionals are suffering from high levels of stress and its accompanying physical and mental health impacts.
The Health of Healthcare Professionals
A Mayo Clinic study published in the Archives of Internal Medicine and reported in the New York Times indicated close to 50% of the physicians surveyed reported ≥ 1 symptom of burnout.1 It also found burnout is more common among physicians than workers in the U.S. as a whole, and, not surprisingly, those in specialties on the “front lines,” such as primary care and emergency medicine, were at the greatest risk.
This end-stage stress is a combination of persistent emotional exhaustion, physical fatigue, and cognitive weariness. When caring for others, self-care often goes to the wayside. This is true for many in the role of caregiver, including parents of young children, those tending to the needs of aging relatives and loved ones, and medical professionals. While caregiving can be incredibly rewarding – even one of life’s greatest gifts – it can come with debilitating stressors. Given that medical professionals’ lives don’t exist in a vacuum, sometimes they play this role in multiple areas and, as a result, multiply the stressors. This leaves limited time and energy left over for other family and friends, pursuing outside interests and hobbies, and (probably last and least) caring for themselves.
The Many Layers of Burnout
Physical and mental challenges associated with burnout often are ignored or are managed by engaging in the types of behaviors that current research and medicine warns against: alcohol and drug abuse, smoking, poor eating habits, limited exercise; in short, self-neglect. Some of the consequences of burnout among healthcare professionals may include depression, anger, bitterness, an increased risk of heart attack, ischemic heart disease, stroke, sudden cardiac death, diabetes, male infertility, both sleep and musculoskeletal disorders, and perhaps not surprisingly, a higher rate of suicide.2
While medical training has evolved to address some of the new complexities arising from the seismic shifts in the healthcare system, limited attention is given to the importance of stress management and burnout prevention once medical professionals have entered the workplace. Where does responsibility fall for caring for health practitioners? Who is responsible for providing the tools for managing this life in the fast lane and the accompanying manifestations of stress in the workplace and at home?
Based on findings of the National Institute for Occupational Safety and Health (NIOSH), employees reporting they are stressed incur healthcare costs that are 46 percent higher than those who are non-stressed. Job stress is commonly defined as "the harmful physical and emotional responses that occur when the demands of the job exceed the capabilities, needs, or resources of the worker." Studies show that employees who feel they have little control over their work in one way or another report higher stress levels. 3 Based on these findings, and combined with the massive changes occurring in healthcare workplaces, a small tsunami is upon us and looms large for those practicing and entering the healthcare industry.
The Healthcare Employer’s Vital Role in Mitigating and Managing Stress
Achieving optimal well-being for healthcare professionals doesn’t happen by accident. In fact, a multi-layered, integrated approach to addressing the most pressing physical and mental challenges associated with burnout can be accomplished only through intentional programming, focused communications, and ample support to ensure efficacy and optimal outcomes. Research indicates that simply providing education and “to-do” lists are often not enough to achieve or sustain desired behavior change. Much like patients who often are aware of much if not all of what is expected, physicians and other healthcare practitioners can find themselves puzzled and frustrated when the outcomes of their own efforts are not achieved or maintained in the long-run.
Employers can play a vital role in helping to assess and manage stress and its impact in the workplace. In the second of our four-part series, “Caregiver Stress in Healthcare,” we’ll explore the specific ways that employers and individual practitioners can set up programming and supports to improve health and mental well-being, rekindle passion and empathy, and raise quality of self-care and care for others.
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- Shanafelt TD. Boone S. Litjen T. et. al. Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population. Arch Intern Med August 20, 2012.
- Shanafelt TD, West C, Zhao C, et al. Relationship between increased personal well-being and enhanced empathy among internal medicine residents. J Gen Intern Med. 2005;20(7):559– 564.
- NIOSH/U. S. Department of Health and Human Services. Stress...At Work. Pub. 99-101. Washington, D.C.: GPO, 1999. <http://www.cdc.gov/niosh/docs/99-101>.