Physician burnout: Trying to reverse the trend

Rochelle R. Torgerson, MD, PhD: “Combating burnout is something that needs to be nurtured, it is going to take some time and some effort. We are going to have to create new structure in our lives.”

Overall physician burnout increased from 45 percent in 2011 to 54 percent in 2014, according to studies. Dermatologists lagged in 2011, with 32 percent experiencing burnout, but they passed the pack by 2014, with 57 percent experiencing burnout. That increase is a concern that was examined in a July 27 forum at the AAD Summer Meeting in New York City.

Why is this happening?

The growth in burnout is linked to changes in the way many physicians practice and the fact that some physicians let their jobs define their personal lives. Tools to combat the problem were offered during “Stepping Out of the Fry Pan: Tools to Mitigate Burnout” (F001), but a quick and easy solution is not on the horizon.

“Combating burnout is something that needs to be nurtured, it is going to take some time and some effort. We are going to have to create new structure in our lives,” Rochelle R. Torgerson, MD, PhD, said in an interview about the session. “This might require some help. We hardly ever seek help, or if we seek help, we do it too late. If you feel you can’t do it alone, you need to ask. There are times to ask for help.”

Dr. Torgerson and her co-presenter, Kathleen Julie Hectorne, MD, are dermatologists at the Mayo Clinic in Rochester, Minnesota, which is a leader in studying physician burnout. Dr. Torgerson said a key to preventing or combating burnout is in its definition:

Burnout occurs when passionate, committed people become deeply disillusioned with a job or career from which they previously had derived much of their identity. It comes as the things that inspire passion and enthusiasm are stripped away and tedious or unpleasant things crowd in.

“The definition is good for physicians because they are well known for their job making up a significant portion of their personal identity,” Dr. Torgerson said. “Once you start monkeying with that and changing the job, that can very quickly have a significant impact on the person.”

How has the job changed?

According to published studies, the majority of physicians said they entered the profession to help people. Unfortunately, recently, they have not been able to spend as much time with patients and have not had as much control of the treatments they can prescribe.

“We need to see more patients and we do not have time to put toward each individual patient,” Dr. Torgerson said. “Our hands are tied with what we can prescribe. Our entire profession is moving itself toward a production line process.

“That puts us at high risk for burnout. We have lost a lot of our autonomy. We don’t have the time to think. It is considered cognitive scarcity. When you lose those things, the rewards start dropping.”

That time crunch hits dermatologists harder than other specialties, Dr. Torgerson said. This may account for the specialty’s rapid increase in burnout.

Change up your game plan

To reverse the trend and adjust to other changes, physicians should look to athletes who undergo both physical and psychological training, and follow a game plan. Psychologically, physicians need to focus on improving their self-focus and their workplace attitudes. They also need to realize they can regulate their stress.

“We want people to assess how they react to the world,” she said. “With that self-focus, if you do it to the best of your ability the majority of the time, you should be minimizing the drain that stresses have on you. Physicians are often in a team environment, so if you do this, you will be reducing the strain on those around you, too.”

Physicians also need to follow a game plan that has three goals — to define their core values and goals, and to better manage their time and tasks, Dr. Torgerson said.

“Once you take time to define your values and goals, you become more efficient at figuring out what is important to you and what is not important to you, and how you want to apportion your time,” she said. “To manage time, put everything into one electronic calendar. Think about your personal time and schedule. Block time for sleep, exercise, family, and personal time. See if it syncs with your priorities. For time management, ask, ‘Does this have to be done, done now, and done by me?’ When presented with new tasks, keep core values and goals in mind. Say ‘no’ appropriately.”

The bottom line, she said, is that physicians need to follow the advice they give to their patients.

“Physicians know this stuff. They can talk the talk, but they just aren’t walking the talk,” Dr. Torgerson said. “They need to eat well, exercise, sleep, go to the doctor, and recharge emotionally and spiritually. It is just a matter of doing it or not doing it. Walk the talk.”

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