With Catherine Miller, RN, JD

Catherine Miller, RN, JD is a Senior Risk Management & Patient Safety Specialist for the Cooperative of American Physicians, Inc. (CAP), in Los Angeles. She can be reached at CMiller@CAPphysicians.com

The Hippocratic Oath requires a new physician to treat the sick to the best of their ability among other things, but growing bureaucratic and financial pressures are siring an epidemic of physician burnout that may be getting in the way of this promise.

Modern Aesthetics® spoke with Catherine Miller, RN, JD, a Senior Risk Management & Patient Safety Specialist for the Cooperative of American Physicians, Inc. (CAP) in Los Angeles, about physician burnout, why we are seeing more of it today, and importantly what doctors can do to avoid or reverse it.

MA:Tell us about physician burnout.

CM: “Physician burnout is a clinical syndrome characterized by emotional exhaustion and loss of enthusiasm for work, feelings of cynicism, and reduced performance. The symptoms of burnout can include feeling drained, overwhelmed, physical exhaustion as well as exercising poor judgment, suffering from a sense of detachment in relationships with co-workers and patients, and experiencing feelings of ineffectiveness. Although the impact to the physician is concerning, there are equally concerning effects on patients, patient safety, and quality of care. Research correlates burnout with disruptive behavior, increased medical errors, lower patient satisfaction scores, and increased malpractice risk. The impact of burnout is extensive. If unaddressed, burnout can result in dire consequences for the individual both personally and professionally. In addition to job dissatisfaction, burnout can contribute to failed relationships, substance abuse, and worsening mental health for the physician. ”

MA:Why is it on the rise?

CM: “Practicing medicine has always been intellectually, physically, and emotionally demanding work. But in addition to performing their clinical duties, today's physicians are doing so much more. The recent restructuring of health care, increased regulatory pressures, and even the introduction of technology has resulted in a ‘tsunami of change' and additional stressors. All these extra responsibilities detract from time spent with patients and threaten a healthy work-life balance. The 2015 Medscape Physician Lifestyle Report, which surveyed thousands of physicians, respondents rated the top five causes of burnout as:

1. Too many bureaucratic tasks
2. Too many hours at work
3. Insufficient income
4. Increasing computerization
5. The impact of the Affordable Care Act “

MA: What should affected doctors do?

CM: “Those most directly responsible for health and healing tend to forego the very treatment they themselves would recommend to any patient. Physicians need to pay attention to their symptoms and do whatever it takes to restore work-life balance—including seeking professional help. Medicine's culture of invincibility has made it difficult for physicians to attend to their basic mental health needs. The danger is, if unaddressed, there's a risk of severe depression and a host of other serious personal and professional sequelae. Organizations concerned about physician health and well-being can adopt a proactive approach to identifying burnout among their medical staff by administering anonymous surveys and by investigating other telltale signs of struggle, including reports of behavioral changes or perhaps a decline in performance or patient satisfaction scores. Hospitals and medical groups can also promote wellness by offering education and resource information via their Physician Health & Wellbeing Committees, whose charter is to assist physicians struggling with behavioral issues, substance abuse, addiction, and mental health challenges.

This Is How I Do It:

One Surgeon's Anti-Burnout Strategies

By Kiya Movassaghi, MD

Stress and burnout are not problems; they are rather dilemmas. Unlike with problems where there are solutions, you cannot solve a dilemma. Instead, one must create a strategy to maintain balance. Over the course of the years, I have integrated the following strategies /wellness practices that have helped me immensely.

Investing in Myself

This includes taking care of my own mental, emotional, and physical sides via coaching, meditation, triathlons, massages, etc.

Hugging it Out

If a patient wants to give me a hug because they appreciate what I have done for them, I stop and hug them during my busy clinic. This is a simple but a powerful emotional boost for me and sets the tone for the rest of the day.

Making Time for the Important Things

Managing a busy schedule requires developing a life calendar that sets aside time with my family and loved ones such as date nights, and learning to say “no” with elegance and grace.

Setting Boundaries

I've developed boundary rituals. Upon arriving home and turning my car off in the garage, I take a deep breath and try to get my mind off of work issues.

Kiya Movassaghi, MD is a clinical assistant professor of plastic surgery at Oregon Health & Science University in Portland and the President of the Northwest Society of Plastic Surgeons. He is also the medical director of Movassaghi Plastic Surgery & Ziba Medical Spa in Portland and a board member of American Society for Aesthetic Plastic Surgery.

Ultimately, it's necessary to make workplace improvements to lighten or streamline physician workload. I recently spoke with an Emergency Department (ED) Chief who was very aware of the workplace challenges of his physician staff. In addition to caring for patients in an impacted ED, the physicians complained about the burdens of documenting in the electronic health record, which was adding extra hours and stress to an already demanding shift. This Chief is currently exploring the benefits of using scribes in the ED to free-up physicians so they can focus on their patients. Being responsive to the sources of physician job dissatisfaction and identifying improvement opportunities is one way of advocating for physicians, preventing burnout, and ensuring that patient's receive best possible care from their providers. “