Tag Archive | physician burnout

Changing Workplace Culture to Avoid Physician Burnout

In the February 6, 2019 issue of JBJS, David A. Rothenberger, MD contributed a thoughtful and practical “What’s Important” article about how to foster well-being among physicians and thus reduce the risk of physician burnout.

Since the article’s publication, Dr. Rothenberger has received many comments from readers. Here are several, de-identified to protect privacy, along with some responses from Dr. Rothenberger:

In my opinion, the internal culture of medicine, and specifically surgery, is to blame for poor mental health, burnout, and depression… [Surgeons are] trying to make up declining reimbursement by working harder. .. I too lived in that culture and relished being the busiest surgeon in the system, knocking out 10 to 12 operations a day,… but after the age of 50, I began noticing age catching up and increasing negativity within the profession. That is about when I decided to bail out. I have never looked back, although I miss my patients. Our profession… rewards self-punishment. Like you, I am hopeful that this will change for future physicians… My hope is that the welcome influx of women physicians will teach us misguided men a thing or two about taking care of oneself, one’s family, and understanding the limits of what we can do.

 

I believe burnout, in my case, was caused by, among other things, the destruction of our fee schedules… My brightest child wanted to follow in my footsteps, and I talked him out of it… I feel society has forsaken us.  I plan to quit this November, and it’s not soon enough.

To which Dr. Rothenberger replied as follows:
“I understand your decision to leave medicine,… but my advice is ‘do not go it alone.’ Get some support from someone you trust who understands this predicament… Plan for your future after medicine.  Re-imagine your life.”

 

I know a lot of physicians here who have problems in their practice, including a lot of my partners. I think the concept of a Chief Wellness Officer [CWO] is a great idea. I plan on forwarding [your “What’s Important” article] to our administration.

To which Dr. Rothenberger replied as follows:
“A CWO will help only if the other leaders of your system are committed to changing the culture of the workplace.  It is not an easy undertaking, but I think the return on investment justifies the multiyear approach we are taking here [at the University of Minnesota].”

 

It is really meaningful that you have emphasized that this is a bigger issue than the individual. I believe you are absolutely correct in highlighting a culture shift that prioritizes giving…factors [such as autonomy] back to physicians. [That] is probably the single most effective way to turn this around.

I am finishing my orthopedic residency… Our hospital system occasionally holds “wellness activities” that typically include massage and similar events, but these often don’t work with a busy surgeon’s schedule.  I’m interested in making burnout prevention a more recognized issue within our department and want to help bring in resources to help our residents and staff, but I am struggling with how best to practically bring this about. Do you have any advice for integrating wellness resources and burnout prevention into a busy orthopaedic department?

To which Dr. Rothenberger replied as follows:
“Wellness activities” like massage, yoga, and exercise classes are often put together by Human Resources for the workforce at large.  They are useful to individuals but do little to change the workplace culture… Our effort here at the University of Minnesota is to build a Well-Being Alliance of health care professionals who are working together as a coalition of the willing to restore well-being and joy to the practice of medicine.  We will do this by changing our workplace culture—a multiyear effort.  Features of our Alliance are that it is

  1. Interprofessional (i.e., it involves MDs, nurses, pharmacists, etc.)
  2. Longitudinal (i.e., it includes students; residents and fellows; early, mid and late-career physicians; and retired members of our community)
  3. Evidence-based as much as possible, and
  4. Financially and operationally sustainable.”

These issues of physician wellness and burnout prevention need to be highlighted locally, and local resources need to be brought to bear to address the challenge. I’m grateful to be at the University of Minnesota, where Dr. Rothenberger and the Well-Being Alliance are tackling the problem in meaningful ways.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

Good Outcomes with After-Hours Hip Fracture Surgery

marc-swiontkowski-2In the June 7, 2017 issue of The Journal of Bone & Joint Surgery, Pincus et al. report on a careful analysis comparing outcomes from hip fracture surgery occurring “after hours” (defined by the authors as weekday evenings between 5 PM and 12 AM) with surgeries occurring during “normal hours” (weekdays from 7 AM to 5 PM). In the busy Ontario trauma center where this study was performed, it is common for patients with blunt trauma to take precedence over seniors who are relatively stable but in need of hip fracture care.

Pincus et al. found that adverse outcomes, in terms of surgical and medical complications, were similar whether the hip surgery occurred during normal hours or after hours.  Interestingly, there was a higher rate of inpatient complications in the normal-hours group, and fewer patients in the after-hours group were discharged to a rehab after surgery than in the normal-hours group.

It has been my impression that highly skilled professional surgeons and their teams are going to put forward their best efforts for all patients—no matter what time of day or night they operate. Concentration, focus, and high standards can generally overcome fatigue. However, the Pincus et al. study should not be viewed as justification for hospital decision makers to forget their commitment to optimize management of all resources, including surgical teams. After-hours care should never become “routine,” and there should be continuous attention on developing alternative solutions, such as moving elective surgery to other facilities or true shift scheduling that provides all members of the team with occasional daytime hours off for rest and management of personal lives.

The authors note that in their Canadian jurisdiction, there are hospital and surgeon-reimbursement incentives that may work to promote after-hours surgery, but the long-term focus must always put patient outcomes first. And we must always remember that good patient outcomes rely on maintaining surgical teams who are experienced and not burnt out.

Marc Swiontkowski, MD
JBJS Editor-in-Chief