Selected Podcast
Organizational Approach to Addressing Physician Burnout
Ron Brewer, PhD discusses the Physician Burnout Committee at Carle Foundation. He shares the symptoms of physician burnout, treatment options available and tips to prevent burnout from happening.
Featuring:
Ron Brewer, PhD
Ron Brewer is a Ph.D. trained Counselor in Education and most recently retired from the University of Illinois College of Medicine as a Clinical Associate Professor in the Department of Psychiatry where he served as an Adjunct Associate Professor in the Department of Surgery. Ron was the counselor for the College of Medicine for years and was active in the Basic Science Sub-Committee as well as the Clinical Affairs Sub-Committee. In addition, he was the Associate Director for Clinical Affairs, and ran an introductory clinical course in the second year and was the Elective Clerkship Director for Scholarly Activities. For the past 20 years Ron has also worked with Carle Foundation Hospital, Carle Physicians Group and other University Schools of Medicine in a process of supporting physicians, Mid-Level health care providers along with other allied health care providers including clinical departments. He was also a faculty member on what was formerly known as Bayer Healthcare Communication (currently the Institute for Healthcare Improvement). Ron has developed physician patient communication workshops, difficult patient workshops and generally consulted on issues pertaining to disruptive physician’s behaviors, physician’s interpersonal skills along with the difficulty of working with a stressful medical ecosystem. Ron has worked with health care team members who mostly are having difficulty with behavioral standards and/or interpersonal communication skills including but not limited too; peer relationships, patient relationships, and allied health care relationships.
Transcription:
Melanie Cole: Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA category 1 credit. To collect credit, please click on the link and complete the episode’s post test.
With increasing administrative responsibilities and reduced time delivering direct patient care, the stress of it all can lead to physician burnout. Here to tell us about that today is my guest Dr. Ron Brewer. He’s a counselor and educator with the Carle Foundation Hospital. Dr. Brewer tell us a little bit about the prevalence of physician burnout these days. What are you seeing?
Ron Brewer, PhD (Guest): Well research tells us, and our own research tells us that we are at about 50% during a physician’s career that they experience or feel burnout. And by burnout what I’m talking about are signs of depersonalization of the patient, anger, depression, cynicism, exhaustion, both physical and emotional, we even see increased errors and decreased production even though people are working harder and longer hours. And then just negative thoughts and behaviors about their job and their career choice. So, some of the disciplines within medicine are experiencing up to in the 70% range during the course of their career. So, it’s prevalent.
Melanie: Wow. It certainly is. And what do you see are some of the primary concerns of a physician that are causing this burnout, I mean with the change to electronic records, insurance issues, never ending I’m sure, long hours, not enough patient time. I mean are these some of the reasons that you are seeing this?
Dr. Brewer: Yeah, the one that most research reports back to the world is the electronic medical chart because it doesn’t seem to provide in a lot of ways, what it said it was to do, which was to make things more efficient. It’s a struggle for physicians and physicians by their very nature were trained to care for patients and in taking time away from the patient; it means really taking time away from life balance. So, we find doctors who spend a lot of time after they get home at night, when they finally do get home at night, working to complete their responsibilities for the medical record system.
Melanie: So, back in the day, you would just write on the patient’s chart what was going on and then that would be filed and that would be done, but you are seeing now that they have to update records and really sit at their computer for hours. Where does receiving patient satisfaction and quality scores fit into this whole picture?
Dr. Brewer: Well, I think one of the complaints that a lot of times we get from a patient is that when the physicians come in with their tablets in their hands; they don’t feel fully listened to, albeit I think they don’t recognize how capable physicians are at multitasking. So, because of that, physicians will put the computer or the tablet down and direct their histories and of course their physicals to the patient which then puts them in a position where then they have to at some point, find time to do the work of the patient record system.
Melanie: Now I know you already answered this question, but I’d like you to reiterate some of the signs and symptoms of physician burnout that may be a loved one would notice or even a patient sitting there or certainly the powers that be?
Dr. Brewer: Well one of the things that we notice in terms of I think from home is that there is a change in behavior. There’s a level of lack of energy. There’s a level of lack of interest, in terms of I’m going home to work, I’m not going home to enjoy my family. There’s a problem with the engagement of positive activities so, things that they have done in the past, are now missing, I mean hobbies, and again, life balance issues so that engagement goes away. And physicians by their very nature don’t want to bother another doctor or an administrator or even a spouse. So, their asking for assistance just doesn’t happen. And so, it’s one of those things where even if help is available; they don’t reach for it because it’s a sign of, to a certain degree, a sign of I’m failing, sign of a weakness if you will.
So, those signs that we look for are the true cynicism about medicine, not just about patients, but it’s about medicine in general. It’s anger, due to lack of time. It’s anger, due to issues that revolve around the practice of medicine and business of medicine together. And then there’s the sign of depression. They are just not where we would expect to see them from two years ago or when we met them or hired them. They seem more lethargic, less interested and again, from an administrative standpoint, there’s an increased level of errors either in the chart or with diagnoses. Mostly with charts, not so much diagnoses because patient care is still at the top of a physician’s game. And the production level starts to decline. And if you are in a production-based business; that lack of production means a lot to their bottom line in a lot of ways and they feel like they are losing a step. And again, it becomes internally focused when this is not a fault of a physician, it’s a national problem. It’s the fault of a bigger system. And that system is healthcare and we haven’t learned to manage this new age of healthcare with electronic medical charts and the mindset that we have to – patients really expect kind of a fast food entity, I want to go in, I want to be treated, I want to be fixed and I want to move on and it all takes a matter of minutes and that’s just not the way healthcare has ever worked.
Melanie: So, what is Carle doing to address physician burnout and how long – tell us a little bit about the physician burnout committee? How long has it been in place and what is the objective?
Dr. Brewer: The burnout committee specifically started as a task force a little over two years ago. A year ago, a little over a year ago; it turned into a committee that answers to its medical directors. And our mission is to try and encourage, engage and learn, teach if you will, educate the medical directors and senior leadership on what to look for so that physicians who have signs and symptoms of physician burnout can be supported in their process of coming back out of burnout so that they can enjoy the practice of medicine again.
And one of the things that I think and this is a personal opinion, is joy is a very difficult place to be, but if we can get physicians to come back to why they are in medicine; I think we give them a whole lot of strength in terms of how they practice and what they think of their practice. So, they don’t lose that step of gee I’m not sure why I’m doing this. Because there are so many other parts and pieces that keep me from that process. And Carle has been very good about how they support their doctors. I believe, and I have heard from experts in the field that we are far beyond a lot of major institutions because Carle is a fairly big place to work. I mean it’s close to 500 physicians strong across the region and so it offers an employee’s assistance program and within that employee’s assistance program it has counselors that will work with our physicians but if they choose not to stay within that system; employee’s assistance program does have a system where they can reach out to the community and offer physicians opportunities to see a psychologist on the outside of Carle System and that’s at no charge to them and that’s at least six visits and can be extended under different circumstances.
I’m one of the people who will reach out to help physicians as medical directors see necessary. I have a PhD in counselor education. I have been – worked for a medical school for 25 years. I have seen resident students and physicians for a long time and I’m willing to not do psychotherapy with physicians but behaviorally approach them on what really happens, what are they dealing with and how do we want to proceed so that they can get back to their level of normality; not necessarily Carle’s but their level of normality. Which is essentially the same because that’s why Carle hired them.
We have senior leadership that – and the committee members that are superb at supplying support for physicians who want support. Dr. Gibb has helped countless numbers of physicians reach out and work with the burnout process and personally helps with that. The committee members have – are on a badge literally that the doctors- all doctors wear around their neck or pinned to their coat so we all have pagers or phone numbers added to that so that we can be reached at any time that they see they need support. We are doing what we can right now, but we are still in process. We have developed modules for leadership that will give them CME credit and when that rolls out, then they can see a whole series of how to, what to, and what to expect. So, that’s where Carle is in the system. And we are working closely with the literature. Dr. Hampton who is the chair of the physician burnout committee is on top of the literature more than anyone I have ever seen. We have Dr. Mickey Trockel who is at Stanford and the Associate Director of their wellness program, very well noted for its burnout process, physician burnout program. He’s coming in November to work with Carle leadership to get them prepared. And we have been in touch with multitudes of other programs including Mayo Clinic to see what they are doing to see how we can borrow their process to make it fit for Carle.
Melanie: So, speak a little bit about the preventative resources that the organization is working on to help with the burnout and as you wrap up for us, Dr. Brewer, tell other physicians what you would like them to know about physician burnout and when you feel it’s important to seek help even if they feel that there’s a stigma that surrounds seeking help for that feeling of burning out.
Dr. Brewer: Well the prevention process has a lot to do with how every day is run at Carle. People who are seriously – seriously enjoy the people they work with, reaching out to them when they see something that’s going just not exactly the way they see it. We have a health system now in terms of a gym in our lower level that people are – it doesn’t just mean physicians, it means all employees can utilize. So, if they need to take a break from their day or while they are on-call, they can certainly go to that gym. We have programs where physicians get together regularly to enjoy each other’s time, pool parties, pre-basketball parties, pre-football parties, that kind of thing. So, one of the things that are difficult for physicians is isolation. Even though you work in a system that’s as big as Carle’s you still feel very isolated from your peers and you don’t really have time to talk to them. So, these mixers if you will, these get togethers really support. Carle also does a lot with quarterly I believe it’s called CPG, Carle Physician’s Group meetings where they hit on major topics for physicians. They just supported a second one on burnout just this past month. So, that’s one of the things that we use to help prevent and manage some of that.
My suggestion to all physicians, albeit, I am not a physician, I can see things a little more objectively sometimes because I’m not in the thick of it. But indeed, I think earlier is better than later. If you feel burned out, you probably are experiencing it to a certain degree which means I’m asking somewhat differently for help, seek support, your medical directors and senior leadership are happy to make referrals, are happy to sit and talk to you. My cell phone number is on the back of the badge that they wear again around their neck or pinned to their coat. Call. It doesn’t take but a minute. We can talk. We can seek information about what do you think is going on. That’s one of my big questions, really is so what happened. What are you dealing with? And since I am not there to judge, nor is EAP; we just want to get a sense of where the physician is so that we can put some measures in place through the support of senior leadership to get the doctor to a better place so we don’t lose high quality physicians which is something Carle has innumerous individuals that are of high quality practicing medicine.
Melanie: Thank you so much Dr. Brewer for coming on and explaining physician burnout and what Carle is doing to address this issue that so many physicians are feeling right now in this time of stress. Thank you again for joining us. You’re listening to Expert Insights with The Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities please visit www.carleconnect.com, that’s www.carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks so much for listening.
Melanie Cole: Expert Insights is an ongoing medical education podcast. The Carle Division of Continuing Education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA category 1 credit. To collect credit, please click on the link and complete the episode’s post test.
With increasing administrative responsibilities and reduced time delivering direct patient care, the stress of it all can lead to physician burnout. Here to tell us about that today is my guest Dr. Ron Brewer. He’s a counselor and educator with the Carle Foundation Hospital. Dr. Brewer tell us a little bit about the prevalence of physician burnout these days. What are you seeing?
Ron Brewer, PhD (Guest): Well research tells us, and our own research tells us that we are at about 50% during a physician’s career that they experience or feel burnout. And by burnout what I’m talking about are signs of depersonalization of the patient, anger, depression, cynicism, exhaustion, both physical and emotional, we even see increased errors and decreased production even though people are working harder and longer hours. And then just negative thoughts and behaviors about their job and their career choice. So, some of the disciplines within medicine are experiencing up to in the 70% range during the course of their career. So, it’s prevalent.
Melanie: Wow. It certainly is. And what do you see are some of the primary concerns of a physician that are causing this burnout, I mean with the change to electronic records, insurance issues, never ending I’m sure, long hours, not enough patient time. I mean are these some of the reasons that you are seeing this?
Dr. Brewer: Yeah, the one that most research reports back to the world is the electronic medical chart because it doesn’t seem to provide in a lot of ways, what it said it was to do, which was to make things more efficient. It’s a struggle for physicians and physicians by their very nature were trained to care for patients and in taking time away from the patient; it means really taking time away from life balance. So, we find doctors who spend a lot of time after they get home at night, when they finally do get home at night, working to complete their responsibilities for the medical record system.
Melanie: So, back in the day, you would just write on the patient’s chart what was going on and then that would be filed and that would be done, but you are seeing now that they have to update records and really sit at their computer for hours. Where does receiving patient satisfaction and quality scores fit into this whole picture?
Dr. Brewer: Well, I think one of the complaints that a lot of times we get from a patient is that when the physicians come in with their tablets in their hands; they don’t feel fully listened to, albeit I think they don’t recognize how capable physicians are at multitasking. So, because of that, physicians will put the computer or the tablet down and direct their histories and of course their physicals to the patient which then puts them in a position where then they have to at some point, find time to do the work of the patient record system.
Melanie: Now I know you already answered this question, but I’d like you to reiterate some of the signs and symptoms of physician burnout that may be a loved one would notice or even a patient sitting there or certainly the powers that be?
Dr. Brewer: Well one of the things that we notice in terms of I think from home is that there is a change in behavior. There’s a level of lack of energy. There’s a level of lack of interest, in terms of I’m going home to work, I’m not going home to enjoy my family. There’s a problem with the engagement of positive activities so, things that they have done in the past, are now missing, I mean hobbies, and again, life balance issues so that engagement goes away. And physicians by their very nature don’t want to bother another doctor or an administrator or even a spouse. So, their asking for assistance just doesn’t happen. And so, it’s one of those things where even if help is available; they don’t reach for it because it’s a sign of, to a certain degree, a sign of I’m failing, sign of a weakness if you will.
So, those signs that we look for are the true cynicism about medicine, not just about patients, but it’s about medicine in general. It’s anger, due to lack of time. It’s anger, due to issues that revolve around the practice of medicine and business of medicine together. And then there’s the sign of depression. They are just not where we would expect to see them from two years ago or when we met them or hired them. They seem more lethargic, less interested and again, from an administrative standpoint, there’s an increased level of errors either in the chart or with diagnoses. Mostly with charts, not so much diagnoses because patient care is still at the top of a physician’s game. And the production level starts to decline. And if you are in a production-based business; that lack of production means a lot to their bottom line in a lot of ways and they feel like they are losing a step. And again, it becomes internally focused when this is not a fault of a physician, it’s a national problem. It’s the fault of a bigger system. And that system is healthcare and we haven’t learned to manage this new age of healthcare with electronic medical charts and the mindset that we have to – patients really expect kind of a fast food entity, I want to go in, I want to be treated, I want to be fixed and I want to move on and it all takes a matter of minutes and that’s just not the way healthcare has ever worked.
Melanie: So, what is Carle doing to address physician burnout and how long – tell us a little bit about the physician burnout committee? How long has it been in place and what is the objective?
Dr. Brewer: The burnout committee specifically started as a task force a little over two years ago. A year ago, a little over a year ago; it turned into a committee that answers to its medical directors. And our mission is to try and encourage, engage and learn, teach if you will, educate the medical directors and senior leadership on what to look for so that physicians who have signs and symptoms of physician burnout can be supported in their process of coming back out of burnout so that they can enjoy the practice of medicine again.
And one of the things that I think and this is a personal opinion, is joy is a very difficult place to be, but if we can get physicians to come back to why they are in medicine; I think we give them a whole lot of strength in terms of how they practice and what they think of their practice. So, they don’t lose that step of gee I’m not sure why I’m doing this. Because there are so many other parts and pieces that keep me from that process. And Carle has been very good about how they support their doctors. I believe, and I have heard from experts in the field that we are far beyond a lot of major institutions because Carle is a fairly big place to work. I mean it’s close to 500 physicians strong across the region and so it offers an employee’s assistance program and within that employee’s assistance program it has counselors that will work with our physicians but if they choose not to stay within that system; employee’s assistance program does have a system where they can reach out to the community and offer physicians opportunities to see a psychologist on the outside of Carle System and that’s at no charge to them and that’s at least six visits and can be extended under different circumstances.
I’m one of the people who will reach out to help physicians as medical directors see necessary. I have a PhD in counselor education. I have been – worked for a medical school for 25 years. I have seen resident students and physicians for a long time and I’m willing to not do psychotherapy with physicians but behaviorally approach them on what really happens, what are they dealing with and how do we want to proceed so that they can get back to their level of normality; not necessarily Carle’s but their level of normality. Which is essentially the same because that’s why Carle hired them.
We have senior leadership that – and the committee members that are superb at supplying support for physicians who want support. Dr. Gibb has helped countless numbers of physicians reach out and work with the burnout process and personally helps with that. The committee members have – are on a badge literally that the doctors- all doctors wear around their neck or pinned to their coat so we all have pagers or phone numbers added to that so that we can be reached at any time that they see they need support. We are doing what we can right now, but we are still in process. We have developed modules for leadership that will give them CME credit and when that rolls out, then they can see a whole series of how to, what to, and what to expect. So, that’s where Carle is in the system. And we are working closely with the literature. Dr. Hampton who is the chair of the physician burnout committee is on top of the literature more than anyone I have ever seen. We have Dr. Mickey Trockel who is at Stanford and the Associate Director of their wellness program, very well noted for its burnout process, physician burnout program. He’s coming in November to work with Carle leadership to get them prepared. And we have been in touch with multitudes of other programs including Mayo Clinic to see what they are doing to see how we can borrow their process to make it fit for Carle.
Melanie: So, speak a little bit about the preventative resources that the organization is working on to help with the burnout and as you wrap up for us, Dr. Brewer, tell other physicians what you would like them to know about physician burnout and when you feel it’s important to seek help even if they feel that there’s a stigma that surrounds seeking help for that feeling of burning out.
Dr. Brewer: Well the prevention process has a lot to do with how every day is run at Carle. People who are seriously – seriously enjoy the people they work with, reaching out to them when they see something that’s going just not exactly the way they see it. We have a health system now in terms of a gym in our lower level that people are – it doesn’t just mean physicians, it means all employees can utilize. So, if they need to take a break from their day or while they are on-call, they can certainly go to that gym. We have programs where physicians get together regularly to enjoy each other’s time, pool parties, pre-basketball parties, pre-football parties, that kind of thing. So, one of the things that are difficult for physicians is isolation. Even though you work in a system that’s as big as Carle’s you still feel very isolated from your peers and you don’t really have time to talk to them. So, these mixers if you will, these get togethers really support. Carle also does a lot with quarterly I believe it’s called CPG, Carle Physician’s Group meetings where they hit on major topics for physicians. They just supported a second one on burnout just this past month. So, that’s one of the things that we use to help prevent and manage some of that.
My suggestion to all physicians, albeit, I am not a physician, I can see things a little more objectively sometimes because I’m not in the thick of it. But indeed, I think earlier is better than later. If you feel burned out, you probably are experiencing it to a certain degree which means I’m asking somewhat differently for help, seek support, your medical directors and senior leadership are happy to make referrals, are happy to sit and talk to you. My cell phone number is on the back of the badge that they wear again around their neck or pinned to their coat. Call. It doesn’t take but a minute. We can talk. We can seek information about what do you think is going on. That’s one of my big questions, really is so what happened. What are you dealing with? And since I am not there to judge, nor is EAP; we just want to get a sense of where the physician is so that we can put some measures in place through the support of senior leadership to get the doctor to a better place so we don’t lose high quality physicians which is something Carle has innumerous individuals that are of high quality practicing medicine.
Melanie: Thank you so much Dr. Brewer for coming on and explaining physician burnout and what Carle is doing to address this issue that so many physicians are feeling right now in this time of stress. Thank you again for joining us. You’re listening to Expert Insights with The Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities please visit www.carleconnect.com, that’s www.carleconnect.com. We hope the information gained will be applicable to your work and life. This is Melanie Cole. Thanks so much for listening.