Physicians are highly educated and engaged in meaningful work — so why are so many so unhappy?
“Doctors are suffering stress, burnout and problems with work-life integration,” said Tait Shanafelt, director for the Program on Physician Well-Being and professor of medicine at Mayo Clinic.
Shanafelt, speaking at the Lisa Heiser Lecture in Chevy Chase Bank Auditorium on March 13, cited national studies indicating that more than half of U.S. physicians suffer from professional burnout, which he defined as emotional exhaustion, cynicism and a loss of purpose that prevents full engagement with work. Physicians who are burned out tend to treat patients and co-workers as objects rather than people, he said, and can transmit their cynical attitude to others in their departments.
Shanafelt, a hematologist-oncologist, was one of the first to study burnout of American doctors and its effects on quality of care. His 17 years of research have uncovered some dismaying truths.
In 2008, in collaboration with the American College of Surgeons, Shanafelt surveyed nearly 25,000 U.S. surgeons. Of the 32 percent who responded, 40 percent were assessed as having burnout.
Shanafelt said his research shows that burnout among U.S. physicians is increasing, for reasons that include pressures to treat large volumes of patients, increased clerical work, less autonomy and frustration with requirements related to keeping electronic health records. The stress is compounded by the perfectionist qualities that characterize many physicians.
For physicians to avoid burnout, he said, they need connections with colleagues, a sense of control over their work and schedules, and opportunities to grow and excel. But doctors can’t do it on their own. The solutions, he said, are “20 percent at the individual level and 80 percent at the system and organization level."
At Johns Hopkins, the Office of Work, Life and Engagement helps employees prevent burnout with services that include community involvement opportunities, employee recognition events and information about creating flexible work schedules. Officials with Johns Hopkins Medicine also plan to implement some of Shanafelt’s ideas as part of the Joy in Medicine initiative.
“Dr. Shanafelt really helped to frame the topic of physician burnout and provided helpful recommendations that could be applied at Johns Hopkins,” says William Baumgartner, vice dean for clinical affairs for the school of medicine, who co-chairs the Joy in Medicine Task Force with Janice Clements, the school of medicine’s vice dean for faculty.
For example, Shanafelt’s research has found increased job satisfaction among doctors when their department leaders keep them informed, support their career development, ask for their opinions on how to improve the work unit and recognize their good work. Shanafelt recently helped pioneer the Listen-Act-Develop approach at Mayo Clinic, which asks physicians to identify their biggest work problems, work within their work units to propose solutions, translate these strategies into action and assess their effectiveness.
Most divisions or departments can identify “simple, tangible, inexpensive things that, with the support of leadership, can improve their work environment within a couple of months,” he said. Solutions might involve delegating clerical responsibilities, adding flexibility to work schedules and making work flows more efficient.
“We want to do more than avoid burnout,” Shanafelt said. “We want to achieve high satisfaction, and we want to thrive.”