June 20, 2018

The secret weapon in Stanford, Mount Sinai, and others' fight against the 'epidemic of physician discontent'

Daily Briefing

    Editor's note: This story has been updated.

    The United States is facing what experts are calling an "epidemic of physician discontent"—and some of the nation's leading hospitals are taking action by bolstering their c-suite with a dedicated chief wellness officer, Lucette Lagnado reports for the Wall Street Journal.

    Learn three surprising truths about physician burnout

    The problem of burnout

    The National Academy of Medicine in a discussion paper last year concluded that more than half of U.S. physicians showed signs of burnout. The paper defined burnout as a syndrome marked by "a high degree of emotional exhaustion … and a low sense of personal accomplishment."

    Further, the paper noted a connection between burnout and the quality of care doctors provide their patients, suggesting that burnout has "a significant effect on quality and risk of malpractice suits."

    Many hospitals have sought to ease physician burnout through wellness programs, Lagnado reports. But to really address the issue hospitals need to reform the system, according to Tait Shanafelt, chief wellness officer at Stanford University School of Medicine. "Telling doctors to eat granola, do yoga, and be more resilient isn't going to address this problem," he said.

    Enter, chief wellness officer

    To lead those reforms, hospitals and health systems throughout the country increasingly are hiring chief wellness officer, Lagnado reports. She notes that Stanford, Mount Sinai Health System, and UAB Medicine have all appointed chief wellness officers, while Johns Hopkins Medicine is aiming to hire one this year.

    David Rogers, a pediatric surgeon and chief wellness officer at UAB, directs doctors to the "well-being index" created by Mayo Clinic to monitor their mental wellbeing. The index includes a brief quiz that asks physicians targeted questions such as, "During the past month, have you worried that your work is hardening you emotionally?" and "During the past month, have you often been bothered by feeling down, depressed, or hopeless?"

    At Mount Sinai, Jonathan Ripp, an internist who recently became the system's chief wellness officer, works to combat physician burnout by reducing clerical duties. One of the leading causes of burnout is the amount of time doctors spend in EHRs, both in the office and at home, Ripp said. To solve this problem, Ripp is having doctors dictate their notes directly into a patient's EHR.

    Another issue, Ripp said, is the number of tasks doctors get "bombarded" with during the day. Ripp wants to implement a team approach in which doctors focus on clinical care and other staff handle remaining tasks. Ultimately, Ripp hopes to reduce nightly electronic work—or "Pajama Time"—by an hour.

    Reducing clerical burdens is also a priority for Shanafelt, who's hired staff to sit in with doctors on appointments and take notes. He said this frees up doctors to see more patients, making it cost effective.

    Addressing physician loneliness

    While efforts to reduce physicians' workloads are beneficial, Lagnado reports that they do not address another key aspect of physician burnout: loneliness.

    According to Shanafelt, physicians report feeling like they've lost a sense of community and are feeling lonelier. "We are interacting with our patients less. We are interacting with our colleagues less," he said. "We are becoming more isolated."

    For instance, in the past physicians had dedicated lounges where they could meet, relax, and talk about cases with each other, Shanafelt said. But those communal spaces are disappearing at many hospitals—and Shanafelt said hospitals should bring them back. "I am pretty sure everyone has a room where they could offer bagels and coffee," he said.

    At Stanford, Shanafelt also has asked departments to gather small groups of doctors to get together for dinner at local restaurants. The hospital covers food but not alcohol. At these meals, Shanafelt said participants are encouraged to talk about things like "life as a physician" (Lagnado, Wall Street Journal, 6/9).

    Learn more: Get 4 key strategies to mitigate physician burnout

    Physician burnout links to a 16% decrease in patient satisfaction, an 11% increase in reported medical errors, increased turnover, and early retirement. Act now to prevent further damage to your business, physicians, and patients.

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