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Physician Wellness: Ways to Reduce Burnout & Early Retirement

In the world of electronic health records, and an increase in the aging population, many physicians find themselves subjected to more intense scrutiny of quality and performance, while they face an ever increasing patient load. They can experience depression and burnout the way many professional do, however, as physicians they may be tempted to care for others before they care for themselves.

Here to discuss the consequences and possible solutions to worrisome physician burnout is J. Michael Straughn Jr.,MD. He is a Gynecologic Oncologist at UAB Medicine.
Physician Wellness: Ways to Reduce Burnout & Early Retirement
Featured Speaker:
J. Michael Straughn Jr., MD
Straughn, J. Michael, Jr., MD is at UAB Medicine and practices Obstetrics & Gynecology, and Gynecologic Oncology.

Learn more about J. Michael Straughn Jr., MD 

Dr. Straughn has no financial relationships related to the content of this activity to disclose. Also, no other speakers, planners or content reviewers have any relevant financial relationships to disclose.

There is no commercial support for this activity.
Transcription:

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Melanie Cole (Host):  In the world of electronic health records and an increase in this aging population; many physicians find themselves subjected to more intense scrutiny of quality and performance while they face an ever-increasing patient load. They can, like the rest of us, experience depression, burnout the way many professionals do; however, as physicians, they may be tempted to care for others before they care for themselves. My guest today is Dr. J. Michael Straughn Jr. He’s a gynecologic oncologist at UAB Medicine. Welcome to the show, Dr. Straughn. Explain a little bit about physician burnout. Are doctors supposed to be gods? Do they have fatigue, depression, family concerns just like the rest of us?

Dr. J. Michael Straughn Jr., MD (Guest):  Yes, that’s an excellent question. Believe it or not, when medical students go through medical school; there just hasn’t been that much education on burnout and so I think when trainees finish up; the majority of their focus is on their patients and obviously many physicians and especially physicians that may take care of serious patients or cancer patients undergo a very strenuous and demanding career. But there has been a lot of focus over the last five to ten years that physician burnout is a major problem that has probably gone sort of underdiagnosed or not well appreciated, but people are finally figuring out that physician burnout is a very serious problem.

Melanie:  Well, I think as you mentioned, in medical school, they may not get much education, but they certainly get initiated with residency and internship in those long hours and late nights and holiday and weekends. What do you think are some of the major causes of this? As I mentioned electronic health records and the aging population; what do you see as some of the major causes?

Dr. Straughn:  You know I think the added stress of quality of care as we put more and more focus on the quality of care that we provide our patients. What comes with that, is this sort of overwhelming sort of feeling that everything must be perfect. All the emails must be answered. All the patients must be seen. And as you mentioned earlier; the electronic medical record probably has added many hours to the week for most physicians and so what has happened in order to get the work done; many physicians have taken that work home in order to work from the computer at home in order to get their work done. So, the added time that people are focused on their patients I think is one of the major contributors. You also mentioned the amount of time that both trainees and physicians spend with their patients. It has been difficult for physicians to turn it off and, so I think a lot of the focus has been on getting physicians to sort of dial back or turn off their practice both at night and on weekends.

Melanie:  Dr. Straughn, do some physicians deny maybe that other doctors have this or does “first do not harm” only apply to their patients? Are you – do you feel in the workplace, are you seeing that doctors are hesitant to even address this subject of burnout because they have got patients to care for?

Dr. Straughn:  Yeah, I think that there has been sort of – that sort of superman complex that many physicians have had through the years that patients require a physician who really doesn’t have any weaknesses and that’s probably a bad way to sort of set up your career. And so, I think most people now are realizing that you are going to experience some of the aspects of burnout which include things like emotional exhaustion, depersonalization, and reduced personal accomplishment and so those are sort of the factors that people are now talking about.

In our field, in 2015, there was a survey of almost 400 gynecologic oncologists and even in that survey, over a third of GYN oncologists admitted to experiencing burnout. And probably even more important is that the burnout rate does appear to be higher in women than in men which is certainly a concern.

Melanie:  Wow, so if so many physicians are experiencing this and when we learn about concussion for example, Dr. Straughn, we learn that players on the field have to kind of keep their eye on each other to recognize those symptoms. Kind of a buddy system. Do you think that that is something that could be tried in the medical workplace and what symptoms would you like other physicians to be on the lookout for with their colleagues so that maybe they can address it or get each other help?

Dr. Straughn:  Yeah, so I think the sort of the symptoms would be people who are having mood changes and so obviously depression has been well-associated with burnout. Certainly, signs of alcohol or drug abuse also have been tied to burnout and certainly in sort of the worst-case scenario would be thoughts of suicide, etc. And so, I think that coworkers need to be aware of those things and obviously if there appears to be a trend towards some mood issues then hopefully physicians can step in and take care of their own. I think many physicians now are trying to really turn their patients over when they are not on call or not working and so, even in my practice in the first five to ten years, when I was on vacation, I would still look at the electronic medical record and talk to people back at home. But I finally learned that when you are off you really need to be off and you have to trust your partners and trainees and other people who are working back at home to take care of your patients. To really turn it off and enjoy your time away from the hospital.

Melanie:  That’s an excellent point. Now, this may be difficult to answer, but what can be done? Does leadership play a role in this, the CEOs of hospitals or somebody that’s running the practice and maybe it’s a multiple physician practice, so as you say you can give up your call time to other physicians? Do you think it’s more up to the physicians, Dr. Straughn or do you think that leadership really needs to step in and address this as they would any other employee workplace issue?

Dr. Straughn:  Yeah, that’s a great question. Specifically, at UAB, I have been very impressed with the leadership as they have begun to address this problem over the last few years. Most of the surveys that have been sent to physicians have included questions about burnout, depression, support from your departmental leadership and so at UAB there has been a big focus on trying to assess how common this problem is. Additionally, UAB has the professional development office which basically provides counseling and coaching for students, residents, fellows and faculty so that now you have a place where you can call and be seen by someone trained in these issues. What’s pretty amazing is that you can be seen usually within 1-2 days. These appointments are free. This information is not in the electronic medical record, so this is a completely confidential counseling session or appointment with an MD to discuss many of the issues that we have talked about and so, hospitals and CEOs as you suggested really have to put the time, the money, the energy, the education into physician wellness and I think many of them are because this is a topic that can no longer go sort of unnoticed or not discussed. So, I have been impressed with many of the hospitals that are really addressing this.

Melanie:  Well as workplace wellness is becoming so popular for the normal employee with workout rooms and massage therapists and even meditation times and yoga, all of that sort of thing; do you see as a possible solution something along those lines? Would you doctors even be willing to take time out and go workout or get a massage or do meditation? What do you see are some possible solutions for this?

Dr. Straughn:  Yeah, you are right, those are things that the hospitals are offering. Obviously, you have to have the time to do it, so, when the services are offered, you still have to have the time away from your clinic or surgery or call and so the first step is to have those there, but then I think people are going to have to either have some time during the day to do that or people are going to have to cover for each other. Obviously, if you are in clinic 8-5 then you can do those things at home or on your own time, but I think if you could find some time to do that during your work day then those things are going to help. There have been some techniques taught which are sort of self-techniques which are basically taking a few minutes in your office whether that’s lying on the floor and stretching or meditation or just some sort of exercises to take a deep breath. I think this is kind of easy quick things to do when you are having a stressful day. But obviously, you can’t do that with patients or in the clinic and, so you do have to find a little bit of time to get away. Another important thing is that many people just won’t disconnect from the email or from the next project on their to do list and, so I think people are going to have to make an effort to sort of sign off during the day a little bit to take some time for themselves.

Melanie:  So, in summary, Dr. Straughn, tell other physicians what you would like them to know about recognizing physician burnout and what you would like they themselves to be experiencing, what you would like them to let people know some possible solutions so that you don’t have maybe errors or medicational issues coming up or any of those kinds of things. Tell your colleagues what you want them to know about this physician burnout so that we can reduce early retirement of you much needed doctors.

Dr. Straughn:  I think the first thing we have to recognize is that the research has been done. Surveys are coming out every year and so the problem is real. So, we have to accept that a very high number of physicians experience differing aspects of burnout. So, awareness and recognition I think is number one. The second is that there are resources to receive education and so in our specialty, we are actually participating in a beta course for GYN oncologists. So, we are actually teaching a four-month course on some different aspects of wellness to our trainees and so if those type of resources are available to you then my recommendation would obviously be to get involved with those things. And then the things that you can control, spending time with your family, getting away from work, the city, whether that’s going to the lake or to the beach, a place outside of your normal environment, travel, sporting events, concerts, those type things that are totally different from medicine. Everybody needs to have some hobbies or some things to do to get away from the things that we like because we obviously like our patients, we like taking care of patients; but everybody has got to have some hobby and people who have families and kids obviously focusing on them is a good way to think about something else, do something else.

Melanie:  Well I think it’s so important everything you have stated to keep that engaged and resilient health professional workforce and thank you so much for being with us today, Dr. Straughn. You’re listening to UAB MedCast. For more information on resources available at UAB Medicine, you can go to www.uabmedicine.org/physician , that’s www.uabmedicine.org/physician. And a community physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. That’s 1-800-822-6478. This is Melanie Cole. Thanks so much for listening.