With reports of physician burnout increasing at alarming rates, the University of Texas System of hospitals and healthcare affiliates is undertaking an unprecedented effort to identify the root causes and develop prevention strategies.
The UT System, which includes six hospitals, is conducting an organizationwide assessment of the problem, creating focus groups and recommending solutions at the clinical, departmental, institutional, and system level. The issue took off after some physicians discussed the emotional toll of burnout at a faculty meeting, and now is becoming a high priority for the university system.
“We are really basing our initiative not just on the UT system — because we have not yet done a thorough assessment of our burnout. We have based our data on the national experience,” says Ann Killary, PhD, a professor of translational molecular pathology at MD Anderson and a member of the Faculty Advisory Council, who is co-leading the physician wellness initiative. “As you know, there is quite a significant literature on this issue in academic medicine. After we started the initiative, we realized that it has become a very urgent problem that has been noted in a number of publications.”
In a move that underscores the severity of the problem, 10 healthcare CEOs recently issued a call to action on the issue and laid out some preliminary steps to address the problem.1 (For more information, see story in this issue.) “Burnout is an experience of emotional exhaustion, depersonalization, and feelings of low achievement and decreased effectiveness,” they noted. “Although the focus of this is physicians, burnout is also a serious problem for nurses and other healthcare workers.”
In that regard, UT Chancellor William H. McRaven also has bought into the issue and is hoping the program in Texas hospitals can serve as a national model, Killary emphasizes. “He has a very bold vision for improving the health and well-being of [physicians],” she says. “He really wants to drive this from the system level.”
Plans call for the UT System to hold a symposium at MD Anderson in Houston in September, convening national thought leaders to discuss the issues underlying physician burnout.
“We feel as though this might be an example for other larger systems if we are successful — to make a national model and a toolkit that might be used. I think many times, institutions [implement] very personal individual-oriented solutions, but this would be very different,” Killary says. “Rather than starting with the individual and trying to improve that person’s wellness, it is starting at a system level. But at the same time we will get at the grassroots — a ground-level view of where the change needs to occur, empowering the voice of those faculty who are in the day-to-day operations of the institutions on the physician side. It could be, we hope, a very powerful model for other large institutions.”
Q&A
Another principal in the project, Jonathan Cheng, MD, chairman of the UT System Faculty Advisory Council, discussed the project further with Hospital Employee Health.
HEH: Can you describe a little more how the project began and what some of your immediate actions will be?
Cheng: This is something that the faculty had been pursuing in conjunction with the leadership of our system for almost a year now. Essentially, it is a ground-level effort with [leadership] support. I think there is a very widespread sense that physicians at our institutions [nationally] are increasingly under pressure from all sides.
[These include] the pressures on their ability to do their work, to take care of patients, and to do their job in pursuit of the academic mission, which for us also includes teaching the next generation of physicians and academic leaders and researchers. Those pressures are getting to a breaking point, based on the numbers that have been available through some reliable national research.
HEH: Several studies, including research conducted at the Mayo Clinic,2 have documented this growing problem.
Cheng: One of the prime indicators of that is the increase in physicians’ burnout over time. It is growing rapidly to the point where a lot of national experts and healthcare leaders are calling it an epidemic. Our concern is that not only does this impact physicians’ ability to provide optimal care for their patients — which we feel strongly they are doing despite all of these pressures — but it is becoming increasingly difficult for them to maintain those efforts. It is requiring more personal and professional sacrifice. The personal sacrifices come in terms of their own well-being, and family and work [balance]. Professional sacrifices potentially come at the cost of education and research. Eventually, this is going to be unsustainable. [Nationally], this jeopardizes the leading role that the American health system has held — being the top innovators and leaders in the medical community.
HEH: What will you be looking for at the local level?
Cheng: We are in the process of finding where the UT system is at on the [national] measuring stick. There is actually evidence at some of our institutions that physicians’ satisfaction [scores] may be higher than national norms. So that is one of the things we are hoping to do. What we are trying to find out — if it really shakes out that some of our physicians at some of our institutions are above national norms — is, “what’s being done right there? How can that be shared and disseminated nationally?”
HEH: Burnout often is characterized as a physician problem, for obvious reasons, but could some of the same issues and solutions have implications for other healthcare fields?
Cheng: Yes, absolutely. There is actually really good evidence now that this problem — talking about doctors first — actually starts in medical school. There are data that before students start medical school their “well-being” is better than their age-matched peers [in other professions]. Within six months after they start medical school, it becomes far worse. There is actually something that happens at the beginning of the medical training process. There has also been increasing amounts of data about the effects of the work environment on the performance of all the other associated healthcare professions, including nursing. There is evidence that burnout and very similar issues are present in nursing, physician trainees, residents, and fellows.
HEH: Do you have any insights into what solutions or strategies are needed to address this problem?
Cheng: We are not adopting any predetermined solutions because we are trying to do an evidence-based approach. But I can tell you some of our broader areas of potential interventions include optimizing medical documentation. One of the implementations that has the potential to have the biggest impact on burnout in workplace environments in general is actually looking at the ground-level problems. What are being identified as the biggest problems at the local level in the work environment? What are the people involved brainstorming as solutions? Most likely, we will be recommending a methodology for doing so and developing a toolkit with all of the individual components down to the individual clinical level.
There also are really good data that [show that] very small improvements in leadership by quantitative assessments has a huge impact on the well-being and the burnout levels of the physicians underneath those leaders. One of the biggest things that comes up when you look at all the literature is [lack of] physician autonomy. That is one of the key drivers of burnout based on the literature, but what does that mean on our academic campuses? Obviously, we don’t run individual practices like private physicians do. On our campuses the traditional order is called “shared governance” because these are academic systems. That’s one of the biggest things that is being reinforced in these systems with potential stakeholder input so that the physicians, employees, and the students all have the opportunity to provide their unique perspectives on the direction of the institutions.
HEH: Will you have focus groups to discuss burnout issues with physicians?
Cheng: We will. Our office of strategic initiatives has a data analytics group, which is extremely powerful. They are actually going to do qualitative and quantitative focus groups in a regimented way at all the heath campuses in order to start understanding what the biggest problems are and, potentially, what the perceived solutions may be. That will help us to develop an instrument for doing baseline well-being assessments of all the physicians on our campuses so we have uniform data. That also will help us shape the conversation we will have at our national symposium in September and the “think tank” that we are establishing afterward, which will be less nationally focused and more UT-specific.
REFERENCES
- Noseworthy J, Madara J, Cosgrove D, et al. Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs. Health Affairs Blog. March 28, 2017: http://bit.ly/2nJWkGj.
- Shanafelt TD, Hasan O, Dyrbye LN. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proceed 2015; 90:1600–1613.
With reports of physician burnout increasing at alarming rates, the University of Texas System of hospitals and healthcare affiliates is undertaking an unprecedented effort to identify the root causes and develop prevention strategies.
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