The call came from Dr. Corey Martin’s boss at Buffalo Hospital on an October evening five years ago: “Corey, you need to get to the hospital right now,” she said. A pediatrician friend had killed himself in the hospital chapel.
The next day, on his way to perform his usual round of colonoscopies, Martin ran into a concerned Medical secretary who remarked, “Oh Corey, I’m so glad you’re here today—I thought I was going to hear it was you.”
Both Martin and the pediatrician had been burned out, victims of long hours spent toiling on electronic medical records instead of interacting with actual patients. Now Martin was experiencing waves of grief—and the idea that it could have been him.
The World Health Organization recently reclassified “burnout” as a syndrome, describing it as “feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”
The problem in medicine has reached such epic proportions that prominent health care organizations call provider burnout a public health crisis. The Minnesota Hospital Association’s frequent surveys show just over a third of Minnesota providers are burned out—a percentage that actually looks good compared to the national average of 44 percent, reported in the most recent survey conducted by researchers from the American Medical Association, the Mayo Clinic, and Stanford University School of Medicine.
Compared to people in other professions—even those with similarly long workdays—physicians burn out more often. The consequences? Burned-out health care providers are more likely to consider suicide. They’re also twice as likely to leave the profession. Patients of affected providers are more likely to fall victim to medical errors and, not surprisingly, express dissatisfaction with the health care system.
The tragedy in Buffalo marked a turning point for Martin. The grieving medical staff sent 15 providers to a conference on physician burnout and resilience “to see if we could learn some tools to help ourselves and each other,” he says.
Addressing medical burnout—like health care itself—is a fast-growing practice. Among the many new and ongoing efforts: The National Academy of Medicine just issued a new 332-page consensus report featuring research from the Mayo Clinic. And the Minnesota Medical Association hopes to become a central repository of resources and interventions that work. (One surprising approach: improv training.) The organization Martin helped found, the Bounce Back Project, cohosted a two-day conference in December.
Some hospital systems and clinics have appointed a leader to take charge of the in-house response to burnout. And that’s just Minnesota.
Minneapolis appears to be so rife with local experts, in fact, that I didn’t even have to leave my block to find two of them. My friend Dr. Natalia Dorf-Biderman is the first professional satisfaction medical director at Methodist Hospital. She and her husband, Dr. Joel Carter, spoke at the December Bounce Back conference. When I walked over to their house for tea, Dorf-Biderman explained why hospitals need this new role.
This current wave of physician burnout is clearly different from what physicians experienced in the past. “We deal with suffering, so there has been burnout throughout history and physicians have had to deal with it,” Dorf-Biderman says. “But now there is this moral distress that comes with it. Because there’s a cognitive dissonance between the care delivery that physicians want to give and the care they can give.”
Many providers have come to view the health care system as a barrier to practicing medicine in a meaningful way, she continues. Organizational and external factors cause about 80 percent of provider burnout, according to the American Medical Association and the American College of Physicians. It’s not just the much-maligned electronic medical records—which, according to surveys and studies, take up over half of a physician’s workday. That’s twice as much time as they spend with patients.
It’s also regulatory pressures that, over the past decade, have encroached on the workday. In the past, Dorf-Biderman says, if you had a patient who needed a walker, for example, you’d grab a prescription pad, scribble the word “walker” alongside your signature, and you’d be set. Now you have to look up about seven different kinds of walkers and consider a dizzying number of options. Two-wheeled or four-wheeled? Should it have brakes? A seat? Bariatric wheels? Next, the doctor must print the form, which can’t be sent electronically. And because the insurance companies require a physician’s signature, the process for any “durable medical equipment” falls on the physician.
“When I’m thinking of all of these minor details, it’s harder to pay attention to the bigger picture,” she says. “This person might be 92, and we should be talking about what’s important.”
Experts don’t necessarily agree on the best approach to tackle the problem. The Minnesota Hospital Association uses data from 94 hospitals across the state that participated annually in a three-year survey to identify and target the biggest problems associated with burnout. In 2018, the survey asked physicians to indicate what specifically triggers distress when doctors deal with electronic health records.
At the top of the list? “Pajama time,” says Dr. Rahul Koranne, the organization’s chief medical officer. “A physician might get done at 5 pm on Friday but then spend four more hours in their jammies trying to complete their Epic chart.”
The organization suggested making patient emails accessible to the entire team, so that if a question came in about medication, for example, a pharmacist could answer.
Systems-level solutions like these are what’s needed to effect permanent change, says Mayo Clinic physician Dr. Lotte Dyrbye, who co-invented an assessment tool called the “Physician Well-Being Index” and served on the committee that developed the National Academy of Medicine report. I asked her what she dreams a typical appointment could look like in the future.
Before the appointment even started, she says, schedulers would have tailored the length of the visit to what the patient needed.
Once she walked into the room, she adds, “I would be able to interact with that patient—from taking a history to coming up with a plan—with minimal interaction with the computer.” That could mean having a team member come along to help, or technology that would capture the visit and translate it into a medical record—“listening” walls, perhaps.
Such changes may be necessary, but doctors shouldn’t wait for them, says Martin, from Buffalo Hospital. He’s focusing his efforts on the immediate by teaching physicians tools—resiliency, self-care, mindfulness—to ward off burnout on an individual basis. “Big organizations don’t turn on a dime; they aren’t going to make it better tomorrow,” he says.
Still, there has been something of a backlash toward this emphasis on personal responsibility, explains mindfulness coach Jacquelyn Fletcher Johnson, CEO of Heartwood Healing in Lakeville—part of the National Academy of Medicine’s Action Collaborative on Clinician Well-Being and Resilience network. Some doctors, she says, have developed “a visceral reaction to the word resilience”—because it suggests they’re to blame for lacking enough of this cure-all.
For his part, Martin now practices family medicine just three days a week. He does consulting work and gives talks on provider burnout two days a week. And he travels and spends quality time with his family.
Fifteen years ago, he says, he would have laughed at his current career choices. But “I’m the happiest I’ve been since becoming a doctor.” For one physician, at least, the cure took.
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