Where physician burnout starts—and how to help stop it
Matriculating medical students have lower distress than similarly aged college graduates in the U.S. That changes starkly, however, during their undergraduate medical education and their distress levels can continue to spiral upward throughout their career in medicine.
A recent AMA Innovations in Medical Education webinar highlighted methods for educating medical students, residents and physicians to prioritize their own well-being and addressing the causes of distress and burnout.
“We must create a healthy culture at all levels in order to address this important issue,” said Maya M. Hammoud, MD, director of Medical Education Innovation in the AMA’s medical education group.
Treating, tracking student distress
The Mayo Clinic School of Medicine, a member of the AMA Accelerating Change in Medical Education Consortium, has done extensive work on the topic.
Mayo’s program on well-being aims to train medical students on the foundational principles of self-care using demonstrable strategies to promote well-being. Those strategies include:
- Arranging visits with a mental health counselor for all matriculating students.
- Teaching stress management, resilience and mindfulness skills
- Subsidizing on-campus fitness center access for all students.
- Making assessments pass/fail during the pre-clinical years.
- Funding student-run wellness activities.
Mayo began measuring student well-being in 2014. Based on the data collected from 2014 to 2016, about 30 percent of students were experiencing high levels of distress, with that number nearly doubling during the third year of med school. Students in high distress carry a higher risk of suicidal ideation, mental health issues, burnout and dropping out of school. As Mayo’s well-being curriculum has become implemented with more students, those figures on distress fell by nearly half in 2016–2017.
Burnout persists in residency
Higher rates of depression, burnout and suicidal ideation are also prevalent among trainees at the GME level. The Resident and Faculty Wellness Program at Oregon Health & Science University (OHSU) tries to remove the barriers that prevent physicians—particularly residents working demanding schedules—from seeking wellness treatment.
Those measures include offering on-site access to free wellness resources such as individual counseling and coaching, a psychiatrist conducting evaluation on the possible use of medication, outreach workshops focusing on resilience and coping skills and suicide prevention screening.
Since 2015, more than 20 percent of OHSU’s residents and fellows have participated in the Resident and Faculty Wellness Program in some capacity.
Addressing well-being in practice
The training years play a vital part in shaping a physician’s mental health throughout their career. Yet they make up only a small portion of a career in medicine. Practicing physicians are experiencing burnout—symptoms of which include emotional exhaustion, depersonalization and low sense of personal accomplishment—and the AMA is working to address it.
The AMA’s STEPS Forward™ collection offers free online modules that help physicians and system leaders learn their risk factors for burnout and adopt medical practice solutions to reignite professional fulfillment and resilience, including modules that focus on professional well-being, such as preventing physician burnout and improving resiliency.
Marie T. Brown, MD, is a senior physician advisor in the AMA’s Physician Satisfaction and Practice Sustainability Group. She spoke to the importance of addressing burnout at every level and the role STEPS Forward plays in doing that.
It is critically important “to model quality, efficient care for students,” Dr. Brown said. “If teaching attendings are experiencing symptoms of burnout, we know it can be contagious. When faculty and residents who interact with medical students feel little enthusiasm and pride in their work, students will likely experience this negativity as well.
“It is important throughout the training process that, wherever we teach medical students—whether in the hospital or clinic—the experience must be run very efficiently with everyone working at the top of their license. Faculty enjoys teaching and attending to tasks which do not require their extensive training, hinders teaching opportunities for the students. Many of the STEPS Forward modules will help [to make sure] our trainers as well as our trainees feeling joy in the work that they do as well.”
Several STEPS Forward modules have been developed from the generous grant funding of the federal Transforming Clinical Practices Initiative (TCPI), an effort designed to help clinicians achieve large-scale health transformation through TCPI’s Practice Transformation Networks.
The AMA, in collaboration with TCPI, is providing technical assistance and peer-level support by way of STEPS Forward resources to enrolled practices. The AMA is also engaging the national physician community in health care transformation through network projects, change packages, success stories and training modules.