How to beat burnout: 7 signs physicians should know

AMA Wire
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If constant stress has you feeling exhausted, detached from patients, or cynical, take notice. You may be in danger of burnout, which studies show is more prevalent among physicians than other professionals. But how can you avoid it? Learn the signs of physician burnout and what you can do to stay motivated on the job.

Mark Linzer, MD, Director of the Division of General Internal Medicine at Hennepin County Medical Center in Minneapolis, has studied physician burnout since 1996. He said he understands why many physicians eventually feel exhausted practicing medicine, but this problem is avoidable. 

“Burnout doesn’t have to be highly expensive to fix,” Dr. Linzer said. “The problem is that no one is listening. People always want to say that physician wellness and performance measures will cost a lot of money, but preventing burnout can actually save money in the long run on recruiting and training new practice staff.”  

If physicians want to keep burnout at bay, Dr. Linzer said there are some serious signs they should never ignore. Here are seven ways to know if your practice is getting the best of you—and when to finally do something about it:  

  • You have a high tolerance to stress. Stress consistently ranks as the number one predictor for burnout among physicians, Dr. Linzer said. “Please don’t ignore the stress, even if you can take it,” he said. Physicians who consistently operate under high stress are at least 15 times more likely to burn out, according to his research.
  • Your practice is exceptionally chaotic.  A quick glance around your practice will let you know if you or your colleagues may cave to stress. “People tend to think it’s the patients that always stress doctors out, but actually, it’s the opposite,” Dr. Linzer said. “Caring for patients keeps doctors motivated. What burns them out is caring for patients in a high-stress environment. Change the environment and you’ll change the overall quality of care.”
  • You don’t agree with your boss’ values or leadership. This one is particularly tricky to identify but “necessary to prevent burnout,” Dr. Linzer said. Whether at a large hospital or private practice, physicians need to feel as if the people leading them also share their values for medicine and patient care. Otherwise, their motivation can slowly wane. 
  • You’re the emotional buffer.  Working with patients requires more than medical expertise. “Often, the doctor acts as an emotional buffer,” Dr. Linzer said. “We will buffer the patient from our own stressful environment until we can’t take it anymore.”
  • Your job constantly interferes with family events.  Spending quality time with loved ones helps physicians perform better. “When they can’t do those things, it’s all they think about during the day and the patient suffers,” Dr. Linzer said, citing work-life interference as one of the most common predictors for burnout among physicians in his studies. 
  • You lack control over your work schedule and free time.  When work demands increase, but control over your schedule doesn’t, stress can kick in and spark burnout. That’s why Dr. Linzer often tells practices, “If you standardize, customize”— a medical mantra to suggest that if physicians must work a long standardized set of hours each week, practices should at least customize their schedules to flexibly fit changes or needs in their daily lives.
  • You don’t take care of yourself. When was the last time you enjoyed a nice bubble bath or morning run? If you continually neglect yourself, you may neglect your patients, too. “As physicians, we want to be altruistic but one of the keys to altruism is self-care,” Dr. Linzer said. 

Did you fit most of these signs? If you think you or your fellow physicians are suffering from excessive stress, check out these tips from residents who have conquered burnout. Find more on maintaining a happy medical family in Physician Family, the AMA Alliance’s magazine.

Also review these burnout busters and physician-friendly tips to increase satisfaction in your practice

Preventing physician burnout is a priority for the AMA’s Professional Satisfaction and Practice Sustainability initiative, which partners with physicians, leaders, and policymakers to reduce the complexity and costs of practicing medicine so physicians can continue to put patients first.

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Interesting.<br/> More interesting is why we hand out advice like this when we know from decades of research it's wrong.<br/> Imagine burnout=PTSD.<br/> If we told our PTSD patients to put on the stiff upper lip, chill, etc., we'd be reported to the state medical board.<br/> So let's call burnout what it is, a failure of leadership at the highest level.<br/> The environment of practice is very controllable.<br/> Drop SGR and spend the dues money using AMA podium to say no to issues that don't improve environment of practice.
you need to be morally self sustaining and preserved so that a practitioner can be proud of its own and be a successful one .
Interesting that # 1 sign is " high tolerance to stress" It is difficult to know the alternatives to having a high tolerance. Perhaps , instead of tolerating stress a physician with low risk for burn out will seek solutions to problems that contribute to a stressful environment. What do other members think about constructive ways to optimize tolerance to stress as a factor for avoiding burn out?
Dr. "Benzonit,"<br/> <br/> I'd like to hear more about ways that burnout is a failure of leadership at the highest level. That's an important concept in my own study of burnout, caregiver fatigue, etc.<br/> <br/> Given that hospital and medical center executives have a responsibility to maintain the best possible set of medical professionals, it would seem that their self-interest would lead them not to fail in a way that doesn't seek to mitigate burnout.<br/> <br/> Thank you,
The greatest contributor to burnout in my opinion is the federal government and the ever-increasing burden of requirements. The computer systems in the hospital are definitely not ready for prime time and their imposition of wasted time horrid. A consult in the hospital yesterday(Sunday) afternoon was straightforward, I was aware of this patient from ten years ago with the same problem, a paper note and one order would have required two minutes of paperwork. The computer led me through many required steps before I would write my note then wouldn't let me write an order in the area clearly labelled "order," a space for a free-hand order. A call to the help desk took seven minutes to be answered, then the young man trying to enable the order space spent fifteen minutes, while he kept repeating, "I don't know why it won't let us do this." Finally he said I needed to shut it down and bring it back up. I didn't want to lose the note, so I said forget it and save the note. I wrote the orders on a paper order form, which the nursing station is not officially supposed to have upon order of the government that we must go paperless. I am a surgeon. My time should be spent in clinical contact and in doing surgery. The computer should occupy 0.001% of my time. Yet, they are such hogwash that they could occupy as much time as they can get away with. RACs, computers, compulsory involvement in ACO's in which the insurance companies want to force doctors to pony up funds if the system spends too much money, all of this will lead to my early retirement. The shame of it is, I am a very good surgeon, altruistic, kind-hearted and very giving. In 2003 I spoke to some doctors from the former East Germany describing their experiences with medicine just before the wall came down. They said that as the bureaucrats realized that there was enough money to pay bureaucrat salaries or pay doctors for doing the work, the doctors became the enemy of the state. They were hit with "recoupment for overpayment," threats that their choice of patient treatment was a criminal offence, etc.. We are on our way as the bureaucracy grows ever larger.
It's disconcerting that the link to download Dr. Linzer's clinical study (<a href="http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Linzer.pdf)" rel='nofollow'>http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/advances-in-patient-safety/vol1/Linzer.pdf)</a> either was never functional or is just wrong (it leads to an AHRQ missing page). <br/> <br/> Also, that no mention was made in this article or today's (8/10/15) article on Burnout to the links between burnout, medical errors, malpractice claims, and suicide. <br/> Why was Mike Myers' excellent audio series on Physician Suicide and its various causes removed from the AMA website? It's as if AMA can't see the forest (or the precipice) for the trees! Glad there IS a "Professional Satisfaction and Practice Sustainability" initiative. Let's hope they are actually listening to people who care enough to read these articles.
I don't think that #1 makes much sense. High stress LOAD maybe, but presumably if you REALLY have a high tolerance you wouldn't be feeling stress...despite it being at high levels. <br/> <br/> I do agree that seeking solutions to problems that contribute to a stressful environment is one way to help reduce the stress, but of course all of the problems that are listed (and mentioned in replies) will also decrease one's willingness/ability/time to do even more.
"russellburck"<br/> Thanks for the inquiry and sorry for the delay; I don't read blogs often<br/> I think this is really interesting.<br/> The job of a CEO/management is to hire people capable of doing the job, getting the tools to do that job, then getting out of the way. (See the pattern of companies Warren Buffett purchases; see recent story on Precision Castparts.)<br/> Management's job is to make that task clear and be in the mix.<br/> So, what is the job for which (we) are hired?<br/> What is the job we are expected to perform?<br/> In the gap lies the failure of management.<br/> <br/> Management needs to figure out what is the objective and remove all other impediments.<br/> This is really very simple.<br/> If the task to be performed does not directly contribute to the success of the task at hand, do not do it. It can better be done elsewhere.<br/> So management needs to learn to put on their big boy pants on and just say "No."<br/> It's not that hard; threats of financial penalties are ludicrous: fine me 2% unless I will surrender 30%?<br/> If the EMR doesn't advance patient care as measured by those at the bedside who are charged with patient care, thanks but no thanks. (How long do you think it would take the free market to respond to this incentive? A week?)<br/> If patient satisfaction was tempered by common sense and best business practices (<a href="http://www.huffingtonpost.com/alexander-kjerulf/top-5-reasons-customer-service_b_5145636.html)," rel='nofollow'>http://www.huffingtonpost.com/alexander-kjerulf/top-5-reasons-customer-service_b_5145636.html),</a> don't you think worker satisfaction would follow? It does in other high tech industries, and we aren't' that special.<br/> I heard Dr. Speck speak to this last year, to wit, What industry would tolerate its best trained workers to be so dispirited?<br/> It's the management.
Dr. "Benzonit":<br/> <br/> Thanks for your reply. I forgot I had even asked a question here.<br/> <br/> I'll get back to you this week about your comments.<br/> <br/> Many thanks,<br/> Russ Burck
I'm not seeing a response to your question about the AMA series on physician suicide. Did you get one? <br/> <br/> It's discomfiting to find a resource and then not be able to find it again. I hope you're able to.<br/> <br/> Russ Burck

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