Almost 87 percent of physicians report they feel moderately to severely stressed and burned out on an average day, and almost 63 percent of them are feeling more stressed and burned out than they did three years ago, according to a recent survey.
The survey, conducted by Physician Wellness Services and Cejka Search from a nationwide, multispecialty sample of more than 2,000 physicians, also captured the causes and effects of physician stress and burnout in external, work-related and personal life-related factors. Because of their stress and burnout, physicians reported suffering from:
- declining job satisfaction
- decreasing productivity
- insufficient work-life balance
- conflict at work and at home
- feelings of irritability, moodiness, anger and hostility
- general tiredness, lack of sleep and difficulty sleeping
- negative impacts on physical health
- mental health issues like depression and anxiety, or such symptoms as apathy, cynicism and less interest in engaging with others or in normal activities
- patient safety-related concerns such as difficulty making decisions, communicating effectively and experiencing increased risk of medical errors
Often, these issues are interrelated, blurring the line between cause and effect. As one respondent noted, tiredness and lack of sleep can result in medical errors. In our clinical work, we have seen that declining job satisfaction is linked to depression and insufficient work-life balance, which also can cause problems with family and co-workers.
The number of physician stressors will only grow, given the pressure from a host of trends and initiatives. Now that physician engagement is a high priority for most health care organizations, it is critical that hospital administrators find ways to lower the stress levels of their medical staff.
Consequences of Physician Stress
For health care organizations, failure to deal with physician stress and burnout can have unfortunate consequences, including:
Disruptive behavior and lower morale. Underlying much of the reported effects of stress and burnout at work and on personal levels, and very evident in the physicians' survey comments, is an increasing sense of apathy and hopelessness — or conversely, anger, resentment and frustration. Along with tangible impacts such as disruptive behavior, plummeting morale can cause conflict at work — with staff members and administrators, colleagues and patients.
Increased turnover and retention challenges. More than 14 percent of respondents said they left a practice due to stress and burnout. Survey respondents identified the desire for a job change —switching to a new job or practice, retiring early, or leaving the practice of medicine entirely — at a combined frequency of 95.2 percent. Even when allowing for some overlap in respondents, that number is untenable in the face of ongoing physician shortages.
Patient safety and quality issues. Numerous studies have linked sleep deprivation, communication issues, decision-making difficulties and conflict with co-workers to adverse events and outcomes and to increased medical malpractice lawsuits.
Lower productivity. Almost 15 percent of survey respondents reported lower productivity as an effect of their stress and burnout, and 41.2 percent desire fewer work hours. These and several other factors cited can affect productivity directly or indirectly. For instance, presenteeism (being present at work physically, but not fully focused or functioning) has been shown to be caused by tiredness and sleep deprivation, depression, challenges in balancing work and life demands, and other factors. Also, almost 25 percent of survey respondents said stress and burnout affects their personal health, which can cause absenteeism and increase an organization's medical costs beyond the revenue lost when a physician is not practicing.
Preventing and Addressing Stress in Physicians
While a small number of organizations have initiatives in place to deal with stress and burnout (15.7 percent as reported by survey respondents), these initiatives are often insufficient, irrelevant, inaccessible or unknown to their physicians. Most respondents who reported some knowledge of organization-sponsored initiatives cited only one; several noted these services were offered at times incompatible with their schedules.
Given the consequences, it is critical that organizations recognize and address stress and burnout and their causes at the individual and organizational levels, using both preventive and mitigative measures.
Three points came up repeatedly in physicians' quest to address stress and burnout, suggesting a number of solutions that should be effective and can be implemented with available resources:
- greater flexibility and control over working hours to mitigate burnout and stress;
- more opportunities for and assistance with taking better care of themselves;
- support on multiple levels in dealing with stress and burnout in their lives.
Flexibility and Control over Working Hours
Of the organization-supported services to help them deal more effectively with stress and burnout, physicians' top choice by far was "ancillary support," at 63 percent. Such support can help address the top three work-related stress factors: paperwork and administrative tasks (39.8 percent), too many hours of work (33.3 percent) and on-call schedules and expectations (26.2 percent). Ancillary support frees up more time for patient care, another wish they expressed.
Two of the top three improvements physicians felt would reduce stress or burnout in their lives — better work hours and less on-call time, and better work-life balance — were related to flexibility and control over time spent at work.
One way to provide more flexibility and control is through part-time practice. Since 2005, the part-time physician workforce has grown by 62 percent. In the Cejka Search/AMGA 2010 Physician Retention Survey, 13 percent of male physicians practiced part time, as did 36 percent of female physicians, compared with 7 percent and 29 percent, respectively, in 2005. This trend creates a need for advanced practice providers (nurse practitioners and physician assistants) who can help provide accessible, effective care when more physicians are opting for fewer (or more flexible) patient care hours.
Opportunities for Better Self-Care
Physicians cited the following as major challenges: lack of sleep; effect on physical, mental and emotional health; and overall lack of time to engage in self-help activities. Exercise was the most-cited self-help activity (63 percent) to address stress and burnout; after ancillary support, on-site exercise facilities or classes are physicians' second-most favored (38.6 percent) organization-sponsored initiative.
Providing time to engage in self-care activities is equally important. Allowing physicians to block out time during the day — and respecting that time — signals that organizations understand the importance of such activities in promoting physician well-being.
Physicians may also need help understanding what good self-care is, especially in light of common self-admitted traits, which make taking care of themselves a low priority. As one respondent commented, "Physician, heal thyself." In our experience, this evolution is not something that happens overnight, and it's an issue for individuals and organizations — their culture and practices. Workshops, facilitated support groups, physician-wellness committees and individual coaching can help.
Support for Dealing with Stress
Physicians cited several support initiatives, both day-to-day and long-term, that would help: wellness initiatives (27.8 percent); education to cope with stress and burnout (23.8 percent); concierge-type services (19.8 percent); and coaching and mentoring resources (18.5 percent). Initiatives such as a physician-specific employee assistance program, an active physician-wellness committee and grand rounds programs can administer these programs.
A sizeable percentage of survey respondents cited conflict — at work and in their personal lives — as both a cause and effect of stress and burnout. This issue ties to communication skills, organizational culture and daily situations that can get out of hand quickly when physicians are stressed and have poor coping skills — sometimes a cause of disruptive behavior. Providing more opportunities for collegial interactions among physicians can help. Facilitated discussions to help physicians identify areas of conflict, and training on more effective communications and better ways to address workplace conflict, can be invaluable in setting a culture that is more supportive and promotes greater job satisfaction.
While administrators can't control stressors such as legislative reform and reimbursement issues, there are many things they can and should do — in a thoughtful and meaningful way so it's not just seen as lip service — to reduce physician stress in order to promote retention and a healthy organizational culture.
Mitchell Best is the COO of Physician Wellness Services in Minneapolis. Alan Rosenstein, M.D., M.B.A., is the medical director of Physician Wellness Services.