For Stressed Docs, Where to Turn?

When I get press releases on physician burnout or stress, my first reaction is to hit delete. Dog Bites Man. Physicians stressed? Is that really news?

Of course docs are stressed, not only from the nature of the job—saving lives (pretty stressful in itself)—but also due to the evolving nature of healthcare reform (which many don't like), mulling whether to get out of the business (especially if they are baby boomers), and considering whether to realign themselves with hospitals (which many are doing). Then there is the worry about malpractice litigation (often constant).

But it seems there is news on the stressed physician front. A recent survey and report by Physician Wellness Services, a Minneapolis, MN-based company that counsels physicians and hospitals on wellness and related issues, and Cejka Search, a St. Louis, MO-based physician executive search firm, shows more physicians are getting stressed and it's getting worse. Moreover, the report concludes that the health systems where they work aren't doing much about it. (Disclaimer: Cejka Search is an advertiser with HealthLeaders Media.)

Yes, physicians are stressed, and their numbers are growing every day. The impact extends beyond the lives of individual doctors and could be consequential for patient care and for physicians' relations with other professionals, such as nurses.

How bad is the problem? The survey shows that 87% of 2,000 physicians reported they were moderately to severely stressed, and 63% said the stress has increased "moderately to dramatically" over the past three years.

Yet only 15% of hospitals, clinics, and other healthcare organizations offered support in a way they thought would be helpful to deal more effectively with stress or burnout, the report says.

For physicians, the work-related stress factors are:

• Administrative demands
• Long work hours
• On-call schedules
• Concerns about medical malpractice lawsuits

All those factors are essentially built into today's job of being a physician, at least for the docs who stick with it.

"The result of this cumulative stress is declining job satisfaction, motivating physicians to change jobs or leave the practice of medicine altogether," the report states. If low morale leads to physicians doing their jobs improperly, then there is concern about patient safety issues, of course.

"I HATE being a doctor," wrote one unnamed and extremely disgruntled physician in response to the survey. "It has changed so much since I started. There is no reward for working your butt off, all future docs will be shift workers. Non-doctors and doctors who are traitors (administrative docs) have too much control over me and my patient's [sic] care. Doctors who provide care are left holding the bag of litigation responsibility but no control over quality of care…I can't wait to get OUT!!!"

"Physicians are seeing that organizations are not really providing the necessary service and support to help them achieve a work/life balance," Alan Rosenstein, MD, medical director for Physician Wellness Services, tells HealthLeaders Media, referring to the survey and report findings. "Some of that would be administrative support and being sensitive to their time demands, or being more proactive in offering them services such as wellness programs or coaching, or something to support them to emotionally adjust to stresses in their environment."

Of doctors who utilized programs inside their healthcare facilities to deal with stress and burnout, 31% said they used wellness initiatives, 29% used workshops and education, 19% used onsite exercise facilities or classes, and 15% used counseling or other behavioral services.

Health systems need to address physician stress and burnout concerns "because this is a serious issue," says Rosenstein, "and right now it's continued burnout because the solutions aren't there. One solution is physician awareness and they do it themselves and take the time to exercise, for instance, and recognize the downstream consequences of stress and burnout."

"On an organizational level, people need to realize physicians are burned out and mistakes can happen," Rosenstein adds. "There's no cookbook that offers one solution. There needs to be a cultural and leadership commitment to this. Whatever is done, through human resources or a medical staff office or a physician wellness committee, it's the intent that is critical to begin making those connections with physicians."

How do physicians want help with stress? Their top choice by far in the survey (63% of respondents) is receiving more "ancillary support," such as physician aides or other staff members to help with paperwork or charting.

Respondents also say there is a need for more "advanced providers such as nurse practitioners and physician assistants who can provide accessible and effective care as physicians scale back their hours."

It is interesting that physicians are calling for more nurse practitioners and physician assistants to help with their workload, as many at the same time decry "Obamacare."

For the most part, docs aren't fans of Obama or the Democrats. Yet the administration may be the driving force behind putting in place help to offset their workload. Under the Patient Protection and Affordable Care Act, $32 million is earmarked for developing more than 600 physician assistant positions, and another $30 million for 600 nurse practitioners, as well as 500 new primary care physicians by 2015.

Ironically, if doctors can't rely on their own hospital systems to initiate programs to help them deal with stress, they may find relief coming from Washington.

Doctors still control what may be their best options for addressing stress and burnout: 63% say they rely on exercise, and 59% say they spend time with family or friends.

I think one physician says it best in the survey: "We have to find a way to help docs recognize burnout. We didn't get through medical training by thinking how it affected us; we just put our heads down and muscled through," she writes. "You can do anything for eight years, but you can't live that way for 40 years. We need to encourage ourselves to develop an external barometer so someone can tell us we're burning out."