Focusing on Wellness During Residency Can Ward Off Burnout Later

Patients, pages, paperwork, painful processes, and payments. These are all common challenges faced daily that can cause burnout.

Rates of physician burnout are higher than that of the general population, and the onset of that mental wear and tear typically occurs during residency, according to Jodie Eckleberry-Hunt, PhD, associate director of behavioral medicine in the family medicine residency program at Beaumont Hospital in Sterling Heights, MI, and lead author of An Exploratory Study of Resident Burnout and Wellness.

Implications for burnout include a poorer quality of patient care. Research shows burned-out residents make more medical errors and are more susceptible to drug or alcohol abuse and depression.

Just as burnout takes root during residency, so can healthy behaviors. “It is time for programs to begin preventatively promoting wellness and not just looking for burnout. I think we miss too many opportunities if we just look for what is wrong versus encouraging what is right,” Eckleberry-Hunt says.

Program leaders and faculty need to proactively address burnout by looking at its causes and doing something about the factors they can influence. Eckleberry-Hunt's study asked residents to identify stressors associated with burnout and factors associated with wellness. Of 32 burnout factors, the 12 stressors that correlate the highest with burnout include:

• Pessimism
• Lack of coping skills for stress
• Desire to be perfect
• Personal bad habits (e.g. alcohol or recreational drug use)
• Little control over schedules
• Lack of control over office processes
• Poor relationships with colleagues
• Lack of time for self care
• Difficult and complicated patients
• Not enough time in the day
• Excessive paperwork
• Regret over chosen career

Some of the factors associated with wellness include:

• Use of a support group for physicians
• Talking about feelings
• Feeling like one has a say in the training program and control over one's schedule
• Having a plan for the future
• Having a supportive work environment
• Feeling connected and compassionate toward patients

A message centered on physician well-being needs to come from the top of the organization, culminating in an institution-wide culture of well-being. Plant the seed for this change by creating a hospital-wide definition of wellness that fits with your institution's current culture. Remind physicians that they must be aware of their wellness.

Social support is a critical aspect of this process. Encourage the creation of a physician-only support groups lead by a psychologist on staff, Eckleberry-Hunt suggests. In her residency program, they have a group dedicated to helping physicians remember why they got involved in medicine, during which participants recount their experiences in the field. Foster a supportive environment by creating a graduate medical education-specific wellness program that is dedicated to educating residents on the topic and helping trainees who become burnt out.

Additionally, measure and monitor burnout. There are several burnout inventories available that can help residents or faculty members determine whether they're reaching the edge. Encourage trainees or attending physicians whose surveys suggest they may be burnt out to seek help.

By making wellness a priority, you create a better work environment for all, and ultimately, improve the patient's experience.