by Madeline Eckenrode, MD, and Karla Williams, MD

Burnout among physicians is a topic that is increasingly in the headlines. A recent article in The New York Times cited several studies linking physician burnout to poor patient outcomes. In April 2017, the Society of General Internal Medicine held their meeting in Washington. The theme of the meeting? “Resilience and Grit: Pursuing Organizational Change and Preventing Burnout in GIM.” In keeping with the growing cultural interest in physician wellness, the Department of Medicine held a grand rounds in September on the topic. UAB hosted Dr. Tait Shanafelt, a nationally known expert in the field, who joined the Stanford University faculty as the very first physician wellness officer in September 2017. The title of his talk was “Finding Meaning, Balance, and Personal Satisfaction in the Practice of Medicine.”

Much of the research on physician wellness is by Shanafelt himself, which was evident during his presentation. He highlighted the factors that contribute to physician burnout including paperwork/administrative tasks, poor leadership, and lacking a sense of purpose. Physicians who feel burnt out are much more likely to commit medical errors, even when compared to those who have been sleep-deprived. A central point of his talk was that it should not be incumbent on physicians alone to prevent and combat burnout with tactics such as meditation and exercise. Although self-care is an excellent practice, he argued that there must be systemic support for physicians. Helping physicians feel empowered by having responsive leaders, creating a collegial work environment, and decreasing the work burdens unrelated to direct patient care are all organizational ways to help get at the underlying causes of burnout.

At Mayo, where Shanafelt previously served as faculty and Director of Medicine Program on Physician Well-Being, an innovative approach to reduce burnout was sponsorship of small group dinners.  At these (free) dinners participants were able to share stories, commiserate, and build a sense of camaraderie and meaning. That sense – of being part of a larger group of people doing meaningful work – is critical to prevent feelings of burnout. When the dinner attendees were surveyed after the intervention, they reported increased job satisfaction and scored lower on burnout indices.

The UAB Department of Medicine is aware of the reality of physician burnout within our institution and the fact that it starts during residency for many.  Burnout is a syndrome that manifests as a spectrum of symptoms including feelings of fatigue and depersonalization that can progress to depression and suicidal ideation.  The syndrome will be experienced by every physician at some point during their career, a period of time that has the potential to rob us of the joys of our calling and prevent us from being able to provide the highest quality of care to our patients.  Within the internal medicine residency program, we surveyed our residents to determine the impact of burnout.  We found that over 30% of respondents (1/3 of the total residency) were experiencing at least one symptom of burnout by the end of the 2016-2017 academic year.

In an effort to counter burnout and continue our efforts to foster wellness and fulfillment within the internal medicine residency program, the Residency Wellness Committee designed and implemented Wellness Panel lunch sessions.  The objectives of each session included identifying the symptoms and signs of burnout, normalizing the experience, fostering a sense of community, and providing information on resources available within our program and institution.  During each session residents were provided the opportunity to hear the stories and advice from their peers who were one PGY level above them in rank.  All of the sessions were well-received by residents with a common thread being the sentiment of relief that comes with the opportunity to share their stories and knowing they are not alone in these experiences. 

The Internal Medicine Residency Program hopes to continue to highlight the importance of cultivating an environment where physician wellness and fulfillment are valued.  We will continue to achieve this goal through both educational curriculum and efforts spearheaded by the Wellness Committee.  In the end, the patients benefit greatly when their physicians are fulfilled and find a sense of purpose in their work.