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Physician Renewal From Burnout to Bonfire PowerPoint Presentation
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Physician Renewal From Burnout to Bonfire

Physician Renewal From Burnout to Bonfire

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Physician Renewal From Burnout to Bonfire

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  1. Physician Renewal From Burnout to Bonfire Marc Borenstein, MD, FACEP Professor and Chair Department of Emergency Medicine University of Missouri School of Medicine

  2. Put Something Big at Stake • Ways you could be listening to this presentation • Interesting/not interesting • I already know this/I don’t know this • What really matters to me in my life now

  3. Definition of Physician Burnout • Emotional exhaustion • Depersonalization • Low personal accomplishment: loss of drive for and sense of satisfaction from work

  4. Definition of Physician Burnout • Differs from depression in that burnout primarily affects an individual’s relationship to their work • Deterioration of values, spirit, dignity, and will • “Silent anguish of the healers”

  5. Epidemiology of Burnout • Early concerns for disproportionate levels of career dissatisfaction • Shiftwork • Work intensity • Lack of respect from medical colleagues

  6. Epidemiology of Burnout • Early concerns for disproportionate levels of career dissatisfaction • Lack of career self-determination • Hourly worker, low compensation • Absence of long-term career growth

  7. Epidemiology of Burnout • ABEM longitudinal study • Response rate 94% (94), 84% (99), 76% (04) • 77-80% EM met or exceeded expectations for career satisfaction • 32% experienced burnout Cydulka RK Korte R Ann Emerg Med 2008 51(6):714-22

  8. Epidemiology of Burnout • ACEP Scientific Assembly attendees • 60% moderate to high burnout • Attrition 7.5% at 5 years and 25% at 10 years • Similar attrition rates in other specialties Goldberg R Boss RW et al AcadEmerg Med 1996 3(12):1156-64

  9. Epidemiology of Burnout • ACEP member survey • 43% response rate • 32% experienced at least one component of burnout • Emotional exhaustion most often • Anxiety/concern for bad outcomes Kuhn G Goldberg R Ann Emerg Med 2009 54:106-13

  10. Epidemiology of Burnout • Mayo Clinic commentary • 30 - 40% of physicians experience burnout • ↑Error, ↓empathy, ↑attrition, • Excessive workloads may increase further Dyrbye LN Shanfeldt TD JAMA 2011 305(19):2009-10

  11. Risk Factors for Burnout • Physician personality traits • Obsessive - compulsive • Striving talents, pursuit of excellence • Empathetic • Repress emotions

  12. Risk Factors for Burnout • ↑Paperwork • ↓Financial reimbursements • ↓Ancillary support • ↓Resources to get non-clinical job(s) done

  13. Risk Factors for Burnout • ↑Malpractice litigation • ↑Compliance and accreditation regulations • ↑ED crowding/inadequate space • Feeling of lack of support for EM and/or the ED from colleagues and/or one’s institution

  14. Risk Factors for Burnout • ↑Debt for residents and attendings • Difficult patients and absence of pre-existing patient/family relationships

  15. Identifying Signs/Symptoms of Burnout • Cynicism, resignation • Anger • Isolation • Apathy, feeling numb or emotionless

  16. Identifying Signs/Symptoms of Burnout • Work no longer enjoyable or fun • No sense of humor or lightness • Increasingly feeling no energy, tired • Increased or new physical symptoms

  17. Identifying Signs/Symptoms of Burnout • Negative attitudes towards self, others, patients • New pattern of lateness, not completing work • Difficulty focusing at work

  18. Identifying Signs/Symptoms of Burnout • Self-medication • New day, same s**t • Same day, same s**t • Same old, same old

  19. Consequences of Burnout • Medical error • Depression • Substance and/or ETOH abuse/addiction

  20. Consequences of Burnout • Partner/relationship discord • Boundary violations • Disruptive behavior

  21. Consequences of Burnout • Physician loss from the workplace • Diminished ED team effectiveness/productivity • Loss of nursing and/or mid-level provider staff

  22. From Burnout to Bonfire • Recognition • Work/career modification • Personal life changes

  23. Burnout Can be Insidious • You’re accomplishing your work and getting things done

  24. Burnout Can be Insidious • Signs/symptoms • Feeling bored, tired • Not having much fun at work • Same old, same old

  25. Burnout Can be Insidious • The job is not a match for who you are, your commitments, and what you can contribute • Is what you’re saying and doing in alignment with your commitments and values in life? • If no in part or all, you’re at risk for burnout

  26. From Burnout to Bonfire • Solutions • Reclaim your childhood vision/mission • Invent a new vision/mission • Take on a bigger game • Consider taking a (careful) risk

  27. From Burnout to Bonfire The important thing is this: to be able at any moment to sacrifice what we are for what we could become Charles Dubois

  28. Identifying Burnout • You’re working on a big, exciting project but have insufficient time to get the job done and have a life outside work

  29. Identifying Burnout • You’re working on a big, exciting project but have insufficient time to get the job done without a life outside work

  30. Identifying Burnout • If the time you spend trying to do it all is taken at the expense of your personal and family life • If yes in part or all, you’re at risk for burnout

  31. Identifying Burnout • Symptoms • Feeling angry • I’m working harder than they are • No one around here cares as much as I do

  32. Identifying Burnout • Symptoms • Tired/sleep deprived, working late at home • Stress with spouse, partner, family • I need a time management class

  33. Self-monitoring • Trying to do it all yourself • May be compensation for a failure to provide leadership • Reliance on skills you already have • Staying within your comfort zone

  34. Self-monitoring • There is insufficient time for you to get everything done • All great projects require a team • Many great projects are not accomplished in a single lifetime

  35. From Burnout to Bonfire • Solutions • Start from where you are • Invent a vision and a bold statement

  36. From Burnout to Bonfire • Solutions • Live your vision for the future in the present • Communicate it……Everywhere! • Be a leader for your life and yourself

  37. From Burnout to Bonfire • Solutions • Get a coach • Build a team

  38. What is Vision? • Future based • Seeing the possibility for something to emerge • Not predicted by past performance or history

  39. What is Vision? • Not defined or determined by circumstances • Invented, created • Exists in language

  40. I’ll Believe It When I See It • What you already know about yourself, the world, and your past is in the way of seeing what’s present and discovering anything new

  41. I’ll Believe It When I See It • The real voyage of discovery consists not in seeking new landscapes but in having new eyes Marcel Proust

  42. Be a Leader for Your Life • Being and living your vision and commitment in the present • Having your actions, behaviors, and communication informed by your vision and commitment

  43. Be a Leader for Your Life • Creating, communicating, and sustaining purposeful context consistent with your vision and your commitment

  44. Why Be a Leader for Your Life? • You have a powerful commitment • Your voice and contribution matter

  45. Why Be a Leader for Your Life? • Leadership galvanizes a team to accomplish a job beyond what can be achieved by the individual • Leadership creates the leverage needed to move the world

  46. The Power of Leverage • 1 EM physician provides care to 3000 pts/yr • Graduate 10 EM residents/yr = 30,000 pts • 30 year career/graduate = 900,000 pts • 10 year RPD career = 9,000,000 pts

  47. The Power of Leverage Never doubt that a small, group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has Margaret Mead

  48. The Bonfire Challenge • Discipline to articulate and sustain a vision and sense of purpose • New and/or expanded non-intellectual skills and responsibility

  49. The Bonfire Challenge • Effective and disciplined communication • Ownership of outcomes and the experience of others • Creative v. descriptive language

  50. From Burnout to Bonfire • 1: Willingness to take ownership • 2: Creating the future through language • 3: Prioritizing choices and taking action • 4: Thinking from abundance