Physician Renewal From Burnout to Bonfire

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