Author: Brenda Varriano
Guest Author: Jason M White
What is Burnout?
Most of us have experienced some component of Burnout in one shape or another. I know that I myself experienced burnout while preparing for my STEP 1 shelf exam. While I was able to hit my goal, I experienced immense fatigue and mental fogginess for weeks following. Fortunately, I recovered.
For those who are curious if they have experienced Burnout, the AAMC defines and measures it by three indicators: 1) emotional exhaustion associated with work-related stress, 2) feeling of detachment toward patients and 3) a low sense of personal accomplishment. Though I was not in my clinical rotations yet, my feeling of detachment resonated into my personal life and relationships.
Introducing Dr. Jason M White
Dr. Jason M White is an Emergency Medicine physician with over 30 years of clinical experience. He has almost a decade of experience at the C-suite level as a Chief Medical Officer (CMO). His administrative responsibilities have included Medical Student and Graduate Medical Education, Quality, Physician Relations, Trauma and Emergency Services. His expertise includes Wellness, Patient Safety, Coaching, Leadership Development, and Patient Experience. He is a board certified by the American Board of Emergency Medicine (ABEM) and the Commission of Medical Management. He is a Clinical Assistant Professor in the College of Medicine at Central Michigan University and has over 40 years of experience teaching medical students and residents. It is with great pleasure that I introduce Dr. White to the iEM community to discuss his experience with Burnout.
Q: What is your experience with Burnout?
The relationship between the specially of Emergency Medicine and Burnout goes back for almost half of the century. When I was in residency 40 years ago, Burnout was already a major topic of discussion. In fact, we used to joke that our residency program was so advanced that we graduated already “burned out” after just three years of training.
In addition, you must remember that early in the history of the specialty many practitioners of Emergency Medicine were itinerant Physicians or Physicians from other specialties since there were few accredited Emergency Medicine residency training programs until the late 1970s.
Therefore, much of the longevity and Burnout data at the time was skewed by the presence of Physicians who were transitioning either into or out of their medical careers. I remember seeing data at that time that said that the average emergency physician only practiced for 7 years.
Nonetheless it put the topic of Burnout on the radar screens of the specialty very early on and I believe for this reason became part of the foundation of the curriculum of our specialty and much discussion.
I don’t believe that I personally experienced Burnout during my clinical career. However, I saw many of my colleagues floundering in the specialty and experiencing Burnout. In many ways the emergency Physicians are the canaries in the coal mine. If our work environment is toxic and unhealthy, we may be among the first to demonstrate symptoms. Much of the emphasis around Burnout has been focused on the individual practitioner which is appropriate. However, it is an incomplete picture if we don’t also consider the practice environment as a significant component of the problem of Burnout.
Q: What are tactics to avoid Burnout?
I believe that there are several excellent tactics which have had success in helping practitioners to avoid Burnout. The basics are all about self-care. We all need to eat healthy, exercise and get an adequate amount of sleep. However, the specialty of Emergency Medicine, by its very nature, is in direct opposition to those fundamental aspects of self-care. The hectic, unpredictable pace of the emergency department makes it difficult to eat right or even at all sometimes. The varied nature of shiftwork and swinging shifts is the enemy of developing good sleep patterns and regular exercise practices.
These foundational factors make it even more important that we understand the factors that contribute to Burnout, the symptoms of Burnout and the ways of preventing, avoiding, and healing from Burnout.
Q: What makes a good Wellness program?
There are as many definitions of Wellness programs as there are Wellness programs. One of the challenges of starting Wellness programs is not everybody has the same definition. I can’t tell you how many times I would try to discuss developing Wellness programs with hospital administrators, and they would already have their own biases and oversimplifications of what successful programs work.
The conversations would quickly devolve into talks about having New Year’s resolution inspired weight-loss competitions and offering $25.00 gasoline gift cards as incentives. Or they would quickly default into discussions about yoga classes and barriers to participation and cost.
Unfortunately, much of the literature around the topic of Wellness has been done in industrial and manufacturing environments where employers may be self-insured and are interested in saving money on their Health Insurance costs by supporting stop-smoking programs or weight-loss programs.
So, the first step is to understand that Health Care providers need a different approach than the manufacturing community. In addition, much of the literature about Burnout in the healthcare environment is anecdotal. This is what we did, and this is how it worked. The bias is to report the elements and components of what are perceived as successful programs while never reporting failures.
In addition, the endpoints of success are highly subjective, challenging to reproduce, and often lack sustainability. For these reasons, we need both better design and better execution of the studies about Wellness and it must be focused on the Health Care community.
I believe that a good Wellness Program for Healthcare Providers should include the following elements at a minimum:
- Acknowledge that we are all at risk for Burnout.
- Educate ourselves about the symptoms of Burnout in ourselves and our colleagues. [see Stages of Burnout]
- Preform self-assessments on a regular basis (probably quarterly) to identify at risk areas in our personal lives. [see Gazelle, Wheel of Life]
- Educate ourselves on successful strategies to address our at-risk areas and tailor them to our unique situations. [see Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself]
- Develop a written plan for how we are going to address our at-risk areas.
- As leaders, educators, and administrators, we must make the “coal mine” as healthy as possible and create an environment of support and emotional safety. We can also provide resources and advisors to assist practitioners in their self-assessments and creation of their personal Wellness plans.
Q: This last question is for fun. I know the quote below is from your medical school interview. Does it still hold true?
Yes! Absolutely still true! However, I might modify it slightly and change it to: “Because I love medicine, I want to help people, and I want my life’s work to have meaning.
Thank you, Dr. White, for taking to time to share your experiences and research on EM Burnout and physician Wellness. I learnt a lot, and I believe, we are acknowledging what will be a shift in how medicine is practiced over the next few years.
References and Further Reading
- Rita A. Manfredi, MD, FACEP and Julia M. Huber, MD, FACEP (Editors). Being Well in Emergency Medicine: ACEP’s Guide to Investing in Yourself https://www.acep.org/globalassets/sites/acep/media/wellness/acepwellnessguide.pdf
- Gazelle, G., Liebschutz, J.M., & Reiss, H. Journal of General Internal Medicine (2015) 30:508. https://doi.org/10.1007/s11606-014-3144-y
- Stanford University WellMDhttps://wellmd.stanford.edu/
- Tait D. Shanafelt, MD, and John H. Noseworthy, MD, CEO. Nine Organizational Strategies to Promote Engagement and Reduce Burnout Mayo Clin Proc. 2017;92(1):129-146 https://www.mayoclinicproceedings.org/article/S0025-6196(16)30625-5/pdf
- Kaplan, J. “All Stressed Out”. BalancED, American College of Emergency Physicians, February 2019 https://www.acep.org/globalassets/sites/bed/bed-documents/presentations-2019/we-18-kaplan_all-stressed-out_preventing-burnout-02_2019.pdf