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Reversing physician burnout requires total change in the culture of medicine

'Do or die' mentality takes hold early, steers many doctors down the road to burnout and self-destruction, experts say.

Beth Jones Sanborn, Managing Editor

Retired physician Dike Drummond now coaches doctors experiencing burnout and teetering on the edge of quitting medicine.Retired physician Dike Drummond now coaches doctors experiencing burnout and teetering on the edge of quitting medicine.

Retired physician Dike Drummond burned out after a 10-years stretch of practicing family medicine that included more than 35,000 patient visits and the traumatic loss of an infant patient. Eventually, he just hit a wall.

"I got to a point where, over about three weeks in my practice, when I would go in it felt like somebody was putting me in chokehold. I took a month off hoping it would go away thinking my battery was just run down. My first day back it was like something had snapped. It was over. I had nothing."

His story is not uncommon. Whether it is the rigors of the job or outside issues that compound an already stressful profession, physician burnout is a real threat to access to care. And as regulations multiply and complicate the medical workload, more and more doctors are looking at cutting hours or retiring altogether.

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[Also: EHRs eating up half of doctors' workday with unpaid labor]

But instead of stepping completely out of the profession, Drummond created a new "practice," coaching doctors who are experiencing burnout and teetering on the edge of quitting medicine. Or worse.

"All my patients are doctors at this point," Drummond said. Through his business,, he has now clocked in over 2,000 hours coaching doctors and has trained five other physicians as coaches.

[Also: Physicians besieged by 'burnout,' pessimistic view of profession, Physicians Foundation study says]

Drummond cited a Mayo study that reported 54.5 percent of physicians were at some stage of burnout. The common story he said he hears is a gradual overwhelming of the doctor that often includes the loss of connection to their original mission. But everyone's story is different in some way. Life issues can either cause burnout, or compound it. A badly traumatic event can be enough for some as well. 

Catherine Miller, senior risk management and patient safety specialist at the Cooperative of American Physicians, and CAP Assurance, agreed that the field of medicine is not exactly known for fostering a great work/life balance. The ever changing regulatory landscape hasn't helped either. Bureaucratic tasks, reporting burdens, too many work hours and increased computerization of medicine, namely EHRs, have converged with the clinical and personal stresses doctors already face.

The symptoms of burnout, not surprisingly, include exhaustion. Others include cynicism, sarcasm and needing to vent as well as questioning whether there is any real purpose to your work and fearfulness of errors if something in their life doesn't change.

"Energy levels plummet and rest doesn't help them recover. It's just a break in the downward spiral," Drummond said.

A heavy toll on doctors

For the doctor experiencing these issues, the personal price paid is high enough. Drummond said burnout can lead to increased depression, substance abuse, divorce and suicide. 

Beyond that, it can affect the entire organization too. Miller said burnout can manifest as decreased productivity, antisocial behavior that impacts staff, declining patient satisfaction scores that are tied to revenue, and attrition. She said research correlates burnout with sub-par clinical performance and increased error rates as well.

"When you look at an adverse event and conduct root cause analysis, often you will find a situation where productivity overrides safety or you'll have a burnt-out physician."

[Also: Bulk of doctors say healthcare is failing to stem physician burnout, survey says]

They become high maintenance employees who drain time away from hospital or practice leadership instead of focusing on duties like optimizing workflows, developing new lines of business, recruiting doctors and anything proactive, Drummond said.

Even though both Miller and Drummond said the effects of burnout can be hard to quantify, one area where the ramifications are clear is turnover. 

From the cost of bringing candidates to town, money spent on recruiting new hires and resources spent bringing a new doctor up to speed, Drummond said when you factor in loss of productivity as well, the cost of turning over single doctor position could be $500,000 to a $1 million depending on their specialty and paygrade. He's seen organizations that turned over 25 percent their of doctors.

Culture clash in medical profession

Before you can stop, or prevent burnout, you have to know where it starts. Miller and Drummond agree its roots go as deep, even back to medical school. The standard for overworking oneself is set here, and there is little to no instruction on stress management or tactics to prevent burnout. Educating on the "never stop, never show weakness" invisible programming prevalent in medical profession could drive doctors early on to develop their own strategy for wellness and colleague support. But that is not what goes on today. And the absence of this education bodes terribly for doctors down the line.

"Education is always the first step. It's like trying to get someone to play baseball when they don't understand gravity. It's this basic thing that's missing," Drummond said.

Miller recounted a news report she'd heard about a female physician who delivered her child one night, then showed up for her shift the next day. That type of overwork is exactly what leads to doctors who act out, who other staff refuse or dread working with, and who make mistakes, Miller said.

Addressing the "do or die" mentality and creating a culture of awareness and mutual support are key. That means encouraging personal burnout prevention strategies, as well as an overreaching one for the organization that seeks input from the doctors themselves.

"Unless you're doing something to prevent and detect burnout, half your folks are frying right now," Drummond said.

Twitter: @BethJSanborn