Physician Burnout — and Resilience

Physician Resiliency and Wellness for Transforming a Health System

Article · May 2, 2018

Since it was launched in 2013 at Novant Health, a unique physician resiliency program has had a positive impact on physician engagement and alignment, helping them to better understand their thoughts, feelings, behaviors, and fundamental commitments to medicine. To date, more than 800 physicians — or approximately half of our employed doctors — have participated in the voluntary resiliency program. In addition to a wealth of anecdotal feedback from participants, data reveal an increase in physician engagement of more than 40 centiles to the 97th percentile, according to Press Ganey. Similar improvements are occurring in nearly every aspect of an internal organization-wide engagement assessment about the physician experience.

Physicians Are Not Invincible

Physicians throughout the nation are faced with the challenge of delivering high-quality care that is increasingly patient-centered, while also keeping pace with the rapid shifts in the economy, technology, and regulatory areas. Changing reimbursement models, market consolidation, new competition (e.g., urgent care, walk-in clinics, and open/online scheduling) and a rise in consumer preference are creating new sources of pressure on physicians and their well-being. Physicians are often physically and emotionally exhausted, which threatens their overall performance and effectiveness.

Novant Health Leadership Development Program Physician Engagement

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This phenomenon, labeled physician burnout, is a growing epidemic that poses serious consequences to hospitals, health systems, and the larger medical enterprise. Moreover, burnout will exacerbate the challenges associated with inadequate physician supply, which is projected to get worse; by 2025, demand for doctors will exceed supply by as many as 61,700 to 94,700 (25th percentile to 75th percentile) — roughly doubling the projected 2018 gap between supply and demand, according to the Association of American Medical Colleges.

It is well documented that physicians have a higher rate of depressive symptoms and suicide than the general population. According to the National Academy of Medicine, an estimated 400 U.S. physicians take their lives every year. We, too, have lost colleagues to suicide, and we have seen others walk away from their profession due to dissatisfaction, omnipresent stressors, or full-blown burnout.

Perhaps because of the stigma associated with depression among medical professionals, many doctors do not talk about the toll their demanding job is taking on their health, their relationships, and their career. As health care leaders, we need to take steps to address the problem, and provide a “safe place” for the conversation to happen.

Changing the Conversation

In recent years, it became evident that the increasing demand for doctors, combined with rising rates of physician burnout, threatened our organization’s ability to consistently deliver quality care and maintain a healthy physician workforce. Recognizing this complex threat, we organized a systematic effort to address physician burnout.

We started by partnering with executive coach Nicholas Beamon, now of OneTeam Leadership, to create a resiliency, wellness, and leadership program, the Novant Health Leadership Development Program. This initiative — which includes a multiday wellness retreat, one-on-one coaching and mentoring program, and single-session intimate conversations — is designed to help our physicians rediscover their core as a basis for developing stronger leadership skills, effectively engage with their peers and patients, and help them achieve better work-life balance.

The premise is rather simple: lead the self, lead the team, and lead the organization. While the work requires deep reflection and a strong commitment to the process, it has increased physician collaboration and created an environment that encourages new ideas and innovation.

The Novant Health Leadership Development Program includes nine critical elements:

  1. Learn how to operate from a deeper personal understanding of purpose.
  2. Develop a keen sense of personal awareness and understanding of how nonconscious patterns of bias, behaviors, and thinking contribute to burnout.
  3. Focus on creating an “attraction to wellness” rather than a solution for burnout.
  4. Develop a new mind-set, new habits, and a commitment to living like “health care athletes,” which includes the concepts of work, rest, recovery, and rejuvenation.
  5. Focus on training to be fully present and aware, or operating from one’s personal core.
  6. Develop a deep understanding of “influential leadership” as a critical skill and learned ability.
  7. Become a more effective person, through intentional daily living.
  8. Redefine the medical group culture by establishing a strong community of physician support, communication, and camaraderie.
  9. Mobilize past participants as champions to address organizational forces that drive burnout, impacting the electronic medical record (EMR), team-based care, mentoring, and even reimbursement models.

Transforming Health Care

As more and more providers participate in the program, word has spread of its personal and professional benefits. Many physicians have reached out directly to Novant Health leaders to express a desire to participate, while others have been referred to the program by a concerned colleague.

Currently, there is waiting list of providers who are willing to give up a weekend — or block out a full day of appointments — to attend either the 3-day retreat or the condensed 1-day version held at an off-site local location. Since its inception, Novant Health has invested more than $2 million to develop, implement, and promote the resiliency program throughout the system for physicians, nurses, and administrative leaders.

  Click To Enlarge.

Among the results from these investments:

  • Our research shows that those who participated in the resiliency program scored higher than nonparticipants — sometimes more than 50% higher — on several key measures, including personal fulfillment, alignment with the health system’s mission, and positive attitudes toward the organization. Further, over the past few years, we have seen nonparticipant scores rise as well — reaching the 90th percentile in some measures — which we attribute in part to a ripple effect of the resiliency program.
  • According to scores from Press Ganey, a provider of patient experience solutions, Novant Health Medical Group participants rank in the 97th percentile in both engagement and alignment with the organization. Prior to the program, engagement scores had been in the 60th percentile.
  • Novant Health’s medical group, as a whole, now ranks in the 90th percentile nationally in physician engagement.
  • Several initiatives have been launched as a result of dialogue that took place during the program. For example, participants have become champions of critical programs and processes. We have developed an EMR optimization team that proactively supports our physicians and enhances their ability to utilize the tool and save them time. Additionally, a yearlong on-boarding program has been launched for all new physicians; the program incorporates wellness, resiliency, and empathic communication skills. Both these services are led by graduates of the Leadership Development Program.

Beyond the metrics, we have received dozens of anecdotal notes of appreciation from medical staff who say the resiliency program has reignited their passion for medicine; made a positive difference in their health and well-being; improved relationships with patients, staff, friends, and family; and even saved marriages. Here are just a few of highlights:

Anecdotal Notes from Medical Staff

“The program made me realize that I wasn’t truly getting to know my patients. I was also not mentally available to my wife and children, even if I was physically present with them. Today, my patient satisfaction has improved and even the mood in the office has become less stressful. I’ve regained my love of seeing patients.”

“The downstream impact of a program — one that focuses on enhancing the lives and relationships of a truly suffering physician population — is immeasurable, especially when you consider the gravity of the decisions we make on a daily basis and the consequences that those decisions have for our patients.”

“My life changed significantly since participating in the physician wellness program. Like many, I was frustrated and overwhelmed, both personally and professionally. By sharing experiences in a nonjudgmental and supportive atmosphere, I was able to gain insight, rejuvenate, and begin to improve my future. Because of this program’s tools and guidance, I have learned how to take control of my happiness and I have a much brighter outlook overall.”

Implementation Tips

For hospital and health system leaders considering developing their own physician resiliency and wellness programs, we suggest you consider the following:

  • Who on your staff will “own” the program? Can you assign this to one individual? At Novant Health, our program is facilitated by our chief human experience officer with support from leadership within our employed medical group.
  • What is the right amount to budget for this type of program for your organization? Novant Health has budgeted approximately $3,500 per physician participant. For other health care providers, such as nurses, the health system has budgeted approximately $400 per participant. We are accredited for 36 hours of Category 1 AMA CME for physicians, and 9 hours of CNU for nurses.
  • What metrics will you use to assess the financial and nonfinancial return on investment? For example, at Novant Health we are looking at the impact of the resiliency and wellness program on recruitment and retention. We have seen a 300% growth in our employed medical group since program inceptions. Replacing a physician can cost an organization two to three times the annual salary of a physician who left, according to a December 2017 report in JAMA. Therefore, retention is of paramount importance to us. Also, our program has impacted the patient experience positively, which is reflected in many reimbursement models.

A Leadership Imperative

As health care systems across the country face unprecedented change and a variety of challenges that are turning business-as-usual practices on their head, physician burnout is an issue that cannot be ignored. Acknowledging that numerous external forces are real — and clinical and executive leaders are not just imaging that their work is getting more challenging — must be an important part of the conversation. While we can encourage physicians to confront and control external forces as much as possible, the focus must be on what they can impact the most, which is their “internal condition.”

At Novant Health, we have learned that an intentional and deliberate focus on physician wellness is critical to operating a high-performing and change-ready health care organization. And we have learned that is the responsibility of the executive leadership team to encourage and enable staff to engage in their own wellness and resiliency. We need to demonstrate that it is possible — and OK — to behave differently in our personal and professional lives by:

  • Slowing down, pressing pause, and being present. Being “all in” for the moments of life — not just for work.
  • Recharging and maintaining our batteries by building in intentional time to recover and rejuvenate.
  • Acknowledging that improving oneself is the access point to improving our life and the lives of those around us.
  • Being realistic about expectations for ourselves and others — you cannot help everyone. Start by being kind to yourself.

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