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Physician Burnout: Call to action INDIVIDUAL PHYSICIANS ARTICLE 3 OF 3
This is the third of three articles on physician burnout. Burnout is a syndrome of emotional exhaustion, depersonalization, cynicism, detachment, and sense of low personal accomplishment.1 Approximately 50 percent of physicians and medical students were experiencing burnout prior to the COVID pandemic. 2,3 Burnout is an individual response to a systemic problem and interventions focusing solely on individual physician resilience are inadequate and miss the national, organizational and practice environment contributors to physician burnout. Organizational and practice environment interventions were the focus of the second article. This article summarizes recommendations and resources for physicians and medical students to promote health and wellbeing and to reduce burnout.
Jeremy Lazarus, MD Past President, American Medical Association
EDUCATION AND AWARENESS Increasing awareness about physician distress and burnout is the first step. In 2015, the American Medical A s sociat ion ( A M A ) launched A M A Steps Forward, an online resource to help physicians learn about wellbeing, burnout, and resilience (https:// edhub.ama-assn.org/steps-forward/ pages/professional-well-being). Many physician organizations such as the American Academy of Family Physicians (AAFP), American College of Emergency Physicians (ACEP), American College of Physicians (ACP), American College of Surgeons (ACS), and the American Psychiatric Association (APA) have online information, resources, and continuing medical education programs (CME). How burned out am I? The National Academy of Medicine (NAM) website has links to several valid and reliable survey instruments (https://nam.edu/ valid-reliable -sur vey-instrumentsmeasure-burnout-well-work-relateddimensions/).4 Measure your well-being and burnout by completing the Oldenburg Burnout Inventory and the PHQ-9 (https:// www.apa.org/depression-guideline/ patient-health-questionnaire.pdf), both available without charge.
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Alexander von Hafften, MD Physician Health Committee, Alaska State Medical Association
WHAT IS RESILIENCE AND HOW TO ENHANCE RESILIENCE Myers defines resilience as the ability to confront adversity and still find hope and meaning in life.5 Tregoning defines resilience as the ability to bounce back or recover from stress.6 There are skills and mindset s that improve resilience. Psychological interventions such as Mindfulness-Based Stress Reduction (MBSR) and Cognitive Behavior Therapy (CBT) calm our mind and decrease negative rumination. These interventions improve wellbeing and resilience by reducing distress, anxiety, and depression. It is unclear if MBSR and CBT reduce burnout directly. This is understandable since national, organizational, and practice environment factors are primary contributors to physician burnout.
PEER SUPPORT Distress and burnout lead to isolation and isolation is more likely when accompanied by anxiety, depression, substance use, and thoughts about suicide. Isolation reinforces psychological distress. Preventing and overcoming the tendency to isolate are impor tant . Develop and foster
supportive relationships with colleagues at work and away from work. Colleagues, mentors, and physician coaches may help by recommending ways to manage workplace stress and communication. Meet with a group of colleagues to discuss the interpersonal aspects of clinical care. Balint training and Balint group participation lower rates of burnout in some physicians and residents. Form a group or participate in an online Balint group through the American Balint Society (https://www.americanbalintsociety. org/content.aspx?page_id=22&club_ id=445043&module_id=406070).7 Meet with a peer- coach. Physician coaching is a peer-to-peer/coach-to-client interaction; not a physician-patient clinical interaction. There is no medical evaluation, diagnosis, or treatment. Corinna Muller wrote an article for Alaska State Medical Association’s Heartbeat newsletter in December 2020 summarizing the positive evidence for physicians coaching physicians.8
SELF-CARE We have to care for ourselves to be able to care for others. Examples of self-care include nurturing our spiritual connections, investing in intimate relationships, seeing the good in others, extending
