"Doctor Burnout" -- WSJ article

[RogueDadMD]

My blog has gone dark for a few weeks and I've been absent from this forum for awhile because of an "Epic" workload.

Came across this today:

https://www.wsj.com/articles/hospitals-address-widespread-doctor-burnout-1528542121?mod=hp_lista_pos1

Frankly nothing new for anyone whose read even a little on this topic.  It just has me thinking,

This last month I've essentially been overwhelmed with my work obligations in a way that I've never been before: travel to 2 conferences for 3 presentations, research grant due to a federal agency, working on a zillion things related to our new EHR, on top of the "regular" workload, and of course regular family obligations (including a vacation that was enjoyable but still almost felt like it was keeping me from work)

We're a few weeks into Ramadan, so trying to manage all this while attempting to fast hasn't helped.

Some of the past month has been quite enjoyable -- I enjoy presenting at conferences and meeting professional colleagues and sometimes even enjoy the traveling.  But the overall combined toll has been exhausting.

Our division is going to be critically short staffed for awhile due to a confluence of circumstances, so I'm facing double the # of night shifts next month (and probably for a few months), with no break in regular responsibilities (and of course the pressure to pick up more of the open shifts).

I don't have any conclusions here -- everything goes in cycles.  I know some people that can sustain this indefinitely, but for regular folks like me, this will lead to "burnout" quickly.  I certainly don't think I'm paid enough to be motivated to sustain this.  The flip side -- what level of pay does make it ok?  If I get a 25% raise will I feel stuck actually trying to maintain this?  Or should that just accelerate my ability to escape it?

I know this crowd decently well so I think I know what people will say, but responses are welcome. 

[Hatton]

In today's WSJ on the front page is this article on widespread physician burnout. If you cannot get through the paywall basically several University Hospitals are appointing Chief wellness officers.  They are addressing the problem of having to complete notes in the EMR from home.  They are putting back in Physician lounges because suddenly they are realizing that camaraderie is important. Thoughts?

[jfoxcpacfp]

I was able to get past the paywall with this trick from @strider_91

[q-school]

how do they address the problem of having to complete notes from home?

they are paying other people to do it?

they can put the lounges back but if they don't create time for people to be there, i'm not sure how effective it will be.

i'm curious to see true successes, not a plan that free bagels will solve things.  call your employee assistance program if you think one of your colleagues is under stress. etc etc

 

[VagabondMD]

q-school wrote:

how do they address the problem of having to complete notes from home?

they are paying other people to do it?

they can put the lounges back but if they don’t create time for people to be there, i’m not sure how effective it will be.

i’m curious to see true successes, not free bagels will hopefully solve things.  call your employee assistance program if you think one of your colleagues is under stress. etc etc

 

Click to expand...

I think that they are first doing the easy, cosmetic things to show their engagement on the issue, checking the box, so to speak. The pendulum continues to swing toward physician burnout being an increasingly significant problem, and they need to demonstrate to their Boards that they are doing something about it. Check!

[Lithium]

Physician lounges are not a safe space from hospital administrators, at least where I work.  This is why the bachelors are usually the ones who host poker night.

[hightower]

jfoxcpacfp wrote:

I was able to get past the paywall with this trick from @strider_91

Click to expand...

That's a really nifty trick BTW.  Thanks again to strider 91

[hightower]

hatton1 wrote:

In today’s WSJ on the front page is this article on widespread physician burnout. If you cannot get through the paywall basically several University Hospitals are appointing Chief wellness officers.  They are addressing the problem of having to complete notes in the EMR from home.  They are putting back in Physician lounges because suddenly they are realizing that camaraderie is important. Thoughts?

Click to expand...

The hospital system I work for has started to pay attention to this as well.  They have had several years of poor physician satisfaction survey results and are trying to find ways to combat the burnout they're seeing.

I'm not sure what the solution is, but I think borrowing some ideas from the silicon valley corporate world wouldn't be a bad idea.  Our work place needs to have some fun and relaxation built in if we're going to be spending so much time there.  I'm not expecting things to go to the extreme of google's offices, but perhaps installing some pinball machines or nap pods in the lounges wouldn't be such a bad idea?

Outside of that, for the hospitalist world, one major area of concern at certain hospitals I've worked at, is reducing the number of phone calls from nurses.  Getting paged and interrupted every 5 minutes or more for 8-12 hours a day is a form of medieval torture in my opinion.  That has to change and that requires a bit of nursing re-education/training.  Learning what is important and not important to call us for.  For instance, a potassium of 3.1-3.4 can wait until we make our rounds.  Or a "critical result" of a platelet count that was low the day before, but actually went up today, doesn't need to be called again.  It's easy stuff, but hospitals have to take these concerns seriously and actually do something about it.

[VagabondMD]

hatton1 wrote:

In today’s WSJ on the front page is this article on widespread physician burnout. If you cannot get through the paywall basically several University Hospitals are appointing Chief wellness officers.  They are addressing the problem of having to complete notes in the EMR from home.  They are putting back in Physician lounges because suddenly they are realizing that camaraderie is important. Thoughts?

Click to expand...

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. While it still exists, it is not nearly as vibrant. For one thing, the food has deteriorated significantly; if I did not know better, I would think that they are trying to kills us.

It is not unusual to see an Administrator in the loung, chatting it up or holding court. Our old CEO, largely loved by docs, would hang out in the lounge, have lunch with friends, and used it, in small amounts, to be accessible. The new CEO occasionally has lunch in the lounge, too, but has a reputation as being doc-unfriendly, so he appears to be intimidating.

As @q-school points out, if no one has time to hang out in the lounge, how can it be of value? In our Hospital, it is situated adjacent to the OR, close to Radiology, ED, Heart station, and GI Lab, so it is in a hub of activity. Realistically, the people most frequently found in the lounge are surgeons in between cases and a gaggle of CRNAs. Primary care docs and medical specialists live further away on the campus, rarely come to the Hospital itself,  and have no time for such nonsense. (This was not always the case.)

[Complete_newbie]

Its probably epidemic.

Anthony Bourdain.

Wonder if all of us are on some scale of burnout.

[Panscan]

Vagabond MD wrote:

hatton1 wrote:

In today’s WSJ on the front page is this article on widespread physician burnout. If you cannot get through the paywall basically several University Hospitals are appointing Chief wellness officers.  They are addressing the problem of having to complete notes in the EMR from home.  They are putting back in Physician lounges because suddenly they are realizing that camaraderie is important. Thoughts?

Click to expand…

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. While it still exists, it is not nearly as vibrant. For one thing, the food has deteriorated significantly; if I did not know better, I would think that they are trying to kills us.

It is not unusual to see an Administrator in the loung, chatting it up or holding court. Our old CEO, largely loved by docs, would hang out in the lounge, have lunch with friends, and used it, in small amounts, to be accessible. The new CEO occasionally has lunch in the lounge, too, but has a reputation as being doc-unfriendly, so he appears to be intimidating.

As @q-school points out, if no one has time to hang out in the lounge, how can it be of value? In our Hospital, it is situated adjacent to the OR, close to Radiology, ED, Heart station, and GI Lab, so it is in a hub of activity. Realistically, the people most frequently found in the lounge are surgeons in between cases and a gaggle of CRNAs. Primary care docs and medical specialists live further away on the campus, rarely come to the Hospital itself,  and have no time for such nonsense. (This was not always the case.)

Click to expand...

It's funny every hospital/OR lounge I've ever been to has been essentially overrun with CRNA. I wonder why that is.

 

Burnout has to do with work flow. I don't think anyone would deny there are more and more hoops to jump through. Which takes time. So it's just not reasonable to expect similar levels of production as 20 years ago with paper charts and etc. Anyone denying this isn't living in real world. You can make nap pods and massages for everyone and all that touchy feely stuff that end of day doesn't actually move needle, but in the end it just comes down to expected workload.

 

[Hatton]

Vagabond MD wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge.

Click to expand...

Panscan wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. While it still exists, it is not nearly as vibrant. For one thing, the food has deteriorated significantly; if I did not know better, I would think that they are trying to kills us. It is not unusual to see an Administrator in the loung, chatting it up or holding court. Our old CEO, largely loved by docs, would hang out in the lounge, have lunch with friends, and used it, in small amounts, to be accessible. The new CEO occasionally has lunch in the lounge, too, but has a reputation as being doc-unfriendly, so he appears to be intimidating. As @q-school points out, if no one has time to hang out in the lounge, how can it be of value? In our Hospital, it is situated adjacent to the OR, close to Radiology, ED, Heart station, and GI Lab, so it is in a hub of activity. Realistically, the people most frequently found in the lounge are surgeons in between cases and a gaggle of CRNAs. Primary care docs and medical specialists live further away on the campus, rarely come to the Hospital itself,  and have no time for such nonsense. (This was not always the case.) Click to expand… It’s funny every hospital/OR lounge I’ve ever been to has been essentially overrun with CRNA. I wonder why that is.

Click to expand...

CRNAs are not allowed in the doctors lounge or cafeteria in my hospital.  Rarely see admins either.  I think camaraderie is what pulls you through the very tough case and keeps you going.  I have never understood why hospitals want to stomp it out.

[Lithium]

hatton1 wrote:

Vagabond MD wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. 

Click to expand…

Panscan wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. While it still exists, it is not nearly as vibrant. For one thing, the food has deteriorated significantly; if I did not know better, I would think that they are trying to kills us. It is not unusual to see an Administrator in the loung, chatting it up or holding court. Our old CEO, largely loved by docs, would hang out in the lounge, have lunch with friends, and used it, in small amounts, to be accessible. The new CEO occasionally has lunch in the lounge, too, but has a reputation as being doc-unfriendly, so he appears to be intimidating. As @q-school points out, if no one has time to hang out in the lounge, how can it be of value? In our Hospital, it is situated adjacent to the OR, close to Radiology, ED, Heart station, and GI Lab, so it is in a hub of activity. Realistically, the people most frequently found in the lounge are surgeons in between cases and a gaggle of CRNAs. Primary care docs and medical specialists live further away on the campus, rarely come to the Hospital itself,  and have no time for such nonsense. (This was not always the case.) Click to expand… It’s funny every hospital/OR lounge I’ve ever been to has been essentially overrun with CRNA. I wonder why that is. 

Click to expand…

CRNAs are not allowed in the doctors lounge or cafeteria in my hospital.  Rarely see admins either.  I think camaraderie is what pulls you through the very tough case and keeps you going.  I have never understood why hospitals want to stomp it out.

Click to expand...

Collectivization is antithetical to administration's goals, which are to maximize their control and minimize our leverage.  In our lounge we have mid-levels, psychologists, administrators, and rotating fellows/residents who hog the computers because they don't have their own offices.  There is also too much propaganda on the walls for my taste.

[Anne]

hatton1 wrote:

Vagabond MD wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. 

Click to expand…

Panscan wrote:

Camaraderie/community are extremely important for reducing burnout. One of the best things about our Hospital was the presence of a vibrant Doctor’s lounge. While it still exists, it is not nearly as vibrant. For one thing, the food has deteriorated significantly; if I did not know better, I would think that they are trying to kills us. It is not unusual to see an Administrator in the loung, chatting it up or holding court. Our old CEO, largely loved by docs, would hang out in the lounge, have lunch with friends, and used it, in small amounts, to be accessible. The new CEO occasionally has lunch in the lounge, too, but has a reputation as being doc-unfriendly, so he appears to be intimidating. As @q-school points out, if no one has time to hang out in the lounge, how can it be of value? In our Hospital, it is situated adjacent to the OR, close to Radiology, ED, Heart station, and GI Lab, so it is in a hub of activity. Realistically, the people most frequently found in the lounge are surgeons in between cases and a gaggle of CRNAs. Primary care docs and medical specialists live further away on the campus, rarely come to the Hospital itself,  and have no time for such nonsense. (This was not always the case.) Click to expand… It’s funny every hospital/OR lounge I’ve ever been to has been essentially overrun with CRNA. I wonder why that is. 

Click to expand…

CRNAs are not allowed in the doctors lounge or cafeteria in my hospital.  Rarely see admins either.  I think camaraderie is what pulls you through the very tough case and keeps you going.  I have never understood why hospitals want to stomp it out.

Click to expand...

Camaraderie is so important.  Not only does it pull you through, but it helps in everyday patient care.  I get what I would categorize as "unnecessary" consults frequently.  I've noticed when the consult comes from someone I don't know, I grumble and think negatively.  When the consult comes from someone I have a good relationship with, I automatically assume that they must have a good reason for it and have a more positive attitude about it.  It also helps when you have a patient issue where you don't think the patient necessarily needs to see another specialist but you just need some guidance on which way to go--if you can call your friend the rheumatologist/hematologist/orthopedic surgeon/whatever and ask a quick question, it often will save the patient from unnecessary testing or office visits.  If you can't make a quick call, or think the person on the other end of the call is going to be irritated about being bothered, you end up just putting in the formal consult as that's the path of least resistance.

The business world understands this.  They spend tons of money flying people around the world to in person meetings even though there is excellent technology for virtual meetings nowadays.  Human relationships matter.

[Dusn]

Who has time to go to a physician's lounge?