Physician burnout - it’s here for sure, now what to do about it? 2018 WSAAI update

This is a Twitter summary from the 2018 WSAAI meeting. This summary was compiled from the tweets posted by @MatthewBowdish, an allergist/immunologist, who attended the 2018 Western Society of Allergy, Asthma and Immunology (WSAAI) meeting. The tweets were labeled #WSAAI. The text was edited and modified by me.

Mark T. O'Hollaren "Is it time to take care of the doctor? Why recapturing the joy of medicine is crucial for the well being of both patients and physicians".

50-60% of physicians are now experiencing clinical symptoms of burnout. 400 physicians per year commit suicide in the US. Editor’s note: Allergist are the specialty with the second lowest level of burnout, a little higher than psychiatrists.

Physician burnout is a progressive loss of idealism, energy, idealism and purpose.

Components of burnout include:

- emotional exhaustion
- cynicism
- ineffectiveness

36% of physicians report that their work schedule leaves enough time for personal/family life, compared with 61% of the general population. Burnout occurs nearly twice as often in physicians compared with other professions.

Physician burnout rates increased in all medical specialties between 2011 and 2014. Cited in NEJM in 2018: students start medical school with stronger mental health profiles than their peers but that pattern reverses by the 2nd year in medical school.

Allergists, perhaps better than any specialty, understand the interplay between host and environment.

While we have not changed much, our environment has:

Burnout is rooted in the anatomy and coherence of the health system in which physicians work. Direct organization interventions have been more likely to lead to reduction in burnout rather than focusing on physician-center interventions.

Although EHR itself is part of the problem, so is the compliance and record-keeping requirements that fuel the need for an EHR.

Physicians spend only 27% of their office day in direct clinical face time with patients - Ann Intern Med 2016.

Important antidotes to burnout include working in an efficient system and bringing two things to the patient experience: 1. the best science and 2. a genuine human connection with our patients.
Dr. O'Hollaren claims that we are moving more towards a consumer-based model in health care. Matthew Bowdish MD @MatthewBowdish: On a personal note, I cannot disagree more with the last point. The health care system is becoming more corporatized, but that is not more consumer oriented...But I guess it all depends on who you think the consumer is in health care, insurers (govt and private) or patients.

Next steps: personally change the way we work, slowly improve the system to bring back meaning and joy, become aware of local, regional and national healthcare environments, become a student of the change process, focus on things you can influence.

Realize that balance is central to this process, begin each day with gratitude, care for yourself and your family, greet each patient with sincerity.

It is important to care for your "work family" also. They are foundational to the healing work that you do. Delegate and download what you safely can.

Keep in touch and know what is going on with your professional colleagues. If we fail to engage, we will abdicate the system design to payers, large systems and the government.

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