Wisdom//

Physician Burnout Is Real. Here are 5 Stages of Change We Can Use to Tackle It.

Reversing burnout cannot happen overnight, but it CAN happen.

TShum/ Getty Images
TShum/ Getty Images

Physician burnout is not only a major medical crisis, but it has also become a public health crisis. Most physicians enter the field of medicine because they want to make a difference in the lives of the patients they serve, despite the long hours and time away from their family and friends. However, when it becomes difficult to keep up with the demands of longer hours, more administrative work, less time for family and social interactions and increased personal demands, they face the risk of burnout.  Some physicians will reach a point where they feel like leaving the profession that they once loved.

Burnout doesn’t happen overnight. A series of stressful events and changes happen over time that build up to a point where one starts to feel like there is no escape. Studies show that doctors are leaving at an alarming rate in search of nonclinical work or a difference career altogether. Even worse, there are an increasing number of physicians who commit suicide each year which some may be at the hands of burnout being a contributing factor. The consequence of physician burnout is a public health crisis because it not only puts the physician at risk but also patients. Physician burnout is also costly. A study at Stanford Medicine revealed that replacing a physician who leaves because of burnout can cost at least $250,000. And that’s just the cost of having to replace doctors who leave.

The good news is that physician burnout can be prevented or reversed. There has been a lot of information aimed at preventing burnout, but what about those physicians who are already experiencing it. Do we forget about them? Are we adopting the belief that once burnout sets in, it can’t be reversed, or we can’t save our physicians from leaving the profession? It takes commitment and work for organizations to fix and heal the system as well as a great deal of support to help physicians obtain the help they need to recover.

In an article on healthaffairs.org Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs, it states that “The high level of burnout among physicians should be considered an early warning sign of dysfunction in our health care system. Professional satisfaction for physicians is primarily driven by the ability to provide high-quality care to patients in an efficient manner. Dissatisfaction is driven by factors that impede this effort, including administrative and regulatory burdens, limitations of current technology, an inefficient practice environment, excessive clerical work, and conflicting payer requirements. High levels of physician burnout can thus be seen as an indicator of poor performance by the underlying system and environment”.

How do we help physicians to heal and adapt a different pattern of behavior that can reverse burnout? What can we change now? Spending too much time talking about what’s wrong and not putting action into place to make small changes toward progress will keep us stuck. The health care system is not going to change overnight. The struggle with EMR systems is not going to magically change in the short term. However, organizations can put into place measures to make the lives of physicians more manageable and physicians can learn how to protect themselves from this public health crisis.

Studies show that most people move through a series of stages when changing their behavior, learning to handle stress or wanting to feel better about life. The Stages of Change Model was developed by two researchers Prochaska and DiClemente to describe this process. They discovered through their research that people go through 5 stages of change as they work to overcome problems or addictions. What if we applied this model to helping physicians overcome burnout. 

The 5 stages of change are:

1. Pre-contemplation: It is thought that people in this stage don’t realize they have a problem. They also do not seek the information necessary about their current situation, so they remain in the dark and don’t ask for help. Sara Berg, Senior Staff Writer AMA Wire, stated that without the support of organizations, physicians are forced to deal with burnout themselves. They are told to heal themselves without guidance or someone who can hold them accountable. Therefore, they remain in this stage without guidance. Organizations can also stay stuck in this stage if they continue to ignore this crisis. Here is where organizations need to do a better job of making sure they are identifying those physicians who may be experiencing burnout to help them move from this stage to one where change can occur. They must also identify what needs to change from a process standpoint, to make the lives of physicians less stressful. Physicians must educate themselves about the signs of burnout, so they can take the necessary steps to seek help.

2. Contemplation: People in this stage are planning on making a change soon. They are aware of their current situation and realize that changing it will bring about positive change. On the flip side they are also very unsure about seeking help or changing. This often causes conflict and will cause some people and organizations to remain in this stage for a very long time. What causes a person to move out of this stage is usually the realization that changing their situation will gain them something in return. For physicians they need to see that the work they are about to put in working on their burnout issue with their current employer is going to lead to an improved work environment, better communication with their patients and more time with family. They need to know that the end result will benefit them, their patients and their families. Organizations must realize that becoming a part of the change will lead to more productive, happier physicians who in turn will stay committed to their positions and continue to improve the lives of patients. So organizations must gain the trust of physicians so that they will do what it takes to deal with burnout.

3. Preparation: People in this stage are ready to make a change in the immediate future. They have an action plan. They start to take small action. Here organizations should have developed a plan of action for their physicians and the physicians are willing participants to the program. It is the responsibility of the organization to move the physician from contemplation to preparation.

4. Action: People in this stage have made changes in the past 6 months. People in this stage not only have taken action but they have also had some positive result from their actions. Here physicians are putting into practice the action plan that was mutually developed and organizations are providing ongoing support and encouragement to help physicians continue making progress.

5. Maintenance: People in this stage have made changes and are able to work at preventing relapse. They are very confident that they can continue with their progress and work hard to try to maintain the change.

We can continue to keep having the same conversations about burnout or take the necessary steps to invest in research, programs and training to find solutions.

References:

Prochaska and DiClemente. The Stages of Change Model.

Healthaffairs.org Physician Burnout Is A Public Health Crisis: A Message To Our Fellow Health Care CEOs 

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