[Editor's note: This story originally was published by Real Clear Health.]
By Marschall S. Runge
Real Clear Health
Doctors and nurses are finally providing care to a large population they have long ignored: themselves.
Although burnout has been a significant problem for decades, it is getting worse with no end in sight. Close to half of caregivers say they have suffered from anxiety, depression and related conditions. Burnout was recognized long before the COVID-19 pandemic but too often the medical community’s approach has been misdirected or inadequate. For many years it was seen as a personal problem, even a sign of weakness, which caregivers were expected to deal with quietly and on their own. But the growing recognition of the tremendous price we were paying for this dangerous neglect – the painful struggles of colleagues trying to balance their personal lives and work in a demanding profession, the exodus of doctors and nurses from our field at a time of increasing demand for their services – has forced us to acknowledge and respond to this stark reality.
Instead of ignoring the reality of burnout, we are now vigorously addressing the urgent need for care for the caregivers. A major step occurred in 2017 when the National Academy of Medicine launched the Action Collaborative on Clinician Well-Being and Resilience which has put the issue front and center while expanding research into documenting the crisis and forging solutions. The Action Collaborative is currently developing a comprehensive “National Plan for Health Workforce Well-Being.”
In 2019 the American Medical Association started its Joy in Medicine Health System Recognition Program which encourages larger organizations to “implement programs and policies that actively support well-being.” It is hard to overstate the importance of this initiative which has not just inspired scores of hospitals and other providers to address burnout but has sparked a broader conversation by allowing organizations to share their effective strategies with others. Michigan Medicine was recognized by this program in 2021 for starting to develop structures and processes to support workplace well-being.
Knowing what works – including innovative peer support programs, emotional resilience training, efforts to address racial trauma and litigation stress, as well as fitness programs, laundry services, child activities and even providing meditation apps – means that each of us doesn’t have to reinvent the wheel. Above all, these efforts have brought burnout out from the shadows, allowing caregivers to acknowledge their struggles and begin the conversation at work
This effort received yet another major boost earlier this year when the Surgeon General of the United States, Dr. Vivek H. Murthy, issued a comprehensive advisory titled “Addressing Health Worker Burnout,” which reported that,
“Burnout among health workers has harmful consequences for patient care and safety, such as decreased time spent between provider and patient, increased medical errors and hospital-acquired infections among patients, and staffing shortages. In addition, health worker burnout can have costly repercussions for the healthcare system, with the best estimates linked to the costs of replacing staff. Researchers estimate that annual burnout-related turnover costs are $9 billion for nurses and $2.6 to $6.3 billion for physicians. These estimates do not include turnover among other types of health workers across the continuum of care.”
The organization that I lead, Michigan Medicine, is one of the growing number of health care systems that has made burnout a priority. In 2019 we created a Wellness Office under the direction of Dr. Kirk J. Brower, Chief Wellness Officer and Professor of Psychiatry, to address the needs of our community – needs that increased exponentially due to the challenges and strains of the COVID-19 pandemic. While Michigan Medicine offers a range of mental health resources to both professional caregivers and medical students through our Office of Counseling and Workplace Resilience, a major thrust of the Wellness Office’s work is to expand our understanding of wellness beyond the individual, in order to see how our workplace creates a climate in which burnout festers.
Caregiver burnout is not a problem suffered by specific individuals as a result of their own life circumstances, but a systemic issue galvanized by the culture of medicine. This is a major reason why doctors and nurses are more likely to suffer burnout than other Americans. As Dr. Chris Sinsky, Vice President of the AMA for Professional Satisfaction, noted, “Burnout manifests in individuals, but originates in systems.” That’s why the Surgeon General advised, “While addressing burnout may include individual-level support, burnout is a distinct workplace phenomenon that primarily calls for a prioritization of systems-oriented, organizational-level solutions.”
As part of our effort to identify the forces that negatively affect workplace wellness, we have appointed Faculty Associates to find scalable solutions to six workplace issues that are leading contributors to burnout. These distinguished experts are:
- Exploring solutions to address administrative burden, particularly focused on organizational email usage among faculty, staff, and learners.
- Evaluating job resources and job demands to improve teamwork and reduce burnout across the institution.
- Developing a multi-faceted approach to facilitate the development of communities of support for parents and other caregivers while working at Michigan Medicine.
- Piloting solutions to address barriers to vacation and sabbatical usage to improve work-home balance among those in the Michigan Medicine community.
- Researching how electronic health record (EHR) usage at Michigan Medicine contributes to burnout and identifying solutions to reduce the negative impact of the EHR on faculty well-being.
- Utilizing a phased approach to identify effective strategies to improve psychological safety among faculty and residents.
As important as the effective strategies that will come out of this research is the message our commitment sends to our faculty, staff, and learners: “We are listening to you and are dedicated to addressing system issues in order to improve your well-being. We have your back. We care about you.”
No one in the medical community believes that we can eliminate burnout. Medicine will always be a highly stressful and demanding calling. But by acknowledging and responding to the systemic factors that create it, I am confident that we can reduce its terrible impact and allow caregivers to reconnect more deeply with the profound joys of medicine.
Marschall S. Runge, former Executive Dean of the UNC School of Medicine, is Executive Vice President for Medical Affairs and Dean of the Medical School for the University of Michigan.
[Editor's note: This story originally was published by Real Clear Health.]
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