"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

From the NEJM:

More than half of U.S. physicians report significant symptoms of burnout — a rate more than twice that among professionals in other fields. Medical students and residents have higher rates of burnout and depression than their peers who are pursuing nonmedical careers. Physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms

"The health system cannot sustain current rates of clinician burnout and continue to deliver safe, high-quality care". What to do?

Here are some examples (more reading available at the reference links below):

- To prevent burnout, Mayo Clinic has leadership-effectiveness scores for every division head and department chair.

- University of Colorado health uses medical assistants to set the agenda for patient visits and write the notes (almost 3 assistants per physician)

References:

http://bit.ly/2rFjlxx
http://bit.ly/2DFQ0sz

Comments:

Amazing when you offload physician administrative tasks. Before this intervention, were they doing 4 people's jobs? https://t.co/kBqorWCTtf

— Shannon McNamara, MD (@ShannonOMac) January 31, 2018

BMJ study: Patients treated by older physicians (60 and older) had higher mortality vs. younger physicians (39 and younger)

From BMJ:

The researchers evaluated a 20% random sample of Medicare fee-for-service beneficiaries aged 65 and older admitted to hospital with a medical condition in 2011-14 and treated by hospitalist physicians.

Main outcome measures 30 day mortality and readmissions and costs of care.

The study included 700,000 admissions managed by 18,800 hospitalist physicians (median age 41).

Patients’ adjusted 30 day mortality rates were:

- 10.8% for physicians younger than 40
- 11.1% for physicians aged 40-49
- 11.3% for physicians aged 50-59
- 12.1% for physicians aged 60 and older

See the figure here: http://www.bmj.com/content/bmj/357/bmj.j1797/F1.large.jpg

Note: Among physicians with a high volume of patients, however, there was no association between physician age and patient mortality.

Within the same hospital, patients treated by older physicians had higher mortality than patients cared for by younger physicians, except those physicians treating high volumes of patients. The calculated "number need to harm (NNH)" was 77.

Patients treated by physicians aged younger than 40 had 0.85 times the odds of dying or an 11% lower probability of dying compared with patients cared for by physicians aged 60 and older. This difference in mortality is comparable with the impact of statins for the primary prevention of cardiovascular mortality on all cause mortality (odds ratio of 0.86) or the impact of β blockers on mortality among patients with myocardial infarction (incidence rate ratio of 0.86), thus indicating that the observed difference in mortality is not only statistically significant but arguably clinically significant.

The adjusted risk difference of 1.3 percentage points suggests that for every 77 patients treated by doctors aged 60 and older, one fewer patient would die within 30 days of admission if those patients were cared for by physicians aged 39 and younger.

Though clinical skills and knowledge accumulated by more experienced physicians could lead to improved quality of care, physicians’ skills might become outdated as scientific knowledge, technology, and clinical guidelines change.

Older physicians might have decreased clinical knowledge, adhere less often to standards of appropriate treatment, and perform worse on process measures of quality with respect to diagnosis, screening, and preventive care.

References:

Physician age and outcomes in elderly patients in hospital in the US: observational study. BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1797 (Published 16 May 2017)
Cite this as: BMJ 2017;357:j1797

Image source: OpenClipArt, https://openclipart.org/detail/284296/instructor

Surgeon grows vegetables across from his hospital to cope with stress and burnout

From this Reuters/Yahoo article:

"Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan. His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients. "You really have to find the balance to put it a little more in perspective," he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected."

Burnout as a syndrome is marked by emotional exhaustion, cynicism and decreased effectiveness. A 2015 Mayo Clinic study found that more than 7% of 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers.

Some blame the way medicine is practiced in the United States since the introduction of EMRs, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

It can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

Atrius Health, Massachusetts' largest independent physicians group, is aiming to cut 1.5 million mouse "clicks" per year.

Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

References:

Counting the costs: U.S. hospitals feeling the pain of physician burnout