Beyond burnout: How to stay engaged and thriving

National Report-Physician burnout is big news, with headlines announcing that burnout affects more than half of the U.S. physician work force. And urology has the distinction of being one of the most burned-out specialties in medicine today. According to Urology Times’ 2015 State of the Specialty survey, burnout is the third most influential factor in urologists’ decision to retire, surpassed only by the government’s influence in medicine and declining reimbursement.

Dr. KaplanDamara Kaplan, MD, PhD, of Albuquerque Urology Associates in Albuquerque, NM, says she thinks she’s burned out.

“If you look at the changes that have been going on in medicine-the loss of autonomy; devaluation of the physician, in general; certainly, loss of professional status; decreased income; increased workload; and the many intrusive government regulations we have to deal with every day in order to do our jobs-those things are certainly leading to my burnout,” Dr. Kaplan said.

As a result of the negativity, Dr. Kaplan says she feels angry and short tempered with people.

“I’m not as patient as I once was. I feel dissatisfied with my professional life, and I think that spills over into my private life,” Dr. Kaplan said.

And this urologist, like so many others, is in the middle of her career. Dr. Kaplan says she plans to practice for at least another 15 years. But something has to change, she says, or it’s going to be a miserable 15 years.

Next: A new day

A new day

There’s help for the disconnected, the numb, and the disengaged. That help comes in the form of evidence-based strategies that work to drive down physician burnout. These are simple, often inexpensive ways in which urologists can reclaim their engagement and passion for practicing medicine.

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A case in point is Mayo Clinic’s successful five-pillar anti-burnout remedy. Mayo’s physician burnout rate is plummeting as the national physician burnout rate climbs. And the impressive stats are directly related to the health system’s five-pronged program, which any practice or system can implement.

Dr. Swensen“The national rate of burnout is 54% for physicians, the equivalent number at Mayo is 32%, and the general population number is between 25% and 28%,” said Stephen Swensen, MD, medical director of the Office of Leadership and Organization Development at Mayo Clinic and professor of radiology at Mayo Medical School, Rochester, MN. “While the American burnout rate for physicians is going higher, we’re approaching the general population numbers for our physicians. We also have a much lower rate than the national burnout rate for urologists.”

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The program is not rocket science, Dr. Swensen says.

“It’s pretty simple. But you have to be intentional about it,” he said.

Next: The big five

The big five

Dr. Swensen, who leads the organizational team in charge of restoring physicians’ engagement and joy in work, says Mayo’s approach addresses essential human needs, including appreciation, being treated fairly, and having some control in the workplace.

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“Research published in peer-reviewed journals shows that these are what human beings need to thrive, to be well, and find purpose in their work,” Dr. Swensen said.

Control over your life. The first piece is how you design your organization, including how you make decisions and select your leaders. It deals with the human need to have some control of one’s life versus being told what to do. Dr. Swensen says urologists and others who partner with leadership or lead organizations and feel like they have a say in where the organization is going are less likely to burn out and more likely to have meaning and purpose in their work.

Leadership. The second pillar addresses leadership, specifically.

“We’ve done a fair amount of research on this at Mayo and published it. If leaders exhibit four basic behaviors, we see that the staff in their work areas are more satisfied, more engaged, and have lower levels of burnout,” Dr. Swensen said.

Basically, if your managers or work-unit leaders communicate transparently, show you appreciation, are interested in your ideas, and are interested in your career development, you are much more likely to thrive and be satisfied and engaged and much less likely to be burned out.

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“We measure that for all our physician leaders and support them so they do better as leaders,” Dr. Swensen said.

Next: 'Pebbles'

‘Pebbles.’ The third pillar, which Dr. Swensen calls “pebbles,” involves asking doctors, directly: What are the pebbles in your shoes? What matters to you? What brings you joy in work? What zaps that joy in work? The idea is to listen; then act.

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“Together, the leadership at the local level works with the doctors to remove those pebbles,” Dr. Swensen said.

The actions might include changing policy or using quality improvement techniques, among others.

“Some of those you can’t fix locally, so the leaders communicate with the organization to help address those. Of course, there are some systemic issues in the country that are beyond the control of an organization,” Dr. Swensen said. “But this removal of pebbles in your shoes, in participative management, in a collaborative way is very effective and is one of the big drivers to remove burnout.”

Camaraderie. The fourth pillar: build camaraderie. Dr. Swensen uses the scientific term “commensality,” which, in essence, is the act of sharing a meal together.

“Dr. Colin West and team found in two randomized controlled trials at Mayo Clinic with doctors that if you get doctors together to meet and talk about some positive things about their careers and professional issues, and you give them lunch, breakfast, or dinner, there are huge dividends for getting rid of burnout,” he said. “There’s less emotional exhaustion, there’s less social isolation, there’s less cynicism, there are more positive feelings about the organization.”

Healthy habits. The last of the pillars falls mostly on the individual urologist. These are healthy habits for well-being, which include diet, exercise, laughter, gratitude, forgiveness, meditation, and sleep.

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“All have strong evidence to support them for wellness, and are part of the resilience to burnout,” Dr. Swensen said.

These things don’t cost a lot of money and pay big dividends, Dr. Swensen says. “It’s just a matter of time and attention,” he said.

Next: About that resilience

About that resilience

Dr. SotileWayne M. Sotile, PhD, founder of the Center for Physician Resilience in Davidson, NC, has treated physicians for burnout for 30 years and speaks about the topic at professional society meetings, including meetings of urologists.

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The problem in urology has gone from embers to a full-blown fire.

“I collaborated with researchers from Mayo in publishing an article 4 years ago that showed burnout rates across all specialties. At the time, urologists had about a 35% burnout rate,” Dr. Sotile said. “The group repeated the survey and published the data at the end of 2015, and urologists had the second highest burnout rate across all specialties. About 64% of urologists are burned out.

“We’ve had over 12,000 physicians as clients, and I’ve been tracking this for these 3 decades. Our focus is, if 60% of urologists are burned out, what are the other 40% doing?”

Dr. Sotile has found that resiliency is the key. It’s the ability to get through difficult times and come out stronger. Stress-hardiness is different than resilience. People who are inherently strong, able to get through suffering, and considered courageous can use those qualities to trudge through medical school. But those qualities won’t keep them resilient for a lifetime of practicing urology, Dr. Sotile says.

“Just trying to ‘muscle through’ is not the way to preserve resilience,” he explained. “Resilient people think a certain way that leads to engagement and helps them to appreciate what they’ve got. So [even when times change] they’re still motivated and find meaning in their work and in their personal life journey.”

The key factors are to re-think, re-frame, and re-engage, he says.

Today’s physicians-especially those who have practiced medicine for a decade or more-have to re-think what is good enough, without comparing it to what they had in days gone by.

“Most urologists realize that they’ve got to be in large conglomerates-either being employed in a health system or part of a large group practice-in order to survive,” Dr. Sotile said. “Re-thinking means accepting the electronic health record as a reality. Regulation is a reality. The need to create alliances in order to stay in business is a reality.”

This balance of what you’ve got versus what you expect or expected to get is tremendously important to resilience because well-being or satisfaction with your work or your personal life is a big predictor of resilience, according to Dr. Sotile.

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“It’s not that we are resilient because we have good work or good family. It’s the satisfaction that we have that generates engagement, which generates good outcomes at work and at home,” he said. “The 40% or so who are resilient and are still practicing urology have accepted that we didn’t go through a seasonal change; we went through a climate change in medicine. The question is, is this a profession that I want to be in?”

Next: Broadening, deepening relationships with people at work, home

The next thing the resilient urologist does is preserve resilience by broadening and deepening his or her relationships with people at work and at home. Dr. Sotile says the need for an emphasis on quality of relationships is research based. Urologists with the highest satisfaction in the specialty say they enjoy working within their teams. They say they still are able to have interactions with patients, and they don’t just focus on the difficult ones. It matters to them that they help people.

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“You never find a resilient urologist who does not get along with people they work with or who is in chronic discord in their personal relationships,” Dr. Sotile said.

One easy way to work in this direction is to counter daily hassles with daily uplifts, according to Dr. Sotile. The hassles are inevitable for any urologist in any work setting.

“Harvesting and generating uplifts is optional, and I promise you that’s the option that resilient urologists, resilient urology groups, and resilient families in medicine are doing today,” Dr. Sotile said.

Engaging in these and other strategies offers the power to help urologists more than make it through the next 10, 15, or 20 years in the specialty. They could help physicians thrive, despite changes that rattle what they know and like about the profession.

“You have to find meaning and purpose in the work you’re doing, even with all the hassles, the new regulations, the time crunches, the electronic health record that doesn’t work the way you want it to. It’s not a matter of just going numb and getting through,” Dr. Sotile said. “That’s how you got through medical training. Seventy percent of people who go through medical training come out with some combination of burnout, depression, anxiety and disillusionment. Surely, that’s not the end result that we want.”

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