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Ramon Jimenez, MD


Published 1/1/2019
Kerri Fitzgerald

Recognizing Physician Burnout and Incorporating Joy into Practice

Changes in health care have increased physician burnout. When physician well-being is suboptimal, patient care can suffer. During a symposium, titled “Professional Well-being and Burn-out” at the AAOS Fall Meeting in San Antonio, Texas, two speakers provided insights to improve work environments, reengage physicians, and promote the highest levels of patient care.

Ramon Jimenez, MD, a senior consultant in an orthopaedic and occupational medical group in Monterey, Calif., began by asking the audience various questions to gauge joy in practice, including:

  • Do you still enjoy orthopaedic surgery?
  • Do you have agency (the capacity to act independently and to make your own free choices), or are you just part of a machine?
  • Is your work enlivening or exhausting?
  • Is futility playing a bigger role in your life?
  • Are you helping people?
  • Does your work contribute to society?
  • Are you making an impact?

He said loss of joy in practice is characterized by feelings of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. Nearly 50 percent of residents and 25 percent to 50 percent of practicing orthopaedic surgeons have lingering or episodic symptoms of burnout, according to Dr. Jimenez.

He highlighted the AAOS Patient Safety Committee’s goal to help restore meaning and purpose to orthopaedic practice by supporting surgeons. The committee is developing online resources for physicians, including self-assessment tools, tips, and other educational initiatives. They are also developing a joy in practice toolkit that describes the importance of early identification of loss of joy in practice and provides useful techniques for maintaining meaning and purpose in work.

When physicians have joy in practice, fewer errors occur and less harm comes to patients. Each additional point on a burnout inventory scale that quantifies depersonalization and exhaustion is associated with an increase in medical errors reported by surgeons, Dr. Jimenez said. Moreover, perceived personal failure due to major medical errors correlates with higher rates of depression, reduced empathy, depersonalization, emotional exhaustion, and lower sense of overall personal accomplishment.

According to study findings, Dr. Jimenez said, compared to physicians in other specialties, orthopaedists rank on the lower end of the burnout spectrum, at 34 percent. In a survey, more than half of physicians listed the following as factors contributing to burnout:

  • too many bureaucratic tasks (leading cause)
  • spending too many hours at work
  • increasing lack of respect
  • increased computerization of practice
  • insufficient compensation

Dr. Jimenez shared various tips and tools physicians can use to increase joy in practice, including surrounding themselves with positive people, creating relationships with patients and their families, finding ways to relieve stress and revitalize their spirits, and adopting a growth mindset. He recommended setting a manageable schedule and measures of success that feel right and doable. “Delegate what can be delegated. You don’t have to do everything yourself,” he said.

Finally, he reminded surgeons to take a genuine interest in each patient. “We’re physicians treating the patients first; we must fall in love with the concept again—with who we are and what we do best.”

Ramon Jimenez, MD
Michael Tutty, PhD, MHA

Next, Michael Tutty, PhD, MHA, group vice president of professional satisfaction and practice sustainability at the American Medical Association (AMA), discussed how overall physician burnout increased from 46 percent in 2011 to 54 percent in 2014. Burnout is higher in physicians compared to the general population (48.8 percent versus 24.4 percent). He noted that electronic health records, long hours, high stress, and increased administrative tasks are factors contributing to physician burnout. “All of those things take attention from providing high-quality care,” he said.

Burnout can lead to lower patient satisfaction, less favorable health outcomes, and potentially increased costs, according to a study. One in five physicians intend to reduce clinical work hours in the next year, and one in 50 intend to leave medicine altogether in the next two years to pursue a different career due to burnout, according to research presented. “This is at a time when we already have a physician shortage,” he reminded the audience.

Physician burnout is a symptom of system dysfunction, said Dr. Tutty. “We believe that about 80 percent of the causes of burnout are system issues. If we’re going to address burnout, we really need to fix the system issues that cause [the] dysfunction,” he said, noting that the AMA is focused on tackling the issue at a national level to identify resources for practices. He talked about the AMA’s Steps Forward initiative (https://edhub.ama-assn.org/steps-forward), which seeks to return joy to practice, with its slogan: “Redesign your practice. Reignite your purpose.”

Dr. Tutty also presented results of an AMA/RAND Corporation study that assessed how healthcare system payment models have impacted physician practice. The pace of change is overwhelming to some, the payment models are more complex, and many practices are operating in a more risk-averse manner. An AMA survey found that 75 percent of physicians described prior authorization as a high or extremely high burden. In addition, 90 percent of surveyed physicians reported that prior authorization sometimes, often, or always delays access to care.

Facilities cannot fix health system issues. “Those are the types of things the AMA can have influence on, so that’s where we’ve been focusing: national issues and how we find resources for the practice,” he said.

Dr. Tutty concluded by noting that trust needs to be restored in U.S. physicians. “We’ve really eroded trust in physicians, and you can see that in how physicians are spending their time,” he said. “We live in an environment where if you don’t document it, it didn’t happen, and where there are more and more procedures and prescriptions that need to be approved by the insurance company.” He advised physicians: “Take care of yourself. But also get involved in your own organization, as there are things you can do to create a better work environment.”

Kerri Fitzgerald is the managing editor of AAOS Now. She can be reached at kefitzgerald@aaos.org.