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    Why burnout is increasing among U.S. dermatologists


    The bigger picture

    Dr. Shanafelt and colleagues stress physician burnout is largely a system issue and that healthcare organizations have a shared responsibility with individual physicians in addressing the problem.

    “If a research study identified a system-based problem that potentially decreased patient safety for 50% of medical encounters in the U.S., we would swiftly move to address the problem. That is precisely the circumstance we are in, and we need an appropriate system level response,” he says.

    Healthcare organizations should focus on improving efficiency in the practice environment, reducing clerical tasks by transferring them to support staff, and nurturing a practice environment that cultivates flexibility and control, Dr. Shanafelt says.

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    “Organizational approaches to help physicians optimize meaning in their work and build connections with their colleagues have also been shown to reduce physician burnout in randomized trials,” he says. “In the present study, over 40% of physicians worked more than 60 hours per week as compared to [about] 7% of U.S. workers. It is essential that healthcare organizations recognize the challenge created by these high work hours and the unpredictability for personal life created by being on call nights and weekends. Organizations must develop strategies that facilitate work-life integration within this context.”

    The study’s researchers noted in the discussion that there are a number of steps individual physicians can take to promote wellness.

    “This often begins by identifying personal and professional values and determining how they will be prioritized when conflicts between personal and professional responsibilities arise. This exercise requires self- awareness, limit setting and reframing. Training in mindfulness based stress reduction, which involves self-awareness, a focus on the present and intentionality in thoughts and actions has also been shown to be an effective approach to reduce physician stress and burnout,” according to the study. “Scientific studies have also identified the habits and qualities that promote resilience in challenging situations, which are skills that can be learned and developed. Attention to self-care, developing personal interests, and protecting and nurturing relationships are also essential.”

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    The problem, Dr. Shanafelt says, is individual solutions are well-intentioned and help, but are inadequate.

    “Without system-based solutions that address the issues in the practice environment, however, we are not going to make meaningful progress,” Dr. Shanafelt says.

    The problem is dermatologists and others can’t wait for system changes because they might never happen, Dr. Matarasso says.

    “[Changing the system] is great in theory, but the healthcare system is a for-profit system, and physicians in the trenches are secondary,” he says.

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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