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“Burnout in Academic Medicine: Is there a happy ending?”

“Burnout in Academic Medicine: Is there a happy ending?”. Steven G. Gabbe, MD Senior Vice President for Health Sciences CEO, OSU Medical Center Professor, Obstetrics and Gynecology July 9, 2012. Learning Objectives. At the conclusion of this presentation, the participants will be able to:

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“Burnout in Academic Medicine: Is there a happy ending?”

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  1. “Burnout in Academic Medicine:Is there a happy ending?” Steven G. Gabbe, MD Senior Vice President for Health Sciences CEO, OSU Medical Center Professor, Obstetrics and Gynecology July 9, 2012

  2. Learning Objectives At the conclusion of this presentation, the participants will be able to: • Describe the characteristics of medical practice that contribute to burnout • Identify the important elements of burnout including emotional exhaustion, depersonalization, and low personal accomplishment • Develop strategies to prevent and treat burnout

  3. Bob Seger – Against The Wind And I guess I lost my way There were oh so many roads I was living to run and running to live Never worried about paying or even how much I owed

  4. Bob Seger – Against The Wind Moving eight miles a minute for months at a time Breaking all of the rules that would bend I began to find myself searching Searching for shelter again and again

  5. Bob Seger – Against The Wind Against the wind A little something against the wind I found myself seeking shelter against the wind

  6. Bob Seger – Against The Wind Well those drifter’s days are past me now I’ve got so much more to think about Deadlines and commitments What to leave in, what to leave outAgainst the wind Well I’m older now and still runnin’ Against the wind

  7. Physician Wellness: A Missing Quality Indicator “When physicians are unwell, the performance of healthcare systems can be suboptimum. Physicians wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care.” Source: Wallace JE, Lemaire JB, Ghali WA. Lancet2009; 374: 1714-21.

  8. Urban Meyer desires balance between football and family At his introductory press conference Monday, Meyer pulled out a folded-up pink piece of paper from his suit pocket. "This is a contract that my kids made me sign before I was allowed to sign a real contract," Meyer said. "It's tougher than any other contract I've signed in my life." The Lantern, December 1, 2011

  9. Job Burnout “What started out as an important, meaningful and challenging work becomes unpleasant, unfulfilling and meaningless. Energy turns into exhaustion, involvement turns into cynicism, and efficacy turns into ineffectiveness.” Source: Maslach et al. Annu Rev Psychol 2001; 52: 387-422.

  10. Burnout • Emotional exhaustion • Depersonalization in relationships with co-workers • A sense of inadequacy or reduced personal accomplishment Source: Maslach, Jackson, Leiter 1996.

  11. Burnout Demands Lack of Resources Work Overload Personal Conflict Diminished: Control Coping Social Support Autonomy Decision Involvement Burnout Exhaustion Cynicism/Depersonalization DiminishedAccomplishments and Efficacy Costs Diminished Organizational Commitment Turnover and Absenteeism Physical Illness Source: Maslach, Jackson, Leiter 1996.

  12. The Resilient Physician “High demand/low control is bad enough; High demand/low control/low support can be deadly.” Source: Sotile W, Sotile M, 2002.

  13. Who Thought Sitting in a Chair Would Be so Hard? “As unprecedented reforms pull our complex organizations in new directions, the department chair is arguably the linchpin bearing the most stress.” Source: Cohen J. Academic Medicine 1998; 73: No. 3.

  14. Questionnaire • Demographic information • Potential stressors • Job satisfaction • Likelihood of stepping down • Methods to relieve stress • Personal efficacy • Maslach Burnout Inventory – Human Services Survey (MBI-HSS) • Interactions with spouse/partner and family • Comments Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  15. Percent of Week (Average) Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  16. Effectiveness As Chair Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  17. “There is tremendous satisfaction in this job, but every day there are tremendous frustrations. Bureaucracy, endless paperwork, audits, OIG, JCAHO, lawyers, etc. take away much of the enjoyment of being chair.” Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  18. Individual Stressors Identified by Department Chairs • Hospital/Department Budget Deficits • Medicare/Medicaid Billing Audits • Loss of Key Faculty • Union Disputes • Faculty/Resident/Staff Dismissal • Defendant in Malpractice Case Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  19. Control Over Professional Life Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  20. Satisfaction with Balance between Personal and Professional Life Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  21. Satisfaction With Current Position (%) Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  22. Likelihood of Stepping Down in Next 1-2 Years Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  23. “I really like what I do. Problem solving is meaningful and rewarding. Yes, it is trying, but it is satisfying to be tired from doing something right.” Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  24. Personal Accomplishment Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  25. “I often feel like I may target faculty and residents when my frustrations are really with the complexity of the workplace over which we (I) have no control.” Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  26. Depersonalization Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  27. “Chairs need to understand that this is a very personally “taking” rather than “giving” job. When one is prepared to give to others and be a support for them, job will suck them dry quickly.” Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  28. Emotional Exhaustion Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  29. Burnout in Chairs of Obstetrics and Gynecology Characteristics • High – Emotional Exhaustion • Moderate-high – Depersonalization • High – Personal Accomplishment Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  30. Mean MBI-HSS Subscale Scoresby Physician Group Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  31. “My partner is my greatest support – I couldn’t do what I do without their help.”

  32. Spouse/Partner Understands “Extra” Work Hours Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  33. “I believe the world we live in is not emotionally healthy. Unless an individual can figure out how to have some quiet time on a daily basis, they will have difficulty dealing with other people’s problems.” Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  34. Stress Management Number • Time with family and friends 93 • Positive approach to life 65 • Hobbies 55 • Exercise 51 • Religion 5 • Alcohol 3 Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  35. Emotional Exhaustion Significant correlations with • Age • Hours worked per week • Spouse/partner support Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  36. Satisfaction with Balance between Personal and Professional Life versus Emotional Exhaustion Score N=27 N=19 N=34 N=8 Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  37. Burnout Significant correlations with • Age • Length of service • Impact of stressors • Satisfaction with balance in life • Effectiveness rating and self-efficacy • Spouse/partner support Source: Gabbe et al. Am J ObstetGynecol 2002; 186: 601-12.

  38. Heavier Workload, Less Personal Control:Impact of Delivery on Obstetricians/Gynecologists’ Career Satisfaction • A questionnaire study of 842 fellows of ACOG (56% response rate) • Ob/Gyns who do not perform deliveries reported working significantly fewer hours per week (52.6 vs. 70) and had more satisfaction with their work activities • Two primary contributing factors for dissatisfaction among ob/gyns who perform deliveries were increased workload and decreased personal control Source: Bettis BA et al. ObstetGynecol 2004; 190: 851-7.

  39. Predictors of Physician Career Satisfaction, Work-Life Balance, and Burnout • Cross-sectional, mailed, self-administered survey of 935 physicians (48% response rate) in specialties characterized by an “uncontrollable lifestyle.” • Both women and men are highly satisfied with their careers. • Women physicians work significantly fewer hours than male physicians, both weekly (54 hours vs. 59 hours) and “on-call” (41 hours vs. 52 hours) • Personal accomplishment and emotional resilience are both strong and significant predictors of career satisfaction Source: Keeton K et al. ObstetGynecol 2007; 109: 949-55.

  40. Predictors of Physician Career Satisfaction, Work-Life Balance, and Burnout • The strongest predictor of work-life balance and burnout was having some control over schedule and hours worked • Physician gender, age, and specialty were not strong independent predictors of career satisfaction, work-life balance or burnout • Ob/Gyns reported significantly more personal accomplishment and work-life balance than general surgeons and significantly more career satisfaction than general internists Source: Keeton K et al. ObstetGynecol 2007; 109: 949-55.

  41. Extreme Jobs: The Dangerous Allure of the 70-hour Workweek “The overwhelming majority of extreme jobholders in our U.S. sample (66%) say they love their jobs…far from seeing themselves as workaholics in need of rescuing, extreme workers wear their commitments like badges of honor…extreme professionals don’t feel exploited; they feel exalted.” Source: Hewlett SA, Luce CB. Harvard Bus. Rev. December 2006: 49-59.

  42. Repercussions of Extreme Jobs for Family, Home and Intimate Life Extreme jobholders say job interferes with Source: Hewlett SA, Luce CB. Harvard Bus. Rev. December 2006: 49-59.

  43. What Are the Main Reasons You Love Your Job? Source: Hewlett SA, Luce CB. Harvard Bus. Rev. December 2006: 49-59.

  44. What Can Be Done to Avoid Burnout at Work? • Greater autonomy in scheduling • More allowance for job sharing and other innovative work structures • Purposeful alignment of personal and professional values and priorities • Onsite backup childcare for nonschool days Source: Dyrbye et al. Arch Surg 2011; 146: 211-17.

  45. Association of an Educational Program in Mindful Communication with Burnout, Empathy, and Attitudes Among Primary Physicians • Study of 70 primary care physicians using mindfulness meditation, self-awareness exercises, narratives about meaningful clinical experiences, appreciative interviews, didactic material and discussion. An 8-week intensive phase and a 10-month maintenance phase. • Conclusions:Participation was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care. Source: Krasner MS et al. JAMA September 2009; 302(12): 1284-93.

  46. Burnout in Medicine: Is There a Happy Ending? • Burnout must be acknowledged • The risks for burnout increase as control in the work environment decreases • The risks for burnout increase as support in the work environment decreases • Burnout is characterized by high emotional exhaustion, high depersonalization, and low personal accomplishment

  47. Burnout in Medicine: Is There a Happy Ending? • The symptoms of burnout include fatigue, insomnia, headaches, and deterioration in relationships with family and friends • The medical consequences of burnout include hypertension, myocardial infarction, depression and colitis • The social consequences of burnout include increased job turnover, alcoholism and drug abuse, and divorce • Starting a new position increases the risk for burnout

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