The past several years of healthcare reform have exacerbated stress for doctors. Paperwork already was a frustrating, time-consuming task that took providers away from patients. Electronic health record requirements from the Centers for Medicare and Medicaid Services added to that.
Other CMS programs have brought more scrutiny and added pressure for physicians to keep costs down. And doctors are asked to see more patients in less time. Doctors who see more patients per week report higher levels of burnout, according to a national study by TINYpulse, which helps track workplace issues like happiness and engagement. The study, released in March, also found that on a scale of one to 10, healthcare employees rate their work-life balance at 5.87, while all other industries average 7.02.
“Many of us work long hours, and we sacrifice time that we could be spending with our families in order to take care of others,” said Dr. Robert Richardson, elected president of the medical staff at St. Vincent Charity Medical Center, who acts as the physician representative on St. Vincent's board of directors.
To top it all off are the driven personalities the healthcare field often attracts. As a group, physicians are predisposed to burnout, Adan said, noting that many are compulsive perfectionists and can be guilt-ridden.
“The culture of being a physician doesn't emphasize at all taking care of yourself and emphasizes being superwoman or superman,” Adan said. “That all combined really puts them at risk of burnout.”
St. Vincent, like most hospitals, has a system in place to identify burnout. A health and wellness committee at the hospital investigates reports of physician impairment, including substance abuse, emotional problems or stress, Richardson said. The idea is not to punish them, but get them help.
The committee, which gets referrals from colleagues, supervisors or providers themselves, provides advice, support or treatment referrals.
Bob Smith is the director of MetroHealth's medical staff assistance program, which offers a free, confidential, on-site outlet where overwhelmed physicians can feel safe addressing their stress. Smith said when the program began three years ago there were significantly more supervisors referring physicians than self-referrals. In the past 18 months, that has flipped.
Though the portion of MetroHealth's medical staff accessing the program has remained steady, more and more are coming on their own, identifying they need support, which is an encouraging sign, Smith said.
Case Western Reserve University is looking for ways to get ahead of provider stress, said Dr. Steven Ricanati, assistant dean for student affairs at Case's School of Medicine.
He said as a pass/fail curriculum, fewer lectures and small-group, team-based learning helps promote collaboration over competition, which decreases stress. From the beginning, he wants students to understand that medicine is a team sport. When physicians work together, they have more support, give better care and are less likely to experience burnout, Ricanati said.
The school also works to identify stressed or overworked students and get them treatment, like university health services. Ricanati oversees one of the school's academic societies, which puts students into small communities to foster close relationships, which can offer support and help identify students who may be struggling.
And in an effort to prevent getting to that point, the school brings out therapy dogs before exams, offers yoga classes and encourages students to get together for social events. Some may sound silly, Ricanati said, but they are a small but important piece of preparing graduates to be flexible in a time of tremendous change for the healthcare industry.
McDonald, the trauma surgeon, presented at one of the panels that discussed the day the victims of the 2012 shooting at Chardon High School came into MetroHealth.
Years later, it still struck deep and strong emotions among presenters and the hundreds gathered. McDonald spoke about a case few heard of that day. While her colleagues worked to save the high school victims, she dealt with many other traumas, including deaths — in particular a 12-year-old boy who was shot. Despite immediate efforts to save the child, he died.
Since then, she has struggled with the conversation around that day. Everyone — the media, the public, hospital administration — wanted to talk about the Chardon victims and offer support for the emotional toll of that case, but no one asked her about the tragedy of the 12-year-old from Cleveland. “That was upsetting to me,” McDonald said. “Every life should be valued.”
She doesn't want attention for every case. It can become a distraction. And she understands, to an extent, why some make news and others don't. But she grieves for all lives, she said, and had a hard time reconciling the attention and discussion around one over another. This panel gave her a chance to discuss and deal with it.
For about a decade, the Cleveland Clinic has offered emotional support through Code Lavender, a service that sends interventions, such as counseling or spiritual care, to patients and caregivers. In a world where people see death and dying every day, it's a busy service, Boissy said.
Because physicians don't typically show vulnerability, creating a culture that promotes that is key after so many years of not acknowledging there was a problem, Boissy said. Cosgrove focusing on the issue at his State of the Clinic and beginning the town halls are good steps toward changing that culture and facilitating a conversation.
Keeping in touch with your emotions but managing them in a way that lets you remain effective is a difficult, but critical balance to maintain, said Dr. Alfred Connors, chief quality officer at MetroHealth. He recalled a time a medical student got embarrassed when he saw her crying after a family made a difficult decision to not take aggressive actions to revive their father if he died.
“I said, 'Don't be ashamed that you get emotional. This is very difficult,' ” he said. “ 'The day you should worry is when it doesn't bother you.'”