Reigniting burned-out physicians

Despite training for years to take care of people, doctors often forget about one vulnerable population: themselves. This self-neglect is bad for patients, doctors, hospitals and the practice of medicine overall.

A voluntary program that's catching on in Colorado hospitals helps physicians build resilience and recapture the sense of fulfillment that led them to medicine in the first place. The methods are simple, but the participants say it has significant benefits for doctors and the hospitals where they work.

“What we are attempting to do is help physicians continue to thrive in what is an imperfect environment,” said Doug Wysockey-Johnson, executive director of a not-for-profit organization called Lumunos.

About eight years ago, Wysockey-Johnson, with the help of Dr. Dianne McCallister, then the chief medical officer of Porter Adventist Hospital in Denver, began developing Lumunos' colleague program for physicians. The idea is to rebuild collegial bonds among doctors to improve their well-being and help reduce burnout and its dangerous consequences. Burned-out doctors are more likely to make mistakes that harm patients, and doctors also are more likely than the general population to commit suicide.

Research indicates the problem is getting worse as doctors' responsibilities expand and pressures mount for them to adapt to using electronic health records and comply with a complex array of quality metrics. Burnout rates were higher among all specialties this year than in 2015, according to a Medscape survey of physicians.

The way Lumunos' program works varies by hospital, but all participants receive a weekly email designed to help them reflect on their work and their lives. The email, only a few paragraphs long, addresses a specific subject, such as how to say no to patients with compassion and clarity. About 350 physicians across all participating hospitals currently receive the email, Wysockey-Johnson said.

Those emails build to monthly 45-minute meetings led by a facilitator who keeps the conversation productive and focused.

“It's a safe place to give honest answers about medicine, patients, the business of medicine, where everything stays in the room,” said Dr. John McLaughlin, who has been a family practitioner at Aurora (Colo.) Medical Center for 22 years. “The moderator brings a good topic each time, with a lot of research behind it,” he said. “It's a fast hour.”

Some of the hospitals also hold evening dinner meetings every few months based on a model called Finding Meaning in Medicine developed by Dr. Rachel Naomi Remen, a professor at the University of California at San Francisco School of Medicine. A few hospitals also host annual retreats for doctors and their families.

The emails and meetings are limited to physicians. “The only time you get to be yourself is when you're with other physicians and with our facilitators,” McCallister said. “Even when you go to a party, people are showing you their moles.”

Today, six hospitals or satellites in or around Denver—the Medical Center of Aurora, its satellite Centennial Campus, the Littleton Adventist Hospital, Parker Adventist Hospital, Porter Adventist Hospital and the Sky Ridge Medical Center—have implemented various elements of the colleague program.

One hospital had used the program and did not renew its latest contract, a decision Wysockey-Johnson said was based partly on funding issues. He said as many as 10 other hospitals are interested.

Isolating and measuring the program's concrete impact on quality and safety is difficult, if not impossible, said Dr. Larry Wood, who retired last year as chief medical officer at Littleton Adventist. Still, he's convinced care is enhanced by the pursuit of improving wellbeing and reducing burnout. Physicians, he said, are more likely to make mistakes when they're stressed.

Another factor that makes it hard to measure the impact is that Lumunos targets physicians who are healthy and stable. “It's easier if you have a highly dysfunctional group of people to measure the effect of an intervention,” Wood said.

Wysockey-Johnson acknowledged that it would be valuable to have hard data, but he cited growing interest and enthusiastic feedback as signs that the program is working.

McLaughlin, the family practitioner in Aurora, said most physicians wonder at some point if the rewards of practicing medicine are worth the stress. “I think it was, but it's a much, much more stressful job than it was when I started.”

But monthly meetings were helping. “It always helps to know there's somebody else going through the same difficulties,” McLaughlin said. “When you really weigh everything, all the pros and cons, it's still a great job to be doing.”