1. Barbara Lee Bass MD, FACS Houston Methodist Hospital
Burnout Protection
Barbara Lee Bass MD, FACS
Houston Methodist Hospital

2. Burnout: work environment stress
Emotional exhaustion
Cynicism: depersonalization
Poor personal accomplishment assessment

3. Slide 2
This year's Medscape survey, echoing other recent national surveys,[1,2] strongly suggests that burnout among US physicians has reached a critical level. Burnout in these surveys is defined as loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment. In this year's Medscape report, the highest percentages of burnout occurred in critical care, urology, and emergency medicine, all at 55%. Family medicine and internal medicine follow closely at 54%. Surgeons fall toward the middle at 51% and are tied with ob/gyns and neurologists. In last year's report, the highest percentages of burnout were in critical care (53%) and emergency medicine (52%). Of note, however, burnout rates for most specialties are higher this year than last, although surgeons reported only a slight increase in burnout rate from 50% in the 2015 Lifestyle Report. A survey published in the Mayo Clinic Proceedings compared burnout between 2011 and 2014 and observed an increase in the percentage of physicians reporting at least one burnout symptom from 45.5% to 54.4%.[1]

4. Burnout: factors Work burden: Lack of “control” Work hours: on call
Residents
Resources
Errors
Work:home conflicts

5. Table 1. Consequences of Physician Stress and Burnout
Professional
Poor judgement in patient care decision making
Hostility toward patients
Medical errors
Adverse patient events
Diminished commitment and dedication to productive, safe and optimal patient care
Difficult relationships with coworkers
Disengagement
Personal
Depression
Anxiety
Sleep disturbances and fatigue
Broken relationships
Alcohol and drug addictions
Marital dysfunction and divorce
Early retirement
Suicide
Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences. Balch CM, Freischlag JA, Shanafelt TD. Arch Surg Apr;144(4): doi: /archsurg

6. Slide 4
In this year's Medscape lifestyle survey, as in previous years, more female surgeons (58%) expressed burnout than their male peers (49%). Of note, these percentages have trended up in general for both male and female physicians since this question was first asked in Medscape's 2013 survey. Among surgeons, burnout has also increased between 2013 and 2016 among men (from 39% to 49%). Burnout in women increased dramatically between 2013 and 2015 (from 43% to 59%) and then held steady, decreasing only from 59% to 58% this year.

7. National Survey of Burnout Among US General Surgery Residents
Elmore, Jefffe, Jin, et al JACS, 2016

8. What are we to do?

9. Recognize the signs
In ourselves
In those around us

10. Recognition Self reflection for Change in yourself Emotionally drained
Exhausted
Irritable
Loss of confidence
Loss of interest
Separation from loved ones

11. Tools for burnout Professional Organizational Practice environment?
Suicide
Depression
Withdrawal
Organizational
Schools
Teaching institutions
Surgical societies
Practice environment?

12. Institutional supports
Maternity leave policies
On site child care
Professional tolerance for flexible schedules
Team surgery
Salary expectations
Improved re-entry pathways

13. Tools for Burnout management
Self awareness

14. MINDFULNESS:
Awareness
Attention
Response
Enhanced awareness of self

15. MINDFULNESS Awareness Attention Response
Recognizing physiological signs of burnout
Heart rate
Breathing rate and pattern
Muscular tension
Fatigue

16. MINDFULNESS self and environment Triggering events Distressing factors
Enhanced awareness of
self and environment
Triggering events
Distressing factors
People
Tasks

17. Resuscitation: professional
Create boundaries between work and home
Know your values and goals for each
Work restructuring: part time?
People and place restructuring
Focus on aspects that are most satisfying

18. Resuscitation: personal
Know your comfort zones
Create actionable bliss points
Attention to physical wellness
Nurture relationships that matter
Be mindful of the passing of events

19. Changing your exposure to stressors
Incoming workload
Reevaluating your work environment
Reconsidering optional activities
Value of a given task
Creating personal infrastructure
Cleaning
Shopping
Family support activities
Keep the tasks you like!

20. Gendered gaps: empowerment
Stick together

21. Figure out you are not alone
Kevin MD writings
Stick together with happy folks
AWS
ACS
SSAT
ASBS
SSO
Avoid “optional” toxic environments

22. Dike Drummond MD: The HappyMD.com

23. Count our blessings

24. University of Virginia School of Medicine

25. Our founding mothers
Our founding mothers

26. Retool

28. Grace: January 24, 2013

31. Never, ever give up your snow days...