The practice environment is the most commonly referenced contributor to burnout for physicians. Drivers such as autonomy, workload, organizational culture, efficiency and resources can lead to burnout and exhaustion.
Pediatricians often report frustration with these barriers to quality practice and patient engagement. More than half report being very or moderately stressed by administrative duties of practice such as documenting patient information in the EHR or catching up on work at home.
"I feel the more we become employees and less physicians it gets harder. Many colleagues have simply gone part time instead of dealing with all of the work. I try to stay diversified–it works for me–I don't have my entire foot in one bucket but multiple buckets, giving me a variety in my practice as well as options in case one thing stops working for me or is causing me too much stress. If I was 100% clinical work I would have already quit but mix of clinical and non-clinical work has kept me in the game." – Pediatrician
Equitable work environments and our wellness
The pediatric workforce is becoming more diverse. However, inequities in the organizational culture and structure continue to contribute to increased stress and burnout. For example, female physicians report having less control over their day-to-day work, are compensated at a lower rate, experience more strain in the work-home balance, and are more likely to report burnout than their male colleagues (JAMA 2019).
Microaggressions are nonverbal and verbal slights or snubs that are often the behavioral manifestations of unconscious bias. Microaggressions occur daily. They may appear harmless but they can accumulate over the course of a day, week or career impacting individuals’ engagement in the work environment as well as their wellness.
- YouTube video: What’s Missing in the Physician Burnout Dialogue: Equity
- Gender Differences in Burnout
- PDF: 5 Tips for reducing your EHR related burnout
Compassion fatigue: Role of the organization
Compassion fatigue, also called vicarious or secondary trauma, results from giving high levels of energy and compassion over a prolonged period to those who are suffering, often without experiencing the positive outcomes of seeing patients improve. Symptoms may include sleep disturbances, intense emotional reactions, isolation, loss of morale, decrease in decision making. Compassion fatigue is different but related to burnout.
Organizational and department leaders should support staff after traumatic or adverse patient events. A practice or organization can:
- Offer respite space where staff can decompress after an adverse event or interaction
- Consider offering resources for depression screening, substance abuse, ect.
- Provide team meetings and debriefing discussions regularly
- Train staff on compassion fatigue
- Train supervisors in reflective supervision, motiviational interviewing
- Recruit staff who are trauma-aware and non-judgemental
Changing organizational culture can be difficult but not impossible. Below is an offering of strategies and resources you can apply within your organization. While exploring these resources, also remember:
- Assess the Problem: What issue do we need to solve?
- Build a Team: Involve leadership: Who can help you create change?
- Determine Areas of Focus: What needs to be changed to increase professional satisfaction?
- Evaluate: How will we know it was successful?
- Creating the Organizational Foundation for Joy in MedicineTM, AMA CME bearing module
- The Business Case for Investing in Physician Well-Being, JAMA Internal Medicine 2017
AAP Practice Transformation
Patients Over Paperwork
Centers for Medicare and Medicaid Services
American Academy of Pediatrics