Carving Out Time to Prevent Physician Burnout: Q&A with Todd Albert, MD

North American Spine Society 34th Annual Meeting Highlight

Peer Reviewed

More than 50% of physicians in the United States report being burned out, and the vast majority are moderately or severely stressed, according to a presentation by Todd Albert, MD, at the North American Spine Society 34th Annual Meeting in Chicago, IL.1-3
Overworked physician with a clock in the foregroundMore than 50% of physicians in the United States report being burned out, and the vast majority are moderately or severely stressed. Photo Source: an accompanying Q&A session at the meeting, attendees asked Dr. Albert questions about burnout among spine care professionals, touching upon such topics as how to carve out time for self-care given the pressures to produce, the impact of cognitive scarcity on burnout, and whether disruptive physicians are actually burned out and should be helped rather than punished. Dr. Albert is Surgeon-in-Chief Emeritus at the Hospital for Spine Surgery (HSS), and Professor in the Department of Orthopaedics at Weill Cornell Medical College in New York, NY.

Question: There is a big conflict between the pressure to produce and perform and the time and resources required for self-care. How do you resolve this conflict?

Dr. Albert: I think you’re right that there is a conflict, but people who are healthy emotionally and take care of themselves are more productive. The key is figuring out how to carve out the time to be healthy. In the absence of doing that, productivity sags and mistakes go up, which is expensive.4 Every person who has figured out how to carve out time to meditate and exercise regularly without fail will say that they are better off now than previously when they were burned out.

Implementing programs to prevent burnout at an institution level is worthwhile, and if hospital administrators say they don’t want to spend money on such programs (the wellness initiative at HSS cost $1 million) they are mistaken, because they are going to lose up to $10 million a year due to the negative effects of burnout.

Question: In some military units and inner-city police departments, check-in sessions with psychotherapists are mandatory. Are you familiar with any places around the country that are doing that in medicine?

Dr. Albert: We’ve talked about check-in sessions, but never in the sense of mandating them. It is a little harder to mandate check-ins with a therapist in a not-for-profit institution, as opposed to the military setting.

Question: My institution also is fortunate in that we took the Maslach Burnout Inventory and scored very high, similar to scores at HSS. However, we share a common benefit that most academic physicians do not have, which is that we have some degree of autonomy and control. Do you know if Stanford University [which pioneered the first physician wellness department] made any structural changes in the way that the physicians control their own destiny? You can give people all the mindfulness, meditation, and self-care time, but what do you do when you are not controlling your own destiny?

Dr. Albert: Stanford was willing to pay a lot of money to create the wellness department and to recruit Tait Shanafelt, MD, who is an expert on the topic, as Chief Wellness Officer. This recruitment alone sends the message to employees that their health is incredibly important to the institution.

I don’t know if Stanford made any structural changes, but I know that Dr. Shanafelt has recommended incentives to participate in wellness programs, such as giving physicians higher bonuses if they participate in these initiatives.

Question: I’m on a committee at a hospital that deals with disruptive physicians. I often feel that there is a strong correlation between the disruptive physician and burnout. Yet, the disruptive physician tends to get punished for bad behaviors and goes down a pathway that is a lot different from a physician identified with burnout. Does your institution have a strategy for dealing with disruptive physicians?

Dr. Albert: We do now, but we didn’t always. And my first question to a disruptive physician is “Are you okay?” I explain that their behavior is not normal and that they are an outlier. And I say, “I want to make sure is everything okay in your home, are you having any other problems, is there something I can do for you?”

I believe that institutions should start with this approach instead of punishment. Yes, the physician should be punished, but they should be “punished” by having to go for help. And when you force people into to get help, it frame-shifts the conversation into “we want to help you.”

I agree with you 100% that of those disruptive physicians are having some kind of mental problem, or some kind of life issue.

Question: What I have found contributing to my burnout is other physicians who are not as well trained. There is a hot-potato effect when you are at the top of the food chain and are seeing a lot of people misdiagnosed—by radiology, neurology, physiatry—and going down the wrong treatment pathway, and then spine surgeons are left holding the patient. That is one thing we don’t talk about: trust of our fellow colleagues in other specialties that is contributing highly to physician burnout. You can exercise as much as you want and put your phone away, but sometimes I think our colleagues contribute to our burnout as much as patients do.

Dr. Albert: I think that is a very good point. Another extension of that theory is that things such as bundled payments and other payment models might cause some physicians to start referring out cases that might be a little more expensive—ie, more complicated and more problematic. In addition, another contributor to burnout is that our patients are more complex and sicker than in the past.

Question: Psychiatrists have high rates of work-life satisfaction and relatively low rates of burnout compared to other physicians.1 Importantly, psychiatrists in training are given time to talk about their experiences in the workplace. I’m wondering if engaging in activities such as sports, hobbies, exercise, and meditation [as proposed in physician wellness interventions] are really a proxy for giving physicians space to think about what they have experienced in the workplace and assimilate it, as opposed to being constantly bombarded with new things and not being able to process what has happened.

Dr. Albert: That is a brilliant point. Cognitive scarcity, which is the need to continuously make consequential decisions that create stress for physicians without time buffers, is one aspect of the mounting burnout epidemic in medicine. We don’t have enough time to assimilate all the things we are deciding about. And what you just described—giving people cognitive time—is the opposite of cognitive scarcity.

Question: I work in an environment where we lack autonomy and control, where you’re employed as a physician with one pay structure. We have a large physician wellness group and physician engagement group, and we just received our engagement scores back and they are incredibly low—way below 50%. And the messaging from the group is that they are trying to fix the problem, yet we continually have our autonomy control removed.

For example, the administration has added on 20% more patient slots on Fridays, which for many people was their administrative day, and has changed our vacation lag time. There is this direct conflict between what the C Suite is pushing, and the push to hire wellness teams and encourage engagement, but not actually backing up the physician leaders to help us accomplish these initiatives.

Dr. Albert: They’re talking the talk, but not walking the walk. It is a shame.

Updated on: 12/20/19
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Preventing Spine Surgeon Burnout and Suicide
Todd J. Albert, MD
Surgeon-in-Chief Emeritus
Professor of Orthopaedic Surgery
Hospital for Special Surgery
Weill Cornell Medical College

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