I want to thank all of our colleagues who took the time to read last month’s Progress Notes and offer suggestions on physician burnout. This topic occupies increasing amounts of both the medical and lay literature.
 
The spring issue of Physician, the magazine of the Pennsylvania Medical Society, had a feature article on “Life in the Balance.” In Pennsylvania, over 82 percent of physicians report signs of burnout. In a large national sample, nearly 50 percent self-report being burned out. Sadly over 400 physicians take their own lives every year.
 
Several physicians reported a common theme: that the demands of caring for others supplant opportunities to care for oneself. Dual professional families, the added financial stress of student loans and failure to celebrate meaningful work well done contribute to emotional exhaustion and depersonalization. The PAMED website even has a section on physician burnout.
 
The article suggests ways to mitigate the stress and isolation, with avenues to get help and support. Many suggestions from our readers centered on team-based care and reinforced protected time away from duties. Some of you commented on feeling better after complaining about the current situation.
 
Increasingly our collegiality is challenged by distance, and our conversations are replaced by electronic communication. The PAMED article includes a report on online connections and community to foster camaraderie and shared experience. We have explored the idea of creating a virtual doctors’ dining room. I am old enough to remember the actual doctors’ dining room at LGH, and while few problems were solved there, the catharsis was therapeutic. Now no one has time to eat, let alone go to a dining room.
 
We heard from you that team-based care helps with professional burdens. Successful teams feature role clarity (standard work), free communication (visibility and transparency), shared efforts (goals) and making a difference (recognition). Many studies report that expressing gratitude benefits all.  Teaming does not happen by chance, requires investment and will continue to be a larger part of our duties. 
 
Several local practices have had positive experiences with this approach, and we plan to feature them in upcoming Progress Notes stories. Within your team, find the pain points and explore what can be done to change them. In Atul Gwande’s book, “Better,” he advises, “start by counting something if you want to improve it.”
 
At our recent kickoff of the Seventh Physician Leadership Academy, Dr. Greg Shea from the Wharton School spoke about change fatigue and resilience. In his words, healthcare change will continue to accelerate, the work will never be done and the task list will never be finished. He suggested finding strength and renewal in those activities rooted in the purpose of the profession -- why we did this -- and give them focus. Make sure they are part of your daily routine, and seek out others to share the burden whenever possible. 
 
I wish I had better answers. Thank you for sharing yours.

Monty

Lee M. Duke II, M.D.
Chief Physician Executive
Progress Notes' Editor-in-Chief
LMDuke@lghealth.org

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