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Boosting physician wellness: Lessons from Stanford at Medicine X

In a small, informal workshop at Stanford Medicine X on Sunday afternoon, a group of medical students, doctors and others met to discuss one of the biggest problems plaguing health care today: physician burnout. By some measures, it affects more than half of all U.S. physicians — and that figure is growing.

"When you are burned out, you are really just trying to survive," said co-presenter Marisa (Mimi) Albert, a program director at Stanford Children's Health. Patient care and productivity plummet, affected doctors struggle to sleep or may grow angry and isolated. Relationships wither — or snap.  "We see this as really important to look at. It has not only a professional impact, but also a deep personal impact," she said.

She and Daniel Murphy, MD, a Stanford pediatric cardiologist shown above, shared some of the insights Stanford and Lucile Packard Children's Hospital Stanford teams have learned from their efforts to curb burnout. First, what it isn't: Burnout is not the lack of professional engagement and it isn't due to a mismatch in compensation, Albert said.

With a Stanford team, including psychiatrist Mickey Trockel, MD, PhD, they developed a model of professional fulfillment and physician well-being. Picture a circle, sliced into three pieces (this paper includes an image). One third is contributed by a "culture of wellness." Does your boss treat you with respect? Are your efforts acknowledged? Are you part of a supportive team?

Another third is "efficiency of practice." How much time do you have to spend feeding electronic medical records? Do you get to see your patients on time or are you having to work late every day? Do you have access to everything you need to do your job well?

The final third is "personal resilience." Murphy commented, "My favorite definition of resilience is the ability to imagine the possibility of improvement." This one is crucially important, but also tricky to convey, Albert and Murphy acknowledged.

Using a survey at Stanford, Murphy and colleagues found that the strongest predictor of burnout was low self-compassion. Self-compassion can be learned, he said, and self-compassion training could be one part of an overall strategy to reduce burnout.

Murphy and Albert also stressed that people who are burned out are not lost causes. "People do come back. It's not a permanent state," Murphy said. "There are things we can do for people and that people can do for themselves."

Stanford is striving to curb the rise of physician burnout. It started the WellMD center to spearhead efforts to boost faculty well-being. And it recently hired its first chief wellness officer, Tait Shanafelt, MD, who began work Sept. 1.

"The goal of the physician wellness program at Stanford is to develop programs and interventions not only for our own folks, but also those that can be used nationally and internationally," Murphy said. "I think it's going to spread beyond health care. Plenty of industries are affected by this."

WellMD is also a co-sponsor of the first American Conference on Physician Health, which will be held in October in San Francisco. It is sold out.

Previously: It's back! Stanford Medicine X returns to campus, Countering the problem of physician burnoutStanford study explores factors linked to burnout in NICU doctors and nurses and Stanford's "time banking" program helps emergency room physicians avoid burnout
Photo courtesy of Stanford Medicine X

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