Improve patient satisfaction, quality outcomes and provider recruitment and retention.

Preventing physician burnout

  • Mark Linzer MD, FACP Hennepin County Medical Center
  • Laura Guzman-Corrales, MPH Hennepin County Medical Center
  • Sara Poplau Hennepin County Medical Center
AMA in partnership with
CME Credits: 0.5
Preventing physician burnout

How will this module help me successfully eliminate burnout and adopt wellness approaches in my practice?

  1. Seven key steps to help you prevent provider burnout
  2. Ten-item survey designed to assist you in assessing burnout
  3. Examples of successful burnout prevention programs in a variety of practice/organization settings

CME accreditation information 

Increasing administrative responsibilities—due to regulatory pressures and evolving payment and care delivery models—reduce the amount of time physicians spend delivering direct patient care. Increasing responsibilities and stress can lead to physician burnout, which plagues 50 percent of practicing physicians. Burnout can have a significant impact on organizational productivity, morale, costs and the quality of care being delivered. By measuring and responding to burnout, physicians and their practices will be able to reduce sources of stress and intervene with programs and policies that support professional well-being.

Preventing physician burnout
Release Date: June 2015
End Date: June 2019

Objectives

At the end of this activity, participants will be able to:

  1. Establish provider wellness as a quality indicator that is regularly measured
  2. Start a wellness committee and appoint a champion
  3. Administer an annual ten-item wellness survey to assess burnout
  4. Initiate selected interventions to address existing burnout and determine approaches to refine and improve the interventions

Target Audience

This activity is designed to meet the educational needs of practicing physicians.

Statement of Need

Physicians face many stressors every day that can lead to burnout. In fact, burnout impacts half of practicing physicians. External stressors that can result in burnout include healthcare reform, Medicare and Medicaid policies, and unemployed and/or uninsured patients. Other stressors are internal, such as administrative demands of the practice, long work hours, on-call schedules, stress of losing a patient and concerns about medical malpractice lawsuits. Learning to mitigate and prevent stress will help reduce burnout rates. In turn, reducing or eliminating burnout can improve patient satisfaction, quality outcomes, provider retention and the overall practice environment. This module will help practices identify and correct sources of stress with interventional approaches to promote wellness and reduce burnout.

Statement of Competency

This activity is designed to address the following ABMS/ACGME competencies: practice-based learning and improvement, interpersonal and communications skills, professionalism, systems-based practice, interdisciplinary teamwork and quality improvement.

Accreditation Statement

The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation Statement

The American Medical Association designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claiming Your CME Credit

To claim AMA PRA Category 1 Credit™, you must 1) view the module content in its entirety, 2) successfully complete the quiz answering 4 out of 5 questions correctly and 3) complete the module.

Planning Committee

  • Rita LePard, AMA CME Program Committee
  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA
  • Krystal White, MBA, Program Administrator, Professional Satisfaction and Practice Sustainability, AMA

Author(s)

  • Mark Linzer MD, FACP, Division Director, General Internal Medicine, Professor of Medicine, Hennepin County Medical Center
  • Laura Guzman-Corrales, MPH, Sr. Project Coordinator, Hennepin County Medical Center
  • Sara Poplau, Assistant Director, Office of Professional Worklife, Hennepin County Medical Center

Faculty

  • Beth Averbeck, MD – Associate Medical Director, Primary Care, HealthPartners Medical Group
  • Mark Linzer MD, FACP, Division Director, General Internal Medicine, Professor of Medicine, Hennepin County Medical Center
  • Laura Guzman-Corrales, MPH, Sr. Project Coordinator, Hennepin County Medical Center
  • Sara Poplau, Assistant Director, Office of Professional Worklife, Hennepin County Medical Center
  • Patrick Alguire, MD, FACP, Senior Vice President, Medical Education, American College of Physicians
  • Eileen Barrett, MD, MPH, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, University of New Mexico
  • Linda Carruthers, RDN, LD, Registered Dietitian/Nutritionist, Licensed Dietitian, Mayo Clinic Health System
  • Susan Thompson Hingle, MD, FACP, Professor of Medicine, Southern Illinois University School of Medicine
  • Carrie A. Horwitch MD, FACP, Key Clinical Faculty, Virginia Mason Medical Center, Seattle, WA
  • Sean McKinney, Vice President, Medical Education, American College of Physicians
  • Christina Reimer, MD, FACP, General Internal Medicine, Colorado Health Medical Group/University of Colorado Health
  • Tait Shanafelt, MD, Professor of Medicine, Mayo Clinic
  • Ellie Rajcevich, MPA, Practice Development Advisor, Professional Satisfaction and Practice Sustainability, AMA
  • Sam Reynolds, MBA, Director, Professional Satisfaction and Practice Sustainability, AMA
  • Christine Sinsky, MD, Vice President, Professional Satisfaction, American Medical Association and Internist, Medical Associates Clinic and Health Plans, Dubuque, IA

About the Professional Satisfaction, Practice Sustainability Group

The AMA Professional Satisfaction and Practice Sustainability group has been tasked with developing and promoting innovative strategies that create sustainable practices. Leveraging findings from the 2013 AMA/RAND Health study, “Factors affecting physician professional satisfaction and their implications for patient care, health systems and health policy,” and other research sources, the group developed a series of practice transformation strategies. Each has the potential to reduce or eliminate inefficiency in broader office-based physician practices and improve health outcomes, increase operational productivity and reduce health care costs.

Disclosure Statement

The content of this activity does not relate to any product of a commercial interest as defined by the ACGME; therefore, neither the planners nor the faculty have relevant financial relationships to disclose.

Media Types

This activity is available to learners through Internet and Print.

Hardware/software Requirements

Adobe Flash 9.0.115 or above
Audio speakers or headphones
Screen resolution of 800X600 or higher
MS Internet Explorer 8.0 or higher, Firefox, Opera, Safari, etc.
Adobe Reader 5.0 or higher

References

  1. Linzer M, Manwell LB, Williams ES, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28‑36, W6‑W9.
  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work‑life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377‑1385.
  3. Shimotsu S, Poplau S, Linzer M. Validation of a brief clinician survey to reduce clinician burnout. Manuscript submitted for publication. 2015.
  4. Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5(11):1431‑1438.
  5. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990‑995.
  6. Linzer M, Poplau S, Grossman E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015.

Additional References

  1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573‑576.
  2. Daskivich TJ, Jardine DA, Tseng J, et al. Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows. J Grad Med Educ. 2015;7(1):143‑147.
  3. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well‑being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544‑1552.
  4. Grant AM. Give and Take: Why Helping Others Drives Our Success. New York, NY: Penguin Press; 2013.
  5. Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health. 1981;71(7):694‑705.
  6. Linzer M, Gerrity M, Douglas JA, McMurray JE, Williams ES, Konrad TR. Physician stress: results from the physician worklife study. Stress Health. 2002;18(1):37‑42.
  7. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29(1):18‑20.
  8. Schwartz T, Gomes J, McCarthy C. The Way We're Working Isn't Working: The Four Forgotten Needs That Energize Great Performance. New York, NY: Free Press; 2010.
  9. Sinsky CA, Willard‑Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high‑functioning primary care practices. Ann Fam Med. 2013;11(3):272‑278.
  10. Viviers S, Lachance L, Maranda MF, Ménard C. Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists. Can J Ophthalmol. 2008;43(5):535‑546.
  11. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714‑1721

Introduction

What is provider burnout?

Burnout is a long‑term stress reaction characterized by depersonalization, including cynical or negative attitudes toward patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients. By measuring and responding to burnout you will be able to:

  • Reduce sources of stress
  • Intervene with programs and policies that support professional well‑being
  • Prevent burnout
Burn out prevention introduction
Steven Lockman, MD

Burnout makes it nearly impossible for individuals to provide compassionate care for their patients.

Steven Lockman, MD, Senior Medical Director, Neurosciences, Orthopedics and Rehabilitation Service Line/Chief, Physical Medicine and Rehabilitation Hennepin County Medical Center, Minneapolis, MN

Seven steps to prevent burnout

  1. Establish wellness as a quality indicator for your practice
  2. Start a wellness committee and/or choose a wellness champion
  3. Distribute an annual wellness survey
  4. Meet regularly with leaders and/or staff to discuss data and interventions to promote wellness
  5. Initiate selected interventions
  6. Repeat the survey within the year to re‑evaluate wellness
  7. Seek answers within the data, refine the interventions and continue to make improvements
  1. 1

    Establish wellness as a quality indicator for your practice

    Encourage your clinic or organization to recognize the impact of burnout on providers as well as patients, the quality of care delivered and finances (e.g., through turnover). Establish provider wellness, which is the inverse of burnout, as a quality indicator that is regularly measured in your practice. Consider using annual burnout scores on the “mini Z” (see step 3) as a sign of the health of the provider workforce within your organization; if scores should slide, use the interventions described in step 5 to turn things around.

  • What factors can contribute to burnout?

    The “big 4” factors known to contribute to stress and burnout include1:

    1. Lack of control over work conditions
    2. Time pressure
    3. Chaotic workplaces
    4. Lack of alignment of values (around mission, purpose and compensation) between providers and their leaders
  • Why should my practice measure provider stress and burnout?

    Recent studies show a national burnout rate of 46 percent among physicians in practice,2 including private practice, academic medical centers and the Department of Veteran's Affairs (VA). With almost half of US doctors showing signs of burnout, and numerous adverse outcomes for physicians linked to burnout, it is an important issue for practices to address. Reducing burnout can have a positive impact on your practice, including higher retention rates, improved devotion to patients, better morale in the office and improved recruitment.

  • Why does control over the work environment matter and how does it contribute to burnout?

    Providers who are unable to control their work are not able to balance the competing demands of the practice with their personal commitments. This results in increased stress and eventual burnout.

    When work demands are balanced by work control (e.g., ability to control one's schedule), burnout is less. When demands are heavy, workers (in this case, providers) use work control to mitigate stress and avoid burnout. For example, providers who are also parents often need to adjust end‑of‑day and start‑of‑day schedules to allow for dropping off or picking children up at child care. Having control over their workday reduces the likelihood of burnout.

  • Why does burnout matter?

    Stressful work conditions and burnout can lead to the following practice issues1:

    • Increased clinician errors
    • Reduced empathy for patients
    • Reduced patient satisfaction
    • Decreased patient adherence to treatment recommendations
    • Increased physician intent to leave the practice
  1. 2

    Start a wellness committee and/or choose a wellness champion

    The wellness committee should be made up of providers (MDs, NPs and PAs) from various disciplines and administrators (finance, management) that can work with your practice or organizational leaders to periodically measure burnout. Members can then present data to providers and brainstorm solutions to challenges. The committee should plan to meet for about one hour a month to review current projects, plan new initiatives, discuss survey data and respond to new opportunities or stresses.

    If you have a solo or small practice, a wellness champion may be a better option. Wellness champions are individuals within an organization that promote the use of wellness resources, model positive behaviors such as leaving work on time and encourage employees to complete the annual wellness survey.

Talking points for leaders Download See all downloadable tools
  • Who should be on the wellness committee in my practice?

    All relevant practice stakeholders should be involved in wellness initiatives. This approach can work for many types of providers, including hospital‑based physicians, surgeons, non‑office‑based physicians and advanced practice providers (NPs and PAs). Depending on the size of the practice or organization, representatives can be drawn from different functional areas. Practice professionals will learn from each other and be able to spread findings and news throughout the organization.

  1. 3

    Distribute an annual wellness survey

    The 10‑item Zero Burnout Program survey,3 also referred to as the “mini Z,” is short and easy to use. Distribute this survey annually to all providers in your practice. The mini Z can be completed individually online below or with paper copies. Solo or small practices can also take the mini Z and use the data to improve the practice environment.

  1. 4

    Meet regularly with leaders and/or staff to discuss data and interventions to promote wellness

    Share mini Z data with practice/departmental leaders or office staff. Meet regularly to discuss the data. An easy way to share the results of the mini Z survey is to create a document with summary data for all respondents. After reviewing the data, identify the areas of greatest concern, either practice‑ or organization‑wide or by department. Based on the problem area(s), select appropriate interventions to address them. More information can be found in the article, "10 Bold Steps to Prevent Burnout In General Internal Medicine."

Preventing Physician Burnout - Step 4: Discuss data and interventions with leaders or staff to promote wellness
  • Should data be shared across the practice or organization?

    That is a choice the wellness committee or wellness champion will have to make. Some leaders may feel they are being attacked if their results are poor. Others may want to see where they rank compared to others. Sharing the data across practices provides an opportunity to introduce thoughtful and consistent programs throughout the organization to strengthen team culture.

  • What about naysayers who believe burnout doesn't matter?
    • Appeal to what they care about, including their experiences as a busy health care provider, administrator or patient. “Would you like yourself or your family members to receive care from a frustrated, cynical or angry provider?”
    • Emphasize the relationship between work conditions that lead to burnout, turnover and recruitment challenges. Replacing a single physician is estimated to cost over $250,0004
    • Provide evidence of the relationships between burnout improvement and beneficial effects on quality and safety in your practice
    • As burnout decreases, assess changes and present findings in key metrics, such as the patient experience, cost of care and staff productivity
  1. 5

    Initiate selected interventions

    Prioritize and select interventions to address burnout where it exists. Interventions may take one of three forms:

    1. Workflow redesign
    2. Better communication between providers in your practice
    3. Quality improvement (QI) projects targeted to clinician concerns
    Tactics to reduce burnout Download See all downloadable tools

    Workflow redesigns to reduce burnout may include: pairing nurses or medical assistants (MAs) with physicians in stable relationships, improving preparation and organization and pre‑visit planning with pre‑visit labs, sharing tasks with non‑physician staff, including having MAs enter patient data into the EHR and altering workflow between MAs and appointment coordinators. You may also consider if the time allotted for daily visits, procedures or bedside inpatient care in your practice is insufficient or if it is causing time pressure for your providers. Please see other STEPS Forward™ modules for suggestions to improve workflow in your practice.

    Communication intervention projects could include: co‑location of key team members (e.g., nurses/medical assistants and providers), daily huddles to discuss complex patients and care coordination and scheduling monthly provider meetings focused on either work‑life issues and personal challenges or difficult patient care management issues. Please see other STEPS Forward™ modules for assistance with improving communication in your practice.

    Targeted QI projects could include: a streamlined prescription renewal process, screening patients for depression, employing clerks instead of clinicians to track forms and send faxes, presenting mini Z data in an open forum to prompt discussions of issues within the practice and hypertension or pre‑diabetes management programs. Please see STEPS Forward™ modules on hypertension and pre-diabetes for guidance on QI recommendations in these areas. Table 1 summarizes interventions performed as part of the Healthy Work Place (HWP) study conducted by Mark Linzer, MD, and colleagues.3 Many of these interventions are the foundation for the recommendations in this and other STEPS Forward™ modules.

Table 1. Examples of interventions to reduce burnout in your practice.*
Workflow Communications Targeted Quality Improvement (QI) Other
Shift to MA entering data into EHR instead of physician. Covered in team documentation Improved interpersonal communication and teamwork. Discussed in team meetings Implementing a hypertension management program Implementing panel management
Better patient flow through the clinic enabled by pre-visit planning including pre-visit laboratory testing Improved opportunities for informal communication among providers, such as a shared lounge or periodic shared meals. Reviewed in team culture Establish quality improvement projects for issues of importance to providers Dashboard of patient population measures for clinicians
Sharing information to make the clinic more efficient Monthly formal discussions on patient care for clinicians to improve collegiality Freeing time for nurses and physicians by implementing synchronized prescription renewal Presentation of wellness data to prompt discussions on changing the clinic environment
Assess workflow between MAs and nurses to identify opportunities for change. Discussed in expanded rooming and discharge protocols Informal survey of clinicians for a ‘wish list’ of issues to be corrected Implementing a pre-diabetes management program
More time for nursing/MA staff to complete tasks Sharing organizational updates with monthly email or meeting with leaders Implementing processes to improve medication adherence
Pairing one MA with each attending physician. Described in expanded rooming and discharge protocols Clinicians meeting individually with leadership to review operations and identify concerns PDSA program for patient portals. Discussed in Lean management
EHR=Electronic Health Record; MA=Medical assistant; PDSA=Plan, Do, Study, Act quality improvement program

*Adapted with permission from: Linzer M, Poplau S, Grossman E, et al. A cluster randomized trial of interventions to improve work conditions and clinician burnout in primary care: results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015 Feb 28 [epub ahead of print].

Your practice may also consider developing a resource list detailing how individual practitioners can reduce burnout through time management, delegation, exercise, sleep and mindfulness. Please see the resiliency module.

  • Should self‑care interventions be included to reduce burnout?

    Yes, self‑care is an important tool that providers in your practice can use to reduce their individual stress levels and prevent burnout. Some self‑care interventions include meditation, getting enough sleep, a regular exercise routine, engaging in other hobbies or taking mini‑breaks throughout the day in a quiet space to decompress. Please see the resiliency module for more details.

  • What are the benefits of addressing burnout?

    By addressing burnout clinics are more likely to achieve other organizational goals, such as better recruitment, higher retention, better quality of care and improved patient safety. A model of burnout prevention is highlighted below:

    Figure 1. Conceptual model of the quality improvement feedback look to prevent physician stress, burnout and turnover.

    Adapted with permission from Linzer M, Levine R, Meltzer D, et al. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29(1):18‑20.

  • Will these interventions cost money?

    Yes, some interventions do have costs associated with them. But burnout is likely to be even more costly to your organization or practice. Each provider who leaves the practice costs money and adds stress to remaining providers. This finding suggests that investing money now to reduce physician stress and burnout could provide significant return on investment down the road.

  • Are the interventions all expensive?

    No, many are very inexpensive. Re‑engineering schedules for provider‑parents and making team meetings more productive are examples of inexpensive interventions. However, some needed interventions to reduce chaos, such as additional exam rooms for more efficient use of provider time, require resource investment.

    Another low cost intervention is discussing clinic or departmental values. Lack of values alignment with leaders is a known contributor to stress and burnout, and by making time to discuss and agree on shared values, you can alleviate this source of stress.

    For example, begin staff meetings with an interesting case and allow time for group discussion. Providers chose this profession for the medicine! Discussing rare or interesting cases can re‑energize your providers and help them reconnect with the joy of practicing medicine. Another free option is to create a list of values that your practice deems important. This exercise can be valuable even in a solo practice. Consider starting with a short menu to expand upon, such as:

    • Excellence
    • Equity
    • Respect
    • Advocacy
    • Quality over productivity
    • Work‑home balance
    • Compassion
  • I've heard people talk about “meetings with meaning.” What are they and how can I use them as an intervention?

    Clinicians have limited time to meet. Research indicates that restructuring meetings to address clinical cases or challenging patients and issues of concern to them, rather than administrative issues, is a successful way to reduce clinician stress. These restructured meetings are called “meetings with meaning.”

  • What is “career fit” and how can that help providers?

    Shanafelt et al. define career fit as the extent to which an individual is able to focus their effort on the aspect of work that they find most meaningful.5 Physicians often have a particular passion they wish to pursue (e.g., education, research, QI). Researchers at Mayo Clinic have shown that when the amount of time a physician has to pursue what they are passionate about falls below 10 to 20 percent, burnout rises dramatically from 29.9 percent to 53.8 percent.5 Physicians may decide to devote part of their work week to what interests them most, be it workflow improvement or improving communication in the office.

  • Can burnout be helped by community service?

    Providers who are burning out may benefit from leading community service programs outside of the clinic, such as providing health education for children or adults. Studies have shown that community service can substantially reduce burnout, as it brings people closer to their true values and mission in medicine.

  • What kind of interventions work for providers with very high burnout?

    Add a comment box on the survey for those respondents that have the highest burnout score (5 on the 5‑point scale, “I am so burned out I cannot go on…”) so that they can provide more information about reasons they are burned out. List a telephone number directly on the survey for the person to call for help, for example, the “Employee Assistance Program,” human resources or a member of the wellness committee. Alternatively, if you do not survey anonymously, you can let individuals know that you will be contacting those that indicate very high burnout.

  1. 6

    Repeat the survey within the year to re‑evaluate wellness

    Compare stress and burnout scores from before and after intervention. Use a simple spreadsheet or graph to show changes in stress levels, burnout, satisfaction, control over work, chaos and alignment of values (if applicable) over time. Develop an understanding of what worked and celebrate those successes. Examine factors that saw no change or a rise after intervention and seek remediable explanations.

  1. 7

    Seek answers within data, refine the interventions and continue the improvements

    Determine which interventions are working; refocus on those interventions and reinvigorate staff to carry them out. In areas where burnout is increasing or observed improvements are not sustained, analyze the mini Z results to guide new or modified interventions. The commitment of the wellness committee or wellness champion to the wellness interventions will help convince providers that your practice is dedicated to staying on a path to reduce burnout.

;

Wellness interventions work

Improving workflows within the practice is the most powerful antidote to burnout. This approach increases the odds of reducing burnout six‑fold.6 Targeted quality improvement projects addressing clinician concerns increase the odds of reducing burnout five‑fold.6 Improving communication between team members can improve the odds of professional satisfaction up to three‑fold.6 Please see other STEPS Forward™ modules for guidance on practice redesign to improve workflow, communication and practice culture.

+ More

Celebrate successes

Try not to embarrass or blame people with negative findings. Be supportive and encourage improvement. Congratulate leaders on successful steps they have taken and provide additional concrete actions they can take. Be creative with them in seeking ways to improve their department, unit or practice. Function as a liaison with clinic administration to find best practices and advocate for bigger organizational or practice changes when they are needed to make a difference for individual departments or units.

+ More

Change is slow and steady

Don't try to move the needle too far too fast. Patience is needed to make sustained work‑life improvements. Small improvements can make a difference in the day‑to‑day work lives of physicians, so do not be discouraged if you cannot make big changes right away.

+ More

The unsolvable can be solved

Don't be intimidated or discouraged by your challenges. Ask your colleagues for possible solutions. You may find that the problem has been discussed and solutions have been identified but not shared across the practice. Be creative when looking for partners. Don't forget you could have allies in departments/units such as Finance and Billing, Environmental Services or Quality Improvement. Every unit/person will see the problem from a different perspective so seek to understand what they see and how they'd fix it.

+ More

Don't be afraid to create new work schedules

Consider alternative clinical structures, such as “7 days on, 7 days off,” even for predominantly ambulatory providers. At Hennepin County Medical Center (HCMC) in Minneapolis, MN, graduating residents suggested a 7‑on, 7‑off model to encourage careers in ambulatory medicine. HCMC took their advice and developed a model program for new faculty hires. They've since hired two physicians and three nurse practitioners to join the two full time clinicians with the 7‑on, 7‑off work schedules. The work schedule includes atypical work hours, but the providers have a week off in‑between. They are leading the organization in certain aspects of innovation, such as measuring the impact of scribes and problem‑oriented charting on quality of care, provider satisfaction and clinic finances.

The creation of a Provider Wellness Program at HCMC demonstrates that we recognize that the well‑being of providers is critical to the health and wellness of our patients. Small changes that come from the suggestions of providers can be hugely impactful and strengthen the unity of the care teams, thereby improving the quality of care and satisfaction of patients, families and providers.

Suzanne Schwartz, MS, Director of Operations
Hennepin County Medical Center, Minneapolis, MN
Suzanne Schwartz, MS
+ More

If you standardize, customize

Remember to adjust standard work for complex lives. Most busy provider schedules don't fit comfortably in four‑hour boxes (8 a.m. to noon, 1 to 5 p.m.). Allow for flexibility, especially around the beginning and end of work shifts.

+ More

Conclusion

Provider stress and burnout can have a significant impact on organizational productivity, morale, costs and the quality of care being delivered. This module will help you take corrective action early by identifying sources of stress and developing interventional approaches that will help your organization reduce burnout and promote wellness.

Burn out prevention conclusion

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References

  1. Linzer M, Manwell LB, Williams ES, et al. Working conditions in primary care: physician reactions and care quality. Ann Intern Med. 2009;151(1):28‑36, W6‑W9.
  2. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work‑life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377‑1385.
  3. Shimotsu S, Poplau S, Linzer M. Validation of a brief clinician survey to reduce clinician burnout. Manuscript submitted for publication. 2015.
  4. Buchbinder SB, Wilson M, Melick CF, Powe NR. Estimates of costs of primary care physician turnover. Am J Manag Care. 1999;5(11):1431‑1438.
  5. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10):990‑995.
  6. Linzer M, Poplau S, Grossman E, et al. A Cluster Randomized Trial of Interventions to Improve Work Conditions and Clinician Burnout in Primary Care: Results from the Healthy Work Place (HWP) Study. J Gen Intern Med. 2015.

Additional References

  1. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573‑576.
  2. Daskivich TJ, Jardine DA, Tseng J, et al. Promotion of wellness and mental health awareness among physicians in training: perspective of a national, multispecialty panel of residents and fellows. J Grad Med Educ. 2015;7(1):143‑147.
  3. Dunn PM, Arnetz BB, Christensen JF, Homer L. Meeting the imperative to improve physician well‑being: assessment of an innovative program. J Gen Intern Med. 2007;22(11):1544‑1552.
  4. Grant AM. Give and Take: Why Helping Others Drives Our Success. New York, NY: Penguin Press; 2013.
  5. Karasek R, Baker D, Marxer F, Ahlbom A, Theorell T. Job decision latitude, job demands, and cardiovascular disease: a prospective study of Swedish men. Am J Public Health. 1981;71(7):694‑705.
  6. Linzer M, Gerrity M, Douglas JA, McMurray JE, Williams ES, Konrad TR. Physician stress: results from the physician worklife study. Stress Health. 2002;18(1):37‑42.
  7. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 bold steps to prevent burnout in general internal medicine. J Gen Intern Med. 2014;29(1):18‑20.
  8. Schwartz T, Gomes J, McCarthy C. The Way We're Working Isn't Working: The Four Forgotten Needs That Energize Great Performance. New York, NY: Free Press; 2010.
  9. Sinsky CA, Willard‑Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high‑functioning primary care practices. Ann Fam Med. 2013;11(3):272‑278.
  10. Viviers S, Lachance L, Maranda MF, Ménard C. Burnout, psychological distress, and overwork: the case of Quebec's ophthalmologists. Can J Ophthalmol. 2008;43(5):535‑546.
  11. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714‑1721.

STEPS in practice

Case 1

How's it working in Boston?

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Case 2

How's it working in Redwood City, CA?

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Case 3

How's it working in Minneapolis?

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Case 4

How's it Working in Palo Alto, CA?

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Case 5

How's it working at Adventist Health System?

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Case 6

How’s it working in Minneapolis?

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Tell your story

Have you implemented your own idea and want to share it with the community or suggest a module?


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Downloadable tools

Go to Resource Library

The tools and resources here can offer implementation support for your practice. You can download and modify them to fit your specific needs.

Complete burnout toolkit

Access all tools and resources for this module.

Download

(ZIP, 2,295 KB)

Module Completion

Individual tools

  • Preventing physician burnout module

    Download a printable PDF version of this module.

    Download

    PDF, 724 KB

    Preview
  • Preventing physician burnout PowerPoint

    Use this PowerPoint presentation to review this module with your team.

    Download

    PPT, 1,356 KB

    Preview
  • Mini Z Survey

    This is the printer-friendly version of the Mini Z survey found in the module.

    Download

    MS WORD, 37 KB

    Preview
  • Talking points for leaders

    These tips will help you encourage leadership to support provider wellness efforts.

    Download

    MS WORD, 38 KB

    Preview
  • Tactics to reduce burnout

    Use these tactics to reduce burnout in your practice.

    Download

    MS WORD, 39 KB

    Preview
  • Zero burnout program survey for clinicians

    This in-depth survey will identify sources of stress and burnout for clinicians.

    Download

    PDF, 353 KB

    Preview
  • AMA Wire - Physician Burnout

    Article adapted from the AMA Wire® that summarizes the STEPS Forward module on Physician Burnout.

    Download

    PDF, 141 KB

    Preview

Implementation support

The AMA is committed to helping you implement the solutions presented in this module.

If you would like to learn about available resources for implementing the strategies presented in this module, please call us at (800) 987‑1106 or send us a message.

Implementation Support

Share your story

Let us know what's working and what's not working - how can we help you?

Contact us

Connect with a practice consultant

Adopting new practices can be challenging. Connect with a consultant who can guide your team through implementation.

Find a consultant

Email the module "[Module Title]"

Obtaining CME credits with STEPS Forward

AMA PRA Category 1 Credit™ will be available for the activity. Physicians should claim only the credit commensurate with the extent of their participation in the activity. In order to claim AMA PRA Category 1 Credit™, you must: 1) view the module in its entirety, 2) successfully complete the quiz by answering 4 out of 5 questions correctly and 3) complete the evaluation.

Already completed this module?

If you have already completed this module, you can claim AMA PRA Category 1 Credit™ or receive a certificate of participation through the AMA Education Center.

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