“Resilience” is a controversial term among physicians, many of whom feel using the word has become a way to assign blame for the negative psychological results of practice conditions over which no physician has control. (See our blog post Why Most Physicians Hate the Term ‘Resilience.’)
But what if we accept the term as Epstein and Krasner define it in a 2013 article in Academic Medicine—“the capacity to respond to stress in a healthy way such that goals are achieved at minimal psychological and physical cost; resilient individuals ‘bounce back’ after challenges while also growing stronger?” We can then see resilience as a concept with the physician’s best interest at heart and is key to avoiding the steep psychological and physical costs of burnout.
The AMA’s STEPS Forward™ curriculum isolates what it terms the “big 4” factors known to contribute to stress and burnout—the major roadblocks to resilience, as adapted from Linzer, Manwell and Williams’ paper “Working Conditions in Primary Care: Physician Reactions and Care Quality” in the Annals of Internal Medicine. These factors are systematic and can be impacted by the organization supporting a culture of well being:
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
“Providers who are unable to control their work are not able to balance the competing demands of the practice with their personal commitments,” the AMA writes. “This results in increased stress and eventual burnout.” Recommendations on the STEPS Forward™ site include:
1) Regular meetings between providers and administration to air and share concerns about workplace issues. Also, for the two groups to discuss their visions for the organization and how to ensure alignment.
2) Increased employment of medical assistants and medical scribes to reduce the time physicians spend documenting cases.
3) Pre-visit planning and pre-visit lab testing to create a more orderly patient flow through the clinic.
By recognizing the factors known to contribute to stress and burnout and following the suggested actions to impact and improve the systematic factors leading to stress and burnout, healthcare leaders can help their physicians be engaged, maintain healthy stress levels and reduce burnout.