EXPERT ANALYSIS FROM THE NORTHWESTERN VASCULAR SYMPOSIUM

CHICAGO (FRONTLINE MEDICAL NEWS) – Vascular surgeons are solidly within the top tier of surgical subspecialists in terms of risk for burnout, Joan M. Anzia, MD, observed at a symposium on vascular surgery sponsored by Northwestern University.

Joining them in this unwelcome company with an elevated rate of lower quality of life are trauma surgeons, urologists, and otolaryngologists, according to the results of a 9-year-old national study of burnout and career satisfaction among American surgeons that has served as a wakeup call for the profession ( Ann Surg. 2009 Sep;250[3]:463-71 ).

The good news for physicians, regardless of specialty, is that the major institutional stakeholders in U.S. medicine, have in the past few years come to recognize that physician burnout is a systemwide problem. It’s associated with abundantly well-documented increases in medical errors and malpractice lawsuits, impaired professionalism, reduced patient satisfaction, staff turnover, depression and suicidal thoughts, and motor vehicle crashes. And these stakeholders are eager to do something about it.

“This is where the biggest impact on burnout is going to be: institutional interventions to target the known drivers of burnout. Looking at nights on call, work compression, looking at the amount of time you guys spend in front of a computer documenting your EHR and your billing. Do you really need to do those things? You need help from midlevel professionals and others who can free you to practice at the top of your life, doing the work you love, which for most surgeons is being in the OR,” said Dr. Anzia , professor of psychiatry and behavioral sciences and the departmental vice chair of education at Northwestern University in Chicago.

The Society for Vascular Surgery is one of many professional specialty organizations that are focusing on the burnout problem. They are joined by the Association of American Medical Colleges, the Accreditation Council for Graduate Medical Education, the National Academy of Medicine, the Liaison Committee on Medical Education, the American Medical Association, and other interested groups.

“Since 2008, burnout rates in every specialty have increased by an average of an absolute 10%. That’s just remarkable, and it’s why people are very, very concerned,” noted the psychiatrist, who serves as the physician health liaison at Northwestern Memorial Hospital. In that capacity, she is frequently called upon to help physicians with the classic manifestations of burnout, including substance use disorders that arose as the practitioners tried to self-treat their burnout rather than seeking help.

A strong signal that the times are changing and physician burnout has become a front burner issue is that, in September 2017, Tait Shanafelt, MD, a prominent researcher in the field while at the Mayo Clinic – assumed the post of chief wellness officer at Stanford (Calif.) Medical Center, the first U.S. academic medical center to create such a post. Dr. Shanafelt was first author of that landmark American College of Surgeons’ commissioned study on burnout among surgical subspecialists.

“He reports only to the dean,” according to Dr. Anzia.

Why are vascular surgeons at such high risk for burnout? According to the Maslach Burnout Inventory , the leading psychological assessment tool for burnout, the syndrome has three main components: emotional exhaustion, a sense of loss of meaning in work, and feeling ineffective in one’s work. Studies show vascular surgeons often score high in all three domains.

Vascular surgeons’ work is extremely stressful. They average 20 hours per week in the OR, and almost 3 nights on call per week. They care for acutely ill patients and perform high-intensity, high-risk procedures in which unpredictable events are common.

“Work compression – not just workload, but facing multiple demands at once that you’re trying to balance – that’s one of the key drivers of burnout, and work compression is really common in vascular surgery,” Dr. Anzia noted.

In the national surgeon burnout study, younger surgeons and those with children still living at home were at increased risk for burnout. So were surgeons whose compensation was entirely based upon the Relative Value Unit system. The number of nights on call per week was another independent risk factor.

Dr. Shanafelt and his coinvestigators found that roughly 30% of respondent surgeons screened positive for depression, and 6.4% of the study population reported having suicidal thoughts within the past 12 months.

“We lose the equivalent of two to three medical school classes worth of physicians every year to suicide. And let me tell you: 98% of those folks, at the time they suicided, had major depression, which is eminently treatable. And the reason they weren’t treated was they, like most physicians, avoided treatment. They had difficulty accessing care. They were worried about stigma, life insurance, things like that. This is a huge problem which is mostly preventable, but we are not addressing it effectively,” Dr. Anzia said.

While institutional interventions aimed at the prevention of physician burnout such as spending less time on the electronic health record will have a major impact on the problem, thought leaders in medical education have come to realize that it also will be necessary to address the broader culture of medicine.

“There are so many implicit beliefs that every one of us grew up with, like ‘I work when I’m sick,’ or ‘I can work without sleep.’ All those things that we believe make us good physicians actually may not be entirely true,” the psychiatrist said.

She reported having no financial conflicts of interest regarding her presentation.

bjancin@frontlinemedcom.com

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