Physician Burnout: Resilience Training is Only Part of the Solution

First, I would like to thank Dr. Prunuske for his kind words. I certainly hope this will prove a useful framework for understanding, communicating, and solving the problems that lead to physician burnout.

Dr. Prunuske suggests that cross-learning between physicians and administrators may help us better understand that root causes of avoidable suffering and negotiate win-win scenarios that meet the needs of both groups. I couldn't possibly agree more. And I think a perspective article or point-counterpoint to help spark that discussion would be very useful.

In fact, when it comes to on-the-ground practice, I would go further. For years, the patient safety community has been arguing for the inclusion of all stakeholders in assessing risk and designing solutions to reduce patient harm. Healthcare systems are just too complex for one or two stakeholder groups to understand all the causes of problems or all the implications of what they hope will be solutions. The people who deliver care are just as worthy of that kind of effort.

Many of the problems that seem to lead to burnout are related to workflow, scope of practice, communication, documentation, technology, and culture [1-7]. These and other boundary-spanning challenges will require a whole-team approach that also includes nurses, allied health professionals, clerical workers, IT experts, and others --not just as participants, but also as beneficiaries of a process to redesign the healthcare system so that it bends to human constraints, instead of expecting humans to bend to the constraints of a broken system.

References:
1. 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; 30(8): 1105-1111.
2. 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.
3. Gidwani R, Nguyen C, Kofoed A, et al. Impact of scribes on physician satisfaction, patient satisfaction, and charting efficiency: a randomized controlled trial. Ann Fam Med. 2017;15(5):427-433.
4. Weidner AKH. Burnout and Scope of Practice in New Family Physicians. Ann Fam Med 2018;16:200-5.
5. Wright AA, Katz IT. Beyond Burnout -- Redesigning Care to Restore Meaning and Sanity for Physicians. NEJM 2018;378:309-11.
6. Downing NL, Bates DW, Longhurst C. Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? Ann Intern Med. 2018 May 08.
7. Card AJ. Physician burnout: Resilience training is only part of the solution. Ann Fam Med 2018;16. doi:10.1370/afm.2223

Competing interests: None declared