Dr. Karim Awad, Chief of Sleep Medicine at Atrius Health, understands clinician burnout on an intimate level—he’s experienced it himself.
“For me, it was really about just feeling exhausted, and I debated whether I should just leave medicine,” says Dr. Awad. “I went through a lot of what doctors and others experience as burnout.”
Fortunately, Dr. Awad was able to tap into a reservoir of resiliency. So, when Dr. Steve Strongwater, President and CEO of Atrius Health, approached Dr. Awad about starting an initiative to address clinician burnout, he knew he had to accept. He became the Medical Director of Clinician Wellness in 2017 to start a program that supports Atrius Health clinicians in combatting this mental health problem.
Nationally, up to 45 percent of healthcare providers develop burnout at some point in their careers—a period of feeling extreme exhaustion linked to overwork or a sense of depersonalization from relationships at work. Many factors contribute to clinician burnout, but a key ingredient is the chipping away at a clinician’s built-in resiliency.
Between national and individual state documentation requirements, organization-specific demands, constant upkeep of the electronic medical records, and the day-to-day stresses of a clinician’s personal life—it’s not surprising that some doctors feel like they’re falling behind.
The hidden costs of burnout have been estimated to cost $4.6 billion annually in the U.S., according to a nationally recognized article in the Annals of Internal Medicine (1) that Dr. Awad co-authored.
Modeling its approach after a system devised at Stanford Medicine, the program at Atrius Health tackles clinician burnout using a framework of three areas: efficiency of practice, culture of wellness, and personal resilience.
Efficiency of Practice
To address efficiency of practice, Dr. Awad has teamed up with staff in Atrius Health’s information technology department and physician leadership to create a new way of managing the day-to-day tasks that make high-quality patient care possible. This digital approach is particularly unique—while many clinics around the country are attempting to address burnout, Atrius Health is one of the few to do so by actually changing the way things are done on an organizational level.
“For every hour that a doctor is face-to-face with a patient, he or she spends two hours in clerical work that doesn’t necessarily have to be done by a doctor,” he says. To make this work more efficient, Atrius Health has co-developed an automated way to do prescription renewal and test result management for certain medications. This has been launched across a number of Atrius Health practice sites already, leaving clinicians more time to focus on patients. Other initiatives have focused on improving providers’ use of the electronic medical record and streamlining in-baskets.
On the non-technical side, Dr. Awad and his team are facilitating the redesign of how individual internal medicine teams function through an initiative called Local Practice Improvement.
“We help each team do their own process improvement, working collaboratively with their nurses and medical assistants,” he says. “We’ve been able to reduce burnout by 50 percent by helping people remove their daily impediments to smoothly providing care to their patients.”
Culture of Wellness
The Clinician Wellness team has developed other programs to address the culture of wellness. Clinician Leadership Development coaching sessions teach department chiefs how to better engage frontline clinicians in departmental decision making. This has already led to improved levels of professional fulfillment in both chiefs who’ve taken the classes and their clinicians.
Another way Atrius Health is improving the “Culture of Wellness” is increased connection with colleagues.
“Medical practice has really changed in recent decades. Nowadays, we spend a lot of time behind the computer screen and we have little interaction during the day with our colleagues except by messaging,” says Dr. Awad. “Sometimes I’ll have doctors with whom I’ve been interacting for years who I’ve never actually met.”
A number of well-designed social events throughout the year enable the collegiality that helps clinicians find companionship with others who share their mission and issues. In one forum that is set up to mimic a “speed dating” event, primary care clinicians talk one-on-one with specialists that they don’t usually get to meet in person. The Facilitated Dinner Program gives clinicians a stipend for a group dinner where they discuss a question about an aspect of their practice while dining. Through these events and special meetings for different subgroups of care providers, Dr. Awad and his team have helped more than 225 clinicians connect with their colleagues since 2018.
Personal Resiliency
The last bucket in the wellness framework deals with regaining the personal resiliency many clinicians lost while battling burnout. Atrius Health offers mindfulness seminars for continuing medical education credit and three-day Lead Yourself retreats where participants can focus on changing detrimental patterns that led to burnout.
The program has only been up and running since 2017, but initial results show a decrease in self-reported burnout by two percentage points from 2018 to 2019. Plans for more programs are in the works, including a system to recognize early signs of burnout.
Dr. Awad says, only partly in jest, “I know that I sleep better at night knowing that Atrius Health is working so hard to ensure that our clinicians are able to bring their whole selves to fully caring for our patients.”
(1) Dyrbye, L., Awad, K., Fiscus, L., Sinsky, C., & Shanafelt, T. (2019). Estimating the Attributable Cost of Physician Burnout in the United States. Annals Of Internal Medicine, 171(8), 600. doi: 10.7326/l19-0522
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