In This Issue:
CHAD MORRIS, Ph.D., Director
Social wellness is something we have the opportunity, and often challenge, to personally define. We each develop our own unique way of reaching beyond oneself and finding connection. Therefore, this newsletter installment is one of my favorites. Whether it includes family, friends, community, or a kitten, team members share diverse ways they are creating social contentment. In our A Study in Wellness column, Christine presents some research on healthcare provider burnout. Medical students and other healthcare providers consistently tell our team how important their social life is in preventing burnout. Personally, I find that building social connection demands a great deal of patience. It has taken time and intentional effort to discover a community of friends that reflect who I am now, not ten or twenty years ago. Within this community, I am the most content when I dampen my more controlling, egoistic characteristics to allow for the spontaneity which kindles relationship. Of course, that doesn’t always happen. But I have been fortunate to find a creative group of human beings, and yes, a kitten, that encourage my growth. With this group, it is always fun to see what comes next. Enjoy!
Registration is open for our 2019
Motivational Interviewing for Behavior Change trainings!
Motivational Interviewing for Behavior Change – Level I: March 4 – 5, 2019
Motivational Interviewing for Behavior Change – Level II: July 29 – 30, 2019
A Study in Wellness
Physician Burnout: A Public Health Crisis
CHRISTINE GARVER-APGAR, Ph.D., Research Director
What is burnout? Burnout is a work-related syndrome involving emotional exhaustion, cynicism, and a sense of reduce personal accomplishment and effectiveness.1 It often arises from chronic stress associated with emotionally intense work demands, particularly when the resources to address those demands are inadequate. Rates of burnout are markedly higher among physicians than people in other careers, even after adjusting for work hours and other factors.2-3 In fact, recent national studies in the U.S. of both physicians-in-training and practicing physicians find rates of burnout symptoms reaching epidemic proportions – approaching or exceeding 50%.3-5
Why is it important? Burnout matters because it is associated with negative consequences for patient care (e.g. increased medical errors and malpractice suits), the physician workforce and healthcare system costs (e.g. reduced productivity and increased turnover), and for physicians’ own care and safety (e.g. increased risk of substance abuse and suicidal ideation).6-12
What can we do about it? Understanding factors which contribute to physician burnout offers clues to potential solutions. Both occupational factors and individual characteristics have been found to predict burnout among physicians and medical students, so the most effective solutions will likely combine both structural or organizational approaches as well as individual-focused approaches.13 Examples of organizational approaches include:
- Mitigating excessive workload by setting fair productivity targets and limits on work hours;
- Minimizing workplace inefficiency through the use of optimized electronic medical records and increasing non-physician staff support for clerical duties;
- Supporting flexible work schedules (including part-time employment) and respecting home responsibilities;
- Increasing physician autonomy through physician leadership, engagement, and shared decision-making;
- Prioritizing physician values by protecting physician time with patients, offering professional development opportunities, and addressing negative effects of productivity-based compensation formulas.
Examples of individual approaches include encouraging physicians to reflect on life priorities and values and attending to their self-care, offering stress management, resiliency and coping, and communication skills trainings, and promoting mindfulness techniques and strategies.
Most interventions to date have focused solely on individual factors, and although these interventions are associated with modest improvements in burnout symptoms, the drivers of burnout are largely rooted within healthcare systems and organizations.14 One of the reasons organizations are reluctant to take effective action is the belief that interventions to reduce burnout will interfere with other organizational objectives and/or be cost prohibitive. In fact, having an engaged physician workforce is vital to achieving organizational objectives, and many effective strategies are cost neutral.15
Wellness in Practice
CINDY MORRIS, Psy.D., Clinical Director
Meet Oliver. He’s the newest addition to our family. When we made the decision to invite a kitten into our lives, we knew that he would bring change, companionship, and love. He has brought all of these things and so much more. Often, we don’t think about our animal friends as supports to our social wellness. Or even as a pathway to growth, change, and mindfulness. Yet, he is all these things. Through my experience with Oliver over the last few weeks, I have come to realize that I underestimated the impact he has and will have on my life.
There are the changes in routine. It takes me longer to get ready in the morning. Food for Oliver and, of course, play. He gets underfoot, weaving between my ankles, seeking attention. If it doesn’t come in the way he wants, he discovers ways to occupy himself, tearing around the house, attacking inanimate objects (curtains, pillows, furniture), and biting anything he can get his mouth around. Then he comes back, his big blue eyes looking at me with a silent plea for a playmate. Sometimes I give in. Then I look at the clock and it prods me back to my other tasks. This can go on—for a while.
This dynamic helps me to be aware that I have lived with an imbalance between work and play. Whether I am actually doing work or set myself to tasks that look a lot like work, there isn’t much space in between when I focus on play. Play for the sake of pure pleasure without any goal or particular purpose. I catch myself thinking at times that I should be doing something else. Oliver’s persistent nudges—a paw tapping my leg, the vibration of his purring, or scratching on something he shouldn’t—brings me back to the present. I focus on how good it feels just to be in his presence. The impossibly soft feel of his fur. And share in his excitement to discover another new object in his environment.
Through his perspective, I’ve discovered a new definition of mindfulness in my life. I have a furry catalyst to remind me when I’m not present, and an important reason to slow down and enjoy the moment. Just because it feels good.
JIM PAVLIK, M.A., Program & Policy Analyst
My preference is toward silence and introspection. When I am presented the option of engaging with others, I tend to decline. A few years ago, my preference for solitude was exercised defensively and therapeutically—providing me a balance that worked for me in a world that frequently demanded engagement. Now with self-checkout grocery stores, self-order restaurants, online chat customer service, long silent commutes, and wireless headphones, we’ve built a world where nearly all social interaction is—or can be—voluntary.
To be clear, my introspective nature and associated social anxiety is not something I experience before events like dinner parties. I’m talking about any activity where normal social interactions might be expected. One example I’ve been thinking about a lot recently is taking my daughter to music class. The class itself is fine. During class, all my attention is on my daughter, singing along, encouraging her to clap her hands or stomp her feet. It’s the moments when I talk to the host before class or answer the “How old is she?”-type questions and other small talk with a half dozen other parents that I dread.
I feel about these moments as I do about certain elements of training for an endurance sport. I don’t like having to do it, but I really love having done it. I know it’s the right thing, especially for my daughter. I feel more engaged in various communities—my family, my geographic community, and my community of “other parents with young children.” Doing these things helps me find a place and a voice in those communities I wouldn’t have if I only observed the social interactions from a distance.
When I look across all my dimensions of wellness and try to spot imbalances, I have to be careful that my unwillingness to engage socially doesn’t turn into an inability to do so. Even though a little socializing goes a long way for me—fills my tank—so to speak, the right level for me is certainly above zero.
In the Flow
KATHIE GARRETT, M.A., Clinical Associate
In my dining room, beneath a lithograph of Hathor, Egyptian Goddess of motherhood and love, rests a small and humble cairn, or stack of stones. I have always loved to collect stones and I have several cairns in my house, each one a reminder of the importance of balance in essential areas of my life.
This cairn is by far my favorite. It represents my family. Each stone embodies either an individual family member or a unit. These stones require careful selection because each must be true to itself, complement the others, and support the structure and balance of this modest monument. My family cairn is dynamic. Slowly but ever changing, it reflects our family’s fluctuations and shifts over time. For instance, at one time, my own mother and my mother-in-law were represented by two vertical flat standing stones that sat atop the broad rock base of my ancestors. Our symbolic mothers, in turn, supported a horizontal flat two-toned clay rock that represented me and my husband. When my mom died, I chose a new base stone with just the slightest green hue, the color of her eyes, and she joined our fathers, grandparents, and long gone ancestors. This foundational stone reminds us of family traditions and patterns, both helpful and not, that inform our core values and way of being in the world.
With my mother’s symbolic transformation, the tall stone on the left, symbolizing my mother-in-law, stood like a lonely bookend, so that jewel was retired and replaced by a small bowl like pink stone, her favorite color, and a shape that better captures her steady role as a gentle and guiding source. She is the replenishing water in our lives and also a scout. Always a step ahead of us in this life, she creates a map of new frontiers. Likewise, my son’s stone, once a perfectly small, oval, contemplative black nugget resting at the cairn summit was eventually replaced by a pure, white bird egg of a river stone that perfectly captures my step grand-son’s innocent, free and turbulent spirit. He reminds us to wonder and take time to play. My son’s curious and introspective spirit merged with his wife’s powerful dancing energy and this union is now symbolized by flat bottomed, top rounded, verdant reddish brown stone. While my husband and I slow down, these two are so alive with possibility, building their careers and family. I feel energized just watching them and it is clear that they are now the fire in our family hearth.
I am looking at my family cairn lovingly and, in this moment, it is just right. However, even as I write this, our family is changing. My daughter-in-law is eight months pregnant with my new grandson and my 90-year-old mother-in-law is relocating from New England to Colorado to be closer to family in her waning years. My husband is newly retired and I can see my own retirement in the near distance. Soon, it will be time to adjust once again to changes in the constitution, order and balance of our family. I don’t yet know how it will look, in reality or in stone, and that does cause some discomfort, but I’m setting my intention now to stay in the flow, trusting that we will maintain balance. I’m also keeping a watchful eye out for the perfect combination of stones, composed of just the right properties, to sit in the protective shadow of Hathor, and convey the next chapter in our family story.
- Maslach C, Jackson SE, Leiter MP (1996). Maslach Burnout Inventory Manual, 3rd ed. Palo Alto, CA: Consulting Psychologists Press.
- Shanafelt TD, Boone S, Tan L, et al. (2012). Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med, 172, 1377-85.
- Shanafelt TD, Hasan O, Dyrbye LN, et al. (2015). Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc, 90, 1600-13.
- West CP, Shanafelt TD, Kolars JC (2011). Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA, 306, 952-60.
- Dyrbye LN, West CP, Satele D, et al. (2014). Burnout among U.S. medical students, residents, and early career physicians relative to the general U.S. population. Acad Med, 89, 443-51.
- Balch CM, Oreskovich MR, Dyrbye LN, et al. (2011). Personal consequences of malpractice lawsuits on American surgeons. J Am Coll Surg, 213, 657-67.
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- West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD (2009). Association of resident fatigue and distress with perceived medical errors. JAMA, 302, 1294-300.
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- West CP, Dyrbye LN, & Shanafelt TD (2018). Physician burnout: contributors, consequences and solutions. J Intern Med, 283, 516-529
- Dyrbye LN, Trockel M, Frank E, et al. (2017). Development of a research agenda to identify evidence-based strategies to improve physician wellness and reduce burnout. Ann Intern Med, 166, 743-4.
- Shanafelt TD, Noseworthy JH (2016). Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc, 92, 129-46.