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When we experience burnout or moral injury as physicians we may lose our ability to care for our patients compassionately and from a stance of cultural humility. Early work on physician burnout focused on individual factors contributing to burnout and individually focused solutions. Telling physicians to "do more yoga" feels like 'victim-blaming' if it is not clearly recognized and made explicit that burnout is largely due to systemic factors in medicine. This module explores both the individual and systemic factors which contribute to burnout and also considers the other side of the coin, resilience and wellness. What are your risk factors for burnout? What are your sources of wellness? What systemic factors have you encountered that contribute to burnout?

o Introduction | 8 minutes

Activities
Videos
Podcasts
Readings
Additional Resources

Activities

Part 1

Read Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level (2019) and write a brief reflection on the following questions:

What do you think of the author's modified Maslow Hierarchy, the figure in the article titled 'Health Professional wellness hierarchy'?
How do you think you are doing in regards to the levels: 'basics', 'safety', 'respect', 'appreciation' and 'heal patients and contribute'?
How do you anticipate this may change as you move through residency and into your career as an attending physician?
Think about your own level of burnout/moral injury and your own wellness practices. What is working well for you? What do you need more or less of?

Part 2

Choose 1 video or podcast from the collection provided and answer the following:

Which video or podcast did you select?
After reviewing, what struck you about what you viewed and how will this impact your future practice as a physician?

Part 3

Written reflection, discuss personal or individual and systems factors which contribute to burnout. Reflect on your own level of burnout using the Mini Z Burnout Survey from AMA.

Part 4

Small group discussion.

Videos

Physician Burnout: Stop Blaming the Individual | 10 minutes
Tait Shanafelt, MD | NEJM Catalyst

It’s time to start treating physician burnout as a system issue, not an individual one. Tait Shanafelt, Chief Wellness Officer for Stanford Medicine and former Director of the Mayo Clinic Department of Medicine Program on Physician Well-Being, lays out how during the NEJM Catalyst June 2016 event, "Leadership: Translating Challenge to Success."

How do we heal medicine? | 18 minutes
Atul Gawande, MD | TED Talk

Our medical systems are broken. Doctors are capable of extraordinary (and expensive) treatments, but they are losing their core focus: actually treating people. Doctor and writer Atul Gawande suggests we take a step back and look at new ways to do medicine -- with fewer cowboys and more pit crews.

Taking Care of the ME in Medicine | 15 minutes
Leslie-Ann Williams, MD, FACP | TEDxSaintThomas

Dr. Williams will discuss the disturbing trend of physician suicide and burnout. She will discuss the importance of physician wellness and discuss ways in which physicians can care for themselves. Her talk brings awareness, provides an outlet where listeners can identify themselves, and stimulates them to action where balance and self care put the ME back in MEdicine.

It's not burnout, It's Moral Injury | 6 minutes
Dr. Zubin Damania | ZDoggMD

It's time to stop the victim shaming...and call it like it is.

Are zombie doctors taking over America? | 20 minutes
Dr. Zubin Damania | TEDMED Talk

Physician Zubin Damania, Director of Healthcare Development for Downtown Project Las Vegas, has a plan to fight back against a system that can dehumanize doctors and patients alike.

How culture connects to healing and recovery | 14 minutes
Fayth Parks | TEDx Augusta

Conventional medicine minimizes cultural formulations as legitimate partners. However, there are connections between cultural practices and modern medicine. Passionate and insightful, psychologist Fayth Parks reveals how common elements in healing traditions connect a person to positive thoughts, feelings, and behaviors. Dr. Parks shares her personal journey and, from her research, an age-old blueprint for healing and recovery.

Doctors in Distress: Saving the Lives of Those Who Save Lives | 19 minutes
Dr. Ed Ellison | TEDx Naperville

Dr. Ed Ellison, leader of one of the world’s largest groups of physicians, pulls back the curtain on one of medicine’s most critical issues: Doctors are suffering. On a quest to enlighten society to the value of recognizing the humanity of our physicians, Dr. Ellison gets real and goes to the heart of the matter, offering a solution to this acute issue.

Why doctors kill themselves | 13 minutes
Pamela Wible | TEDMED

Founder of the ideal medical care movement Pamela Wible shares why, in order to heal patients, physicians must first heal their profession – and what can happen if they don’t.

Listening to Shame | 21 minutes
Brene Brown | TED

Shame is an unspoken epidemic, the secret behind many forms of broken behavior. Brené Brown, whose earlier talk on vulnerability became a viral hit, explores what can happen when people confront their shame head-on. Her own humor, humanity and vulnerability shine through every word.

The happy secret to better work | 12 minutes
Shawn Achor | TED

We believe that we should work to be happy, but could that be backwards? In this fast-moving and entertaining talk from TEDxBloomington, psychologist Shawn Achor argues that actually happiness inspires productivity.

A concert of melody and medicine | 11 minutes
Suzie Brown | TEDMED

Cardiologist and singer-songwriter Suzie Brown gives a vulnerable, evocative performance that tugs at our heartstrings. She is accompanied by her husband, Scot Sax.

Dreamers to Doctors

Click this link to watch a series of short videos documenting pre-health Dreamers focusing on undocumented youth who are aspiring to be health professionals.

Podcasts

Balancing Mothering and Medicine with Amy Gottlieb | 30 minutes
Amy Gottlieb, MD | Safe Space Radio

Women’s health doctor Amy Gottlieb describes her bad mother anxiety due to her absences from her child necessitated by her training. She talks about how balancing work and family can affect mothering and often results in fears that we are doing both badly. She also names some legislative and employment reforms that are needed in order to support women as working mothers.

Hidden Emotions | 30 minutes
Aaron Lazare, MD | Safe Space Radio

This episode concludes Safe Space Radio’s series on loneliness, guilt, humiliation, and jealousy with a story that combines all four. We also revisit an earlier interview with Dr. Aaron Lazare about shame and humiliation and how these self-conscious emotions intersect with the feelings we hide.

Burnout and Practicing Today's Medicine | 25 minutes
Dr. Lorna Lynn | ABIM

In this podcast, listen to Dr. Lorna Lynn—an internist and the vice president of medical education research at the American Board of Internal Medicine (ABIM)—discuss physician burnout with three members of ABIM’s Critical Care Medicine Board: Drs. Ruth Kleinpell, Laura Evans and Bruno DiGiovine.

Empathy and Data: A Path Toward Healing | 39 minutes
Peter Yellowlees, MD | Joy of Medicine on Call Podcast

SSV Medicine contributor and family practice physician, Dr. Megan Babb talks to host, Dr. Peter Yellowlees, about the two pandemics in this country; one viral, the other social. Dr. Babb has become a powerful voice for social change, the rights and empowerment of women, and the importance of using data to move us toward a better tomorrow.

Readings

Beyond Burnout: A Physician Wellness Hierarchy Designed to Prioritize Interventions at the Systems Level (2019)

In this review article by Shapiro et al in the American Journal of Medicine, the authors suggest a modified Maslow's hierarchy model to organize variables related to burnout in order to define and prioritize interventions.

Breaking the Stigma — A Physician’s Perspective on Self-Care and Recovery (2017)

In this NEJM Perspective piece, Adam Hill, MD reflects on his own history of depression, suicidality and alcohol use and the stigma and barriers physicians face in seeking their own mental health care. He discusses a cultural revolution prompted by sharing our own vulnerabilities, challenging stigma and finding community.

Burnout Among Health Care Professionals (2017)

In this National Academy of Medicine Discussion Paper, Dyrbye et al. discuss the changes in medicine including payment reform, electronic medical records, patient portals and publicly reported quality metrics impact physician burnout.

Medscape National Physician Burnout & Suicide Report (2020)

Click on this link to see results of the Medscape annual physician burnout and suicide report.

Burnout Among U.S. Medical School Faculty (2019)

This AAMC brief reports on the rates of burnout among U.S. Medical School Faculty by department, by rank, and by race and gender.

Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population (2012)

In this Archives of Internal Medicine article, Shanafelt et al. discuss a national study of burnout among US physicians from all specialties and report substantial differences by specialty as well as differences compared to the general population including more dissatisfaction with work-life balance.

Controlled Interventions to Reduce Burnout in Physicians (2016)

In this JAMA Internal Medicine article, Panagioti et al. summarize a literature review of clinical trials of studies of interventions targeting burnout. Their findings suggest that burnout is a problem of the whole health care organization rather than individuals.

From Triple to Quadruple Aim - Care of the Patient Requires Care of the Provider (2014)

In this Annals of Family Medicine article authors Bodenheimer and Sinsky propose that physician burnout imperils the Triple Aim (patient experience, population health, reducing costs) and that improving the work life of health care providers is necessary in an expansion of the Triple Aim to the Quadruple Aim.

Medical Students’ Exposure to the Humanities Correlates with Positive Personal Qualities and Reduced Burnout: A Multi-Institutional U.S. Survey (2018)

In this Journal of General Internal Medicine, Mangione et al. discuss the results of an online survey of medical students testing the hypothesis that more exposure to the humanities is correlated with higher levels of positive physician qualities and lower levels of negative qualities that are detrimental to physician well being.

Physician burnout: contributors, consequences and solutions (2018)

In this Journal of Internal Medicine article, West et al. discuss the systemic drivers behind burnout and the resulting adverse effects on patients, the healthcare workforce and overall costs. They review organizational solutions as well as individually focused solutions.

For the Young Doctor About to Burn Out (2014)

In this Atlantic article, author Richard Gunderman, discusses a report in the Journal of Academic Medicine describing high burnout in medical students. He points us to the humanities and draws a comparison to the novel Middlemarch by Mary Ann Evans.

Resilience Is About How You Recharge, Not How You Endure (2016)

In this Harvard Business Review article, authors Shawn Achor and Michele Gielan discuss the culture of workaholism and misconceptions around what we've been taught about resilience. They point to the need for both internal and external recovery periods.

My Intern (2021)

In this March 2021 Perspectives article in the NEJM Richard Leiter writes about losing an intern colleague to suicide.

Misogyny in Medicine (2021)

In this JAMA op ed by Erica Kaye, MD, MPH, she describes the insidious and overt misogyny in medicine and how it contributes to burnout in medicine for women.

Additional Resources

American Psychiatric Association Well-being and Burnout Tool Kit (2020)

This APA toolkit has self-assessment tools, wellness resources and discussions about what the APA is doing for advocacy around physician wellness. Check out your own specialty association sites to see if similar resources exist.

American Medical Association: Burnout and Wellbeing

Click this link for AMA resources and CME trainings related to burnout and wellness.

The Happy MD.com

Check out this site for tools, strategies and trainings related to happiness in medicine. Topics covered include: Stress Management, Burnout Prevention, Life Balance, Mindfulness, Practice and Work Flow Efficiency, and Quadruple Aim Physician Leadership Training.

Stanford WellMD

Click this link for Stanford's WellMD site for tools and tips about wellness.

Mind-Body STREAM

Click the link to access the Ohio State University College of Medicine's Mind-Body Skills Training for Resilience, Effectiveness, and Mindfulness (STREAM) program, an innovative on-line education program for health professionals. The purpose of this program is to help you learn and practice skills that will help you personally and professionally to become more resilient in the face of stress, more clinically effective in helping patients, and more mindful in your daily life as you learn the latest scientific research about mind-body skills, engage in reflective practices, and use our free online recordings of evidence-based mind-body practices. Whether you are a seasoned professional or still in training, you will find helpful information and practices to address the needs of the patients and clients for whom you care.

Healing Alone (2019)

In this Guardian piece by Isabel Hanson and Safdar Ahmed the story of a first-year doctor and a widower in the hospital is told in graphic novel format.

How You Spend Your Time

This tool from the Covey Leadership Center differentiates excellence from perfection and offers a framework for how we spend our time considering the urgency of the task compared to the importance of the task.

Local MMC Resources

GME Social Worker, Molly Snedon LCSW | SNEDEM@mmc.org | 207-662-3335
- Molly is available to all house staff!
- GME Wellness Resources
  - Find various resources here including a recommended reading list