by Zach Read - firstname.lastname@example.org
No official diagnosis for burnout syndrome exists, but in today’s health care environment, physicians are increasingly experiencing classic signs of the condition: emotional exhaustion, depersonalization, and a reduced sense of accomplishment or loss of meaning in one’s work.
When suffering from burnout, physicians often find it difficult to recover during time off, see their energy level decrease, become cynical or detached, blame patients for problems, or question the quality and importance of the care they provide. If untreated, burnout can evolve into major depression and lead to more serious mental health issues.
Today, with the generous support of the Sanders Clinician Scholar Program, funded by Charles A. Sanders, MD, former chair of the UNC Health Care Board of Directors, Samantha Meltzer-Brody, MD, MPH, has launched a pilot program, “Taking Care of Our Own,” which raises awareness of burnout syndrome and other mental health concerns and offers residents at UNC Hospitals the necessary resources to combat these issues.
Meltzer-Brody began educating residents and clinical staff about burnout ten years ago when she received an invitation from Robert Strauss, MD, professor of obstetrics and gynecology, and former training director, to speak to the OB-GYN residents about issues related to burnout and mental health issues during residency. After several years of speaking with residents, she developed a curriculum for the Department of Obstetrics and Gynecology. Her lectures were an immediate success; they became so popular, in fact, that she began receiving treatment referrals for residents in clinical departments across UNC Hospitals.
Nearly two years into her four-year appointment as a Sanders Clinician Scholar, Meltzer-Brody has found that the program is flourishing. Its success can be traced, in part, to the tools possessed by those she helps and to the willingness of department leaders and residents to openly discuss the program.
“It’s an incredibly rewarding group of people to work with,” says Meltzer-Brody. “You’re talking about smart, hardworking, accomplished people who, in large numbers, get better. What I’ve found is that when one person comes forward to talk about burnout, it opens the doors for others.”
For residents and physicians, accessibility to the program comes at just the right time, as burnout and stress nationwide have reached record levels, despite the implementation of duty hour restrictions. Reflecting on the impact of "Taking Care of Our Own" to date, Meltzer-Brody draws three important conclusions.
“First, based on the results of the past year, I’m impressed more than ever by the need for the program,” says Meltzer-Brody, who receives feedback and interest from residents and department leaders after each lecture she gives. “Second, the reaction has been so positive that it’s clear we need to develop a team to handle the demand. We've recently applied for additional funding to expand our services as the stressors from the changing landscape of health care continue to impact our profession. And third, there needs to be more research to understand burnout—not just documentation of the prevalence of it but research that tries to understand the factors driving it, because the only way you’re going to address the issue is to make systematic changes based on the underlying causes.”
Burnout can be traced to any number of origins, including the changing landscape of the practice of medicine that increases workplace stress, more hours spent alone on the job, and significant and stressful events in the personal lives of physicians, among other factors. Despite its prevalence, Meltzer-Brody believes that views of mental illness and firmly held notions about the profession prevent many physicians from seeking help.
“If you have a respiratory infection that you try and fight on your own but it continues to persist, it’s better to get an antibiotic from the outpatient doctor when you’re a little sick rather than wait until you can’t breathe with pneumonia and are hospitalized,” says Meltzer-Brody. “So I tell residents, ‘Let’s not wait until your performance suffers to treat the problem; let’s take care of the problem in its early stages.”
During the past several years, Meltzer-Brody’s work has found supporters among training directors across clinical departments.
“Dr. Meltzer-Brody has been an integral resource person and source of support and information for our residents and our residency program,” says AnnaMarie Connolly, MD, professor of obstetrics and gynecology and training director. “Dr. Meltzer-Brody interacts with our residents both formally and informally about taking care of themselves and each other. Working directly with our residents about these issues empowers everybody to recognize that there are resources available to all.”
Other supportive departments include pediatrics. Julie Byerley, MD, MPH, associate professor of pediatrics, believes the program meets a critical and previously unmet need.
“It’s important to have resources immediately available when problems arise,” says Byerley. “Dr. Meltzer-Brody is incredibly talented; has good common sense about how to relate to residents, both one on one and in large groups; and is a very effective communicator. She helps residents name the issue and provides an opportunity for them to talk in a safe environment.”
According to Meltzer-Brody, the more support “Taking Care of Our Own” receives from department leaders, the easier it is for residents to seek help—and, in turn, the greater the likelihood of reducing burnout among residents.
“The training director and chief resident can play critical roles,” says Meltzer-Brody. “If they’re supportive and they approach interns or residents and tell them that it looks like they’re having a hard time, then it changes the culture. When I look at some of the departments we’ve worked with and see how they’ve changed, it’s clear that all you need is a few people who are pegged as supportive and things can change. Change doesn’t simply occur through lecturing.”
As a training director in pediatrics, Byerley has experienced the role department leaders can play in reducing burnout. At the same time, she believes that the program is so well designed and that Meltzer-Brody is so well suited to work with young physicians, that residents can comfortably seek support on their own, without the aid of department leaders.
“It’s important that leaders support it,” says Byerley. “But Dr. Meltzer-Brody provides such an easily available service that residents can get help even without directors being involved—residents can seek it on their own.”
Kenan Penaskovic, MD, assistant professor of psychiatry, and other colleagues of Meltzer-Brody’s have helped implement “Taking Care of Our Own.” He appreciates the commitment of Meltzer-Brody and the university and testifies that the program is making a difference.
“We’re seeing it story by story,” Penaskovic says. “We’ve been able to get people help and to address the factors that are impacting them. We’ve had people who have sought help and gotten the assistance they needed and returned to work.”
To Penaskovic, the caregiver role presents unique challenges.
“We see medical providers experience stress and burnout at a much higher rate than in other professions,” he continues. “As physicians we generally are insightful about illness in others, but there’s something unique about the demanding nature of our work—something about the caregiver role. Doctors generally have certain demographic factors and resources that one would think would be protective against experiencing burnout. But even with duty hour restrictions, people still have issues because of the things they see, the responsibility they have, the suffering and mortality they witness.”
Meltzer-Brody’s goal is to finish developing a research survey for house staff based on what she and her colleagues have been observing through the program. She plans to go from department to department and ask training directors to incentivize their house staff to complete it. To ensure that the program continues on its trajectory, she expects to have measurable data points that detail the number of people treated and lectures given, the growth of the program, and other outcomes of the initiative during her term as a Sanders scholar.
“My interest in the next year and over the following years is to take the program from a grassroots level, providing care to the individual, to something that is thoughtful, research-based, and ultimately transportable to other places,” Meltzer-Brody says.
With increased willingness of residents and training directors to discuss issues related to burnout, Meltzer-Brody is encouraged that her message is reaching physicians and residents around the UNC Hospitals’ community; she’s confident that she’ll reach her goal for the program.
“‘Taking Care of Our Own’ implies that we have responsibility, as physicians and as a community, to take care of our own, in particular to aid our trainees,” says Meltzer-Brody. “The program very much fits the spirit of the Sanders award, which seeks innovative ways to improve the practice of medicine.”
For those interested in learning more about burnout and the Taking Care of Our Own program, visit: http://www.med.unc.edu/psych/education/taking-care-of-our-own