Health-care authorities in the U.S. are pushing for a value-based system to optimize health-care budgets and drive health outcomes. The push is especially aggressive in costly disease areas, such as diabetes.
Diabetes physicians have a contributing role in the reduction of health-care costs by ensuring that diabetes patients meet health targets. However, the job of diabetes physicians is not easy given the size of the patient population and the complexities of the disease. More than 100 million adults in the U.S. have diabetes or prediabetes and require medical care.1
Essentially, the need to improve health-care value is increasing the workload and stress levels of many diabetes physicians. Amidst the pressures of the job, it is easy for physicians to set aside their own well-being, thereby placing themselves at risk of burnout.2 Indeed, the state of physician mental health is a cause for concern, with a 2018 survey involving 15,000 U.S. physicians showing that two-thirds of them feel burnt out, depressed or both.3
What is burnout?
Burnout is a state of exhaustion due to chronic stress in the job.4 It has three main characteristics: emotional exhaustion, detachment and reduced personal accomplishment.5 According to Mark Heyman, Diabetes Psychologist, “Emotional exhaustion is feeling overwhelmed by the responsibility of caring for people with diabetes, and having no reserve left. Burnt out physicians often experience depersonalization, or feeling detached from others, including their patients, co-workers, family and friends. Burnout can often result in a feeling of lack of accomplishment; sufferers do not get any personal joy or meaning from the work they are doing.”
Signs of physician burnout
A constant state of exhaustion is a manifestation of a mental health imbalance, and physicians must regularly check themselves for signs of it.4 According to Matthew Hatson, Resilience Consultant, “Burnout is [also] characterized by deregulation of normal healthy function. I often see this manifesting as sleep issues, shifts in behavior, digestive issues, fatigue and decreased levels of social engagement.”
Some early signs of burnout can be easily missed, such as feeling consistently out of step, taking small issues personally, an inability to concentrate on tasks, and showing aggressive behavior towards others. The signs can also be physical, such as unexplained body pain, headaches and dizziness.6
The negative effects of burnout
If left unchecked, burnout can adversely affect a physician in many ways. According to Heyman, “Physicians who are burnt out tend to have lower job satisfaction and are much less likely to stay in their current job. Prolonged exhaustion can also have a big impact on the physician’s quality of life, including relationships, and non-work related interests and activities.”
Burnout can also threaten patient safety and the quality of care that physicians deliver. “This can have a big impact on both the physician and the patient. Burnt out physicians are more likely to deliver substandard care and make mistakes, [and so have] an impact on patient health outcomes,” says Heyman. Indeed, studies show that physician burnout can relate to risky prescribing behavior, reduced patient adherence, increased medical error rates and poor chronic disease management.2
A weakened ability to show empathy due to emotional exhaustion is detrimental to patients. For example, during a diagnosis discussion, many diabetes physicians reportedly find it burdensome to achieve patient acceptance of their condition. Research shows that physician empathy is directly related to a successful patient acceptance of diabetes. So, as physicians show less empathy, patients are less able to come to terms with their newly diagnosed condition.7
The causes of physician burnout
Determining the root cause of physician burnout is a crucial first step towards addressing it. Michelle Dossett of Massachusetts General Hospital, who is the lead in a study on this subject, says that many of the stressors contributing to physician burnout are external. Research shows that some of the common external drivers for physicians include work frustrations, administrative burden, medico-legal problems, reimbursement issues, difficult patients and maintaining a work-life balance.2
Caring specifically for diabetes patients involves many external sources of stress, including:
• Workload and complexity — caring for patients at different stages of diabetes results in a caseload of patients with different medical needs;
• Fast-paced days at the clinic or hospital;
• Inadequate resources — working with more patients in a limited time period; a lack of organizational support for medical resources;
• Organization structure — dealing with organizational hierarchy, policy restrictions and performance targets; and
• Inadequate skills or preparation — young diabetes physicians struggling with an expanding workload; caring for difficult patients.8
How to deal with burnout
Physicians require three types of support to reduce the risk of burnout:
Physicians need to maintain a habit of self-care and well-being. “Following a healthy lifestyle — healthy eating, regular exercise and good sleep — can help providers to cope with stress,” says Heyman. According to Dossett, “Self-care strategies can help reduce the physical, cognitive and emotional impacts of stressors. They increase one’s resilience to stress and [improve] overall sense of well-being, helping one to function more effectively in the face of stressors.” Dossett also recommends the following self-care tools:
• Gratitude and positive psychology-based approaches;
• Cognitive restructuring;
• Mini relaxations or breathing techniques; and
• Yoga or tai chi.
2. Social support
Experts also point to the need for social support. “Physicians need to connect with friends and family. Those with supportive relationships — both at work and outside of work — tend to cope better when feelings of burnout arise,” says Heyman.
3. Professional support
Help from mental health specialists might also be necessary. According to Heyman, “If stress and burnout are impacting a physician’s mood, behavior or physical health, it may be helpful [for them] to talk with a mental health provider to get support and coping strategies.”
The overall goal of harnessing different types of support is to boost resilience and promote a positive perspective of work, which can help address or prevent burnout.2 “Resilience is our capacity to handle physical, mental and emotional stress, and the speed at which we recover a healthy function after exposure to extreme stress,” explains Hatson. As the demands of the job become heavier, resilience will be necessary for diabetes physicians to consistently provide quality care — to themselves and their patients.
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