Preventing burnout is essential medicine for physicians

Audrey Hepburn often quoted this “beauty” tip from humorist Sam Levenson: “People, even more than things, have to be restored, renewed, revived, reclaimed, and redeemed; never throw anyone out.” This seems very relevant to us all as physicians: You can't look anywhere nowadays and not read about the dissatisfaction and lack of well-being in doctors.

This is by no means a new problem, but it remains an incredibly complicated one to solve, and one that now comes with a new sense of urgency. As our patients grow older and sicker, our doctors are also becoming older, many nearing retirement age. Fewer medical students and residents are choosing to go into internal medicine, especially primary care internal medicine, thus there is a worsening physician shortage issue.

It is felt acutely by the spectrum of the medical system when each physician retires early or stops seeing patients out of frustration or exasperation. Our hearts break each time we lose another colleague to depression and suicide. This is simply something we cannot ignore. We must face it head on with the same level of commitment as other systemic issues.

ACP is working to identify and address the root causes of the problem that most affect the practice of internal medicine and creating a network of support for distressed internists. The College is also collaborating with other organizations that are also addressing physician well-being issues, such as the National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience, the American Medical Association, and the Collaborative for Healing and Renewal in Medicine.

It has been estimated that nearly 80% of the causes of physician dissatisfaction and lack of well-being are systems issues. ACP has long identified reducing administrative complexities or burdens as a priority, and the Patients Before Paperwork Initiative addresses systems challenges and seeks to reinvigorate the patient-physician relationship by challenging unnecessary practice tasks.

The College's ongoing efforts to achieve this goal have included developing and maintaining related policy, participating in efforts to work to alleviate specific regulatory and insurance requirements, and striving to eliminate other unessential tasks that detract from patient care and contribute to physician dissatisfaction and lack of well-being.

The College provides feedback and recommendations to regulatory agencies, Congress, and other key stakeholders and collaborates with key groups and organizations to update regulations and policies to reduce excessive administrative tasks. ACP's foundational set of policy recommendations on reducing excessive administrative tasks, “Putting Patients First by Reducing Administrative Tasks in Health Care: A Position Paper of the American College of Physicians,” was published in Annals of Internal Medicine in 2017. It provides a cohesive framework for identifying and evaluating administrative tasks and outlines detailed recommendations to reduce excessive administrative tasks across the health care system.

The momentum around this issue is mounting. Recently, CMS released its own “Patients Over Paperwork” initiative to reduce administrative regulatory burdens.

To assist with this effort, we are soliciting feedback from members using a data collection tool so that we can better prioritize our efforts to address those tasks our members find most burdensome. This tool will allow you to enter either an administrative task or a best practice, and entries will be added to the Administrative Tasks and Best Practices Library. The plan is for this library to eventually become accessible on ACPOnline, once the data are more robust.

Obviously, changing the intricate, complex labyrinth we call the U.S. health care system will take time. In the meantime, we must take care of our physicians and physicians-in-training who are suffering. Therefore, in January 2017, ACP launched the Physician Well-being and Professional Satisfaction Task Force to help focus efforts to address this complex problem.

The task force's mission is to help ACP be a leading voice in providing guidance and resources that optimize internists' well-being and engagement to best serve our patients and our communities, and its vision is to create a safe and nurturing community where ACP members feel valued by, connected to, and supported by one another and the organization in a way that promotes personal well-being and professional satisfaction.

The task force includes a patient representative to help us identify novel ways that patients and clinicians can partner to address these issues. The foundation of this effort is 125 Well-Being Champions who will be accessible through our ACP chapters. Our Champions will be available to help individuals, practices, and organizations measure burnout and select interventions to promote well-being and professional satisfaction.

ACP will provide access to and develop resources focusing on the efficiency of practice, personal resilience, and the culture of wellness to assist individuals, practices, organizations, and training programs in promoting internist well-being and professional satisfaction. These resources will be accessible to our members on the ACP website.

To me, the best things about ACP are its people and the power of the human connection. I believe that we can utilize the incredible experience, intelligence, resilience, spirit, and commitment of our members to significantly improve the well-being and professional satisfaction of our internists and internists-in-training. Together we can restore the joy of being a doctor and the meaning in medicine. Please do not hesitate to reach out to us with your feedback and thoughts.

This is a monumental challenge, not only for ACP, but for the profession of medicine as a whole. Nonetheless, it is essential.

ACP will provide access to and develop resources focusing on the efficiency of practice, personal resilience, and the culture of wellness in order to assist individuals, practices, organizations, and training programs in promoting internist well-being and professional satisfaction.