Self-care can be difficult because physicians may feel the burden of dealing with overwork and stress is placed on their shoulders. But experts say that while individual actions cannot replace—or even challenge the primacy of—larger systemic change, they are an important piece of armor protecting physicians from suffering burnout’s myriad ill effects.
“Our systems are set up in ways that increase physician stress and can lead to physician burnout and dissatisfaction,” said Kevin Hopkins, MD, a family doctor and physician director of health system engagement for the AMA, who is a co-author of the AMA STEPS Forward® “Value of Feeling Valued Playbook.”
“The best mitigators are system solutions. However, we also recognize that—particularly in larger health systems—it takes a long time to turn a big boat, and we really encourage physicians not necessarily to wait,” said Dr. Hopkins. “Because, what if that change never comes?”
The problem of physician burnout in the U.S. isn’t going away. Though fewer physicians are experiencing burnout than did during the high-water mark in the COVID-19 public health emergency, 43% of doctors are still experiencing at least one symptom.
Meanwhile, the cost of physician burnout is high, causing an avalanche of negative consequences to the doctors themselves, as well as their patients, colleagues, employers and loved ones.
That’s why, as the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine®.
It’s been proven that physicians who feel valued are less likely to experience burnout. The playbook offers organizations and leaders five strategies they can use to show physicians exactly how important they are. The fourth strategy covers how physicians can develop individual resilience and care for their own well-being, and how leaders can help them with both goals.
Removing stigma, a key first step
Though burnout should not be mistaken for a mental health diagnosis, there are important connections between the two, said Dr. Hopkins.
“People who are burned out are more likely to suffer from depression and anxiety and other mental health disorders, but burnout in and of itself is not one,” he said. “You think of things like decreased motivation, decreased self-value, seeing or feeling like our work doesn't help anybody or doesn't make a difference as symptoms of burnout, but can also be symptoms of depression.
“So, there's certainly some overlap, and because of that,” Dr. Hopkins added, “we recognize the importance of physicians who are burned out or burning out potentially needing professional behavioral health help to make sure that they don't get to depression” or mental health crises.
A mindset shift also needs to happen, he said, so that physicians view seeking help as the responsible, healthy choice.
“For centuries, physicians have seen admitting that they need help or asking for help as a sign of weakness, and we don't like to do that,” Dr. Hopkins said. “But it can be a very powerful thing when a colleague or even a learner—a medical student or a resident—sees an attending physician who may be struggling and getting the help that they need so that it doesn't become a bigger problem.”
The playbook also points out the importance of organizations ensuring that the credentialling and licensing processes do not further the myth that physicians will be punished or jeopardize their jobs or responsibilities if they seek mental health treatment.
Stigmatizing or inappropriate questions should be removed “about a clinician’s past mental health, addiction or substance-use history,” says the playbook, so that licensing and credentialling are the least of a physician’s concerns when they’re deciding to seek the treatment that could save their lives.
Putting a focus on resilience
The phrase “self-care” has become a buzzword over the years, conjuring up images of bubble baths and chair massages. For driven and motivated physicians, it can seem like a low priority, or even frivolous at times.
“Many physicians feel like, ‘That's something I don't have time for,’ but self-care is more than just in-the-moment relaxation,” said another of the playbook’s authors, Jill Jin, MD, MPH, an internist and senior physician adviser for the AMA. “Self-care is important for optimizing your individual resilience so that you are less likely to burn out when you have a really tough week on service or in clinic or when there's an adverse patient event.
“If something tough happens, which is inevitable in patient care and in the world of medicine, you will have the tools and the resilience to overcome that in a way that does not result in stress injury and burnout,” Dr. Jin added.
The playbook offers well-being, resilience and burnout as a continuum, with physicians being at different points of the spectrum throughout their careers. When they experience an adverse event, for example, or a period of particularly high physical or mental exertion, they can descend into further stress or even burnout. Resilience is the “ladder” that allows physicians to climb back to recovery and eventual well-being.
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Taking action is needed
The playbook recognizes that both organizations and individual physicians can create resilience and take self-care actions in several ways. Physicians can embrace self-care by prioritizing to-do lists, setting boundaries, limiting commitments, decisions and distractions, taking breaks and connecting socially.
In all cases, it’s about improving a physician’s ability to respond to the natural stressors and difficulties of a demanding, high-stakes profession.
“Making sure that we're not draining our battery down to zero every single day is important for maintaining resilience,” Dr. Hopkins said, as is “recognizing that it's OK to say no, even to things that we could do but that we choose not to do, particularly things that are work-related—making sure that we have firm boundaries in our lives.”
Finding ways for well-being to grow
Self-care involves much more than taking one yoga class or offering mindfulness tips on the cafeteria bulletin board, the experts said. Organizations—and physicians themselves—need to find ways to create the space into which recovery and well-being can grow.
“You can stretch a rubber band so far and it springs back, but if you stretch it too far or too many times, it loses its elasticity and it no longer has the ability to spring back,” Dr. Hopkins said. “We're seeing a whole generation of physicians that has been stretched out and has lost their elasticity.
“That affects our ability to have resilience, to bounce back and, ultimately, also feeds the burnout epidemic,” he added.
AMA STEPS Forward open-access toolkits and playbooks offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
