The power of social support in managing physician burnout

For any member of the healthcare and medical community, the daunting problem of physician burnout is no secret.

Physician burnout is condition characterized by exhaustion, depersonalization, and lack of efficacy. For healthcare workers, these symptoms are often caused by constant ongoing exposure to stressful job conditions and the conditioning of institutional education to never make mistakes and to never show weakness. Just as well, physician burnout is extremely common, especially for healthcare professionals that are overworked in high-stress job positions.

Physician burnout is not a new condition — in a 2011 study, it was found that burnout impacts as much as half of all physicians. In a 2002 study, it was discovered that around 50% of all medical leaves were taken due to physician burnout.

[Source: https://www.frontiersin.org/articles/10.3389/fpsyg.2020.623587/full#B21]

This was the reality of the physician burnout landscape in the U.S. pre-COVID. Today, the risk and prevalence of physician burnout is even more severe and not only limited to physicians. The 2020 Coping with COVID study, which surveyed of 20,947 healthcare workers across the U.S., revealed that 49% of responders suffered from burnout.

What are the solutions for managing physician burnout in the modern, COVID-era? How can burnout be prevented instead of treated?

While there are numerous strategies for managing burnout, such as (but not limited to) mindfulness practices, professional coaching, lifestyle changes, and improved work hours, this quick guide will focus on why social support is an excellent tool for addressing and preventing physician burnout. We’ll also explore how social support works to improve the mental well-being of healthcare workers in general.

To start, let’s learn a bit about how social support can address or prevent physician burnout.

How Can Social Support Address or Prevent Physician Burnout?

Social support can be powerful in the fight against physician burnout, instances of physician suicide, and a wealth of other mental health conditions. Social or peer support can be described as simply the act of talking about stressors with other people — be they friends, colleagues, peers, or mental health professionals. Communication in addition to the opportunity to vent can have incredible benefits on one’s mental well-being. To understand the benefit social or peer support can help, it helps to understand just how much stress can affect the brain and cause burnout.

In a review published in 2019 by a group of researchers, psychiatrists, and neurologists in the U.S., the effect of physician burnout was observed in an attempt to understand different effective strategies for managing this condition. Social support was one of their noted recommendations. In addition to their discoveries, the researchers broke down how physician burnout can occur.

Chronic exposure to stress in any scenario can lead to loss of top-down control of the prefrontal cortex over the human limbic system, which decreases one’s healthy response to stress exposure. This excess of activity of the prefrontal cortex can lead to poor attention, poor memory, difficulty managing emotions, and difficulty managing cravings. According to the review, social support is one of many things that can reduce these negative effects on the human brain.

With this in mind, it’s clear why social support is so vital when it comes to preventing physician burnout. In a 2016 academic paper by Jo Shapiro (MD) and Pamela Galowitz, the notion of peer support was explored in depth, as well as the potential for institutional implementation of peer support programs.

“A foundational component of the BWH peer support program is our commitment to having trained clinician peers (peer supporters) offer support to their colleagues (peers),” reads the paper, “In our experience, clinicians rarely access available support from mental health providers after adverse and other emotionally stressful events.”

In addition to this problem, many physicians struggle with accepting support from non-physicians. The solution to this problem could be ongoing peer-specific support groups that are implemented by healthcare institutions.

“This reluctance to expose personal vulnerability is consistent with our understanding that physicians generally find it highly challenging and countercultural to publicly acknowledge their self-perceived weakness in front of non-physicians,” the paper continues, “We validated this observation in our 2012 survey study, in which we found that physicians want support from their physician colleagues.”

So how exactly does peer support help reduce the effects of a stress injury or physician burnout? There are many things that simple peer support can offer:

- If a physician has suffered a stress injury that resulted in hospitalization, peer support can help during the recovery process.

- Peer support can offer greater levels of empowerment and engagement. This likely comes from the social connection experienced when interacting with one’s peers.

- The mutual exchange of coping strategies and resilience strategies can be emotionally and tangibly beneficial.

- Peer support makes it substantially easier for physicians to open up, as they are in a position to talk about their experiences with individuals who understand the stressors of the healthcare world.

- Peer support allows physicians to learn coping mechanisms and healthy forms of resilience-building from individuals who have been in the healthcare industry for longer than them.

- Feelings of isolation and not being understood can be dealt with by investing time into peer support.

[Source: https://www.psychiatryadvisor.com/home/topics/general-psychiatry/exploring-the-value-of-peer-support-for-mental-health/, https://medium.com/first-responders/10-benefits-of-peer-support-d7e2e1956682]

Preventing Physician Burnout with Resiliency

As the 2019 review’s researchers continued exploring new methods to overcome physician burnout, they noticed that the word “resilience” was given various definitions by different authors. The agenda was all the same — building resilience can be defined as growing mental strength over adversity, resulting in an ability to “bounce back” and avoid potential stress-related medical errors.

Quantifying resilience can be difficult, but there are measures that can be taken to assess overall resilience in order to check on a physician’s abilities when working within a stressful environment to ultimately avoid potential mental health pitfalls. Namely, in the context of the review, the researchers employed a 25-step questionnaire designed to help subject determine their current state of resilience.

“Resilience research further explored that active coping mechanisms such as goal-directed behaviors, problem-solving, confronting problems, and seeking social support when required help reduce stress,” reads the 2019 review, “This avoids denial of the problem, illicit substance use, blaming someone else, and venting constant negative feelings.”

To sum up the research on managing burnout, resilience is a necessity in the healthcare field for maintaining mental fortitude and focus when exposed repeatedly to excessive stress. However, resilience is not merely a talent — it is a learned behavior and a skill that can take time and energy to perfect. A few ways healthcare workers can improve their overall resilience are enhancing quality of sleep, focusing on positive emotions they are experiencing, and improving their overall life satisfaction. How can those who are building their resilience avoid physician burnout and other potential mental health problems? Seeking support from peers has proven to be one very effective way to mitigate these mental health problems.

Strategies and Best Practices for Managing Physician Burnout

The first step in addressing physician burnout is recognizing it. The 22-item Maslach Burnout Inventory (MBI) is currently the gold-standard for measuring burnout in scientific research, but healthcare professionals can often recognize their own burnout with simply doing an internal check-in to see if they are feeling any of the three cardinal symptoms of burnout: exhaustion, depersonalization, or lack of efficacy. Feeling one of these three symptoms is a good indicator that a healthcare worker may be experiencing burnout. Reducing these feelings of burnout can be done via a variety of strategies and best practices:

- Seek out a physician support group. These are quite handy, as there are plenty of online-only options and many of these support groups are free to attend. A few well-known groups include PRI, MassMed (you do not need to work in Massachusetts to attend), and MHA National. Additionally, many hospitals, especially larger facilities, will offer virtual or in-person peer support groups for their employees. Talk with your HR leader for more information about what your employer offers.

- Be more mindful of scheduling time off. This can be a huge roadblock for many physicians who often struggle with taking time off. However, regular vacation days and days off can be significantly beneficial in the fight against physician burnout.

- Take the time to assess your symptoms. Physician burnout can sneak up on anyone. Due to the nature of stress injuries and the ongoing stressful nature of medical environments, one may not even realize how burnt out and mentally unwell they actually are. Assess yourself for symptoms of burnout, which can be found here.

- Examine the condition of your office and facility. A lot of the time, changing systems and processes that aren’t optimal can help reduce the chances of physician burnout. This must be a collaborative process with your staff and your partners as well. Some potential system changes include revision of EHR templates, improving patient management systems, better workflows for streamlining various office processes, and reducing administrative time. Just as well, if possible, it may be beneficial to outsource various administrative tasks or hire extra help in the office to reduce overall physician involvement and stress.

- As with any mental health care strategy, there are a few extra things one can do in their life to prevent or manage physician burnout. Such things include regular exercise, meditation, a healthy diet, avoidance of drugs and alcohol, and ongoing counseling.

[Source: https://www.thedoctors.com/articles/real-world-strategies-for-physician-burnout/, https://www.frontiersin.org/articles/10.3389/fpsyg.2020.623587/full, https://www.ama-assn.org/practice-management/physician-health/know-what-do-when-peer-experiencing-significant-stress, https://www.aafp.org/fpm/2015/0900/p42.html]

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