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    De-stressing ob/gyn

     

    Preventing burn out

    All of us, young and old, face the same frenetic pace of patient care and keeping up with new medical knowledge. We all face loss of autonomy from mounting administrative and regulatory burdens, as well as time and financial pressures, the chronic stress of professional liability, and uncertainty about future federal healthcare policies. And at some point we need to ask when these stressors will exceed our ability to adapt, accommodate, and avoid burnout. Burnout occurs when there is a pervasive sense of emotional exhaustion, depersonalization, and lack of accomplishment.10,11 Other manifestations of physician distress include substance abuse, depression, disillusionment, and divorce. Burnout has been linked to an increase in suicidal ideation among medical students.12 A Medscape Lifestyle Report survey reported that in 2015, 46% of US physicians on the front lines of patient care reported burnout, compared with 40% just 2 years earlier.13 These numbers are consistent with other studies.14 In the “happiness at work” metric, ob/gyns scored in the middle of specialties between happy dermatologists and unhappy internists; however, 10% of ob/gyns reported having the highest severity scores for burnout.13 As with the medical profession in general, female ob/gyns reported a higher prevalence of burnout (55%) than males (42%). Perhaps most concerning, higher rates of burnout were reported in younger physicians, with 53% of ob/gyns ≤ 35 years reporting this symptom. This finding suggests that our survey may not be so biased after all.

     

    Short-term solutions

    Attempting to implement strategies for reducing physician burnout is difficult. Exercise and good nutrition are tough when you are working 80 hours a week. Taking enough vacation time is also difficult if you are facing declining reimbursements and increased overhead. A rich spiritual life helps, but religion isn’t a pill you can take.

     

    Long-term solutions

    It is time for our professional organizations to re-examine ob/gyn residency training. Should we track all rising fourth-year residents through either a 2-year subspecialty fellowship or 2 more years of primary care and general ob/gyn surgical training? Similarly, it is past time for a rigorous, empirical, specialty-specific reassessment of the 80-hour resident work week. We should also work through our professional societies and their political action committees to eliminate ineffective, nonevidenced-based and excessive federal and state regulations. Start with EHR Meaningful Use regulations. The government should conduct a definitive study of the public health impact of the widespread introduction of EHRs. If there is no benefit, their use should be curtailed or they should be redesigned to reduce documentation burdens. If there is evidence of benefit, government and commercial payers should reimburse the costs of their use (eg, the 2–3 hours a day busy clinicians waste typing and clicking) or pay the costs of scribes. Finally, in light of the convergence of a Republican Congress, Executive Branch, and Supreme Court, let’s implement true professional liability insurance reform.

    Next: How is the profession changing?

    Take-home message

    A confluence of factors has conspired to exert unique stress on ob/gyns. The situation has been exacerbated by an outdated graduate medical education system and partisan political chaos to create a toxic stew that promotes physician burnout and distress. Individuals can take steps to restore their enthusiasm, engagement, and energy for our great profession, but substantial reforms of physician training, a new work-flow model, and reform of our regulatory and payment systems are also needed.

    References

    1. Densen P. Challenges and opportunities facing medical education. Trans Am Clin Climatol Assoc. 2011;122:48-58.

    2. Gleicher N. Cesarean section rates in the United States. The short-term failure of the National Consensus Development Conference in 1980. JAMA. 1984;252(23):3273-6.

    3. Hoover KW, Tao G, Kent CK. Trends in the diagnosis and treatment of ectopic pregnancy in the United States. Obstet Gynecol. 2010;115(3):495-502.

    4. Ghazal S, Pal L. Perspective on hormone therapy 10 years after the WHI. Maturitas. 2013;76(3):208-12. Review.

    5. http://www.centerwatch.com/drug-information/fda-approvals/ (accessed 1/16/17)

    6. Guntupalli SR, Doo DW, Guy M, et al. Preparedness of Obstetrics and Gynecology Residents for Fellowship Training. Obstet Gynecol. 2015;126(3):559-568.

    7. Doo DW, Powell M, Novetsky A, Sheeder J, Guntupalli SR. Preparedness of Ob/Gyn residents for fellowship training in gynecologic oncology. Gynecol Oncol Rep. 2015;12:55-60.

    8. Powell J, Gilo N, Foote M, Gil K, Lavin JP. Vacuum and forceps training in residency: experience and self-reported competency. J Perinatol. 2007;27(6):343-6

    9. Wright JD, Herzog TJ, Tsui J, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol. 2013;122(2 Pt 1):233-41.

    10. Shanafelt T, Dyrbye L. Oncologist burnout: causes, consequences, and responses. J Clin Oncol. 2012;30(11):1235-41. Review.

    11. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians. Am J Med. 2003 ;114(6):513-9.

    12. Dyrbye LN, Thomas MR, Massie FS, et al. Burnout and suicidal ideation among U.S. medical students. Ann Intern Med. 2008;149(5):334-41.

    13. http://www.medscape.com/viewarticle/838437 (accessed 1/16/17)

    14. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377-85


    Charles J Lockwood, MD, MHCM
    Dr Lockwood, Editor-in-Chief, is Dean of the Morsani College of Medicine and Senior Vice President of USF Health, University of South ...

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