The Journal of the Arkansas Medical Society Med Journal July 2019 Final 2 | Page 19

Meaning is another key to job satisfaction. “Meaning is a key driver for us humans,” said Dr. Messias. “Victor Frankl was a Holocaust survivor who was trained in medicine and psychiatry and lost his whole family in concentration camps. He wrote that ‘Striving to find meaning in one’s life is the primary motivational force in man.’ And it is. We have to find a sense of meaning in our lives. Key drivers of burnout and engagement in physicians. What’s Driving Physician Burnout? No matter how you look at professional burnout – globally, as a nation, or here in Arkansas – health care sectors seem the most prone to it. Dr. Messias addressed reasons for these very real findings. “There are several drivers, if you will,” he ex- plained, pulling from research done at the Mayo clinic to reveal culprits like heavy workload, increasing job demands, changes to the health care system, increased access, increased workload, and – per- haps because of all of these – a lack of work-life bal- ance. “Physicians, by nature, are hard-working and demanding of themselves, but at some point, we need some boundaries around clinical time and patient de- mands, so that we can have our own lives, too.” Honing in on electronic medical records as a connected factor, Dr. Messias said, frankly, “These have not been designed for us. They promise us a lot and have delivered little so far. We need to have better systems that work for physicians and nurses. Without that, burnout is not going to go away. I tell you, efficiency and resources are key factors. Data from EPIC, the largest electronic medical record sys- tem in the country, shows that in a typical day, peak EMR times are from 10 a.m. to 2 p.m. Lunch time is a big time for EPIC, and there are peak times also on Saturday and Sunday nights. This is not an efficient system. In fact, a recent piece in the New Yorker** by surgeon Atul Gawande was titled ‘Why Doctors Hate their Computers.’” What Can Be Done? Turning to solutions, Dr. Messias shared with at- tendees what was being done at UAMS to address professional burnout. The University’s wellness pro- grams are patterned on research by The Mayo Clinic* and focus on promoting positive engagement and reducing burnout by acknowledging and assessing problems, implementing interventions and cultivating community, providing resources that promote work- life balance and self-care, and more. NUMBER 1 “I’m not here today to sell you a mindfulness program,” said Dr. Messias, boiling down his thoughts on personal solutions. “I do not believe, and there is data to prove, that you cannot do this alone. You can- not, by yourself, be mindful, be present, and solve your own professional burnout problem. Your professional burnout problem must have organizational changes. There are individual interventions and there are or- ganizational changes to propose. I have also become convinced that there’s a leadership component. “To address professional burnout in health care, we need a more supportive, transparent, and less hi- erarchical model of organization. Professionals want, and need, to see meaning and purpose in what they do and to have a sense of control of their work pro- cesses. This will reduce burnout and increase engage- ment. We need to show that we care for each other.” Meaning & Control at Work According to Dr. Messias, it’s not news that job control affects job satisfaction. Citing studies conduct- ed as far back as the 1970s, he said, “This has been known in HR for 40 years, and about a year ago, Har- vard Business Review had a front-page article on ‘To Reduce Burnout on Your Team, Give People a Sense of Control.’ Can we give physicians a sense of con- trol? We must, because without that sense of control, we’re all going to be burnt out. I can show you the relationship between a sense of control and burnout. The more burnout, the less control. “It’s funny that physicians would be the people complaining about a lack of control, but the truth is that the changes in health care in the last 30 years have eroded the sense of control that physicians used to have. To an extent, we have contributed to that by giving away some of the key leadership positions in health care organizations and in health care - policy making circles to either non-health care workers al- together or to non-physicians. That’s why associations like the Arkansas Medical Society are important, so that physicians can retake their place at these tables. “That’s good. As a psychiatrist, I can use that. As an epidemiologist, I have a couple of questions about it in my survey, and now I’m putting them together with my burnout data … People that said they always found a sense of meaning in their day, the level of burnout was about 20%, but people with the least amount of meaning in their work had the highest level of burnout. So, finding that mean- ing back in what we do, in the value of our profes- sion, and in our mission, will help us with this.” To find out how to add more meaning at work, UAMS asked their clinicians to share, in 10 words, what makes their days meaningful. “The number one word was patients,” he said. “Being able to help patients. Being able to care for patients. That’s what makes health care meaningful. So, going back to this basic value of health care will help us ad- dress this.” Conclusions “From global statistics down to Arkansas phy- sicians,” said Dr. Messias, “it’s clear that the more we find purpose and control in our work, the less we experience professional burnout. The more we can focus on caring for patients, the more purpose we find in our work.” Dr. Messias is happy to talk to you about start- ing wellness interventions in your institution. “I think it is part of UAMS to create and use studies like we did, but also to disseminate that knowledge to others,” he said. “I would love to see some of this done at a statewide level. I’d love to engage with you. I respect what you do.” To get the conversation started, email him at [email protected]. *To find the full report on the Mayo Clinic’s organizational strategies, search mayoclin- icproceedings.org for the article, “Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engage- ment and Reduce Burnout.” Also find “Burnout Among Physicians Compared With Individu- als With a Professional or Doctoral Degree in a Field Outside of Medicine.” **https://www.newyorker.com/magazine/2018/ 11/12/ why-doctors-hate-their-computers JULY 2019 • 19