Which interventions reduce physician burnout?

life preserverFifteen years ago, Dr. Colin West was introduced to Dr. Tait Shanafelt, who is now the Director of the Mayo Clinic Department of Medicine Program on Physician Well-being.  With the combination of Dr. Shanafelt’s early academic interest in physician burnout and Dr. West’s methodological expertise, they developed a longitudinal study to investigate resident burnout. The study showed powerful associations between burnout and many concerning endpoints, including major medical errors. These findings launched the investigators to pursue the question of how to enhance physician well-being.

As other researchers started investigating burnout, the body of evidence surrounding this problem grew, ultimately revealing physician burnout in epidemic proportions. Several years later, interventions started being implemented to reduce burnout.

With a grant from the Arnold P. Gold Foundation Research Institute’s Mapping the Landscape initiative, Dr. West and his colleagues Dr. Lotte Dyrbye, Dr. Shanafelt, and medical librarian Patricia Erwin, set out to determine which types of burnout interventions have been effective. Their study, Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis, has been published in the September 28, 2016 issue of The Lancet along with commentary co-authored by Ronald Epstein, MD, another Mapping the Landscape grant recipient.

West’s team examined randomized control trials and cohort studies of interventions to reduce burnout in physicians. They investigated the effectiveness of the interventions at reducing the outcomes of overall burnout, emotional exhaustion, and depersonalization using validated measures. They evaluated interventions targeting the individual (such as mindfulness and stress management training) as well as interventions targeting the organizational level (such as duty-hour requirements and modifications to clinical workflow). They found that both types of interventions were effective at reducing burnout rates for all of the studied outcome measures.

“Receiving a grant from The Gold Foundation, which has a long history of advancing humanism in medicine, helped strengthen and support our work. It energized us; we were able to align our goals with something greater than ourselves,” says West.

West has advice for physician leaders and hospital administrators who are looking to design interventions to address burnout. “Take a step back and engage the people you are trying to help. Asking them to describe their difficulties can help identify which drivers of burnout need to be addressed where they work.”

Dr. West also endorsed the need for further research in this area. “Not every intervention is going to speak to every physician. We have to develop a diverse menu of approaches, and try to understand how those different menu items interconnect.” Dr. West and colleagues noted several gaps in the research in their extensive literature review. For example, the effect of combining individual and organizational interventions has not been studied.

After completing their literature review, West and his team were awarded a Discovery grant from the Gold Foundation Research Institute to work with physicians to identify which specific approaches their employer/institution could offer to reduce work-home interference, a documented driver of physician burnout and distress.

Dr. West’s vision for the future is inspiring. “There are solutions that work, and our paper has catalogued those. We don’t have to wait; we can start now to roll out approaches that will help residents and practicing physicians with these issues in the present.”

Ali Rae

Health Communications Fellow at the Gold Foundation Research Institute

Ali I. Rae is in his fourth year of pursuing an MD/MPH at Brown and Columbia Universities respectively, with a concentration in Medical Humanities and Ethics. He writes poetry and fiction, as well as nonfiction on research topics with special interest in medical education, health policy, and the neurosciences.