At Mayo Clinic, Researchers Burrow Into Burnout

If the Mayo Clinic -- widely regarded as one of the most enlightened health systems in the world -- struggles with high rates of physician burnout, no health system is immune.

Mayo's leaders are acutely aware that some of its physicians suffer from burnout because they have created a team, led by Dr. Tait Shanafelt, that studies professional satisfaction among physicians and other health workers.

Shanafelt, a cancer specialist, is also director of the Mayo Clinic's Program on Physician Well-Being. His concern for the plight of overstressed physicians stems from his days as a resident at the University of Washington in Seattle in 1999, where he noted troubling behavior among other residents. In some cases, colleagues cut corners in their care, or reacted irritably to co-workers or patients.

"You'd think, 'This seems so incongruent with what this person's about,'" he says.

Shanafelt's residency included a month devoted to a research topic of his choice. He described his observations to his research adviser, who theorized that the residents were suffering from burnout and said, "Let's put together a team and explore it." Their resulting study of residents at University of Washington-affiliated hospitals appeared in the journal Annals of Internal Medicine in 2002.

The study used a widely accepted assessment tool, the Maslach Burnout Inventory, to measure emotional exhaustion and a loss of empathy for patients among doctors.

"They found really striking associations -- residents that were burned out were more likely to report fundamentally inappropriate patient care behaviors," says Dr. Colin West, a Mayo Clinic expert in biostatistics and study design who has become one of Shanafelt's primary collaborators.

For example, internal medicine residents who registered burnout were more likely to discharge patients prematurely to lighten their workload; to report that they had committed medical errors; to pay little attention to the impact of an illness on a patient; and to feel little or no sadness about a patient's death. The findings made national headlines.

When Shanafelt arrived at the Mayo Clinic, headquartered in Rochester, Minnesota, he met West. With the administration's encouragement, the two began studying burnout among Mayo physicians as intently as anthropologists study civilizations. They launched a study of professional satisfaction and burnout among medical residents that has been underway for more than a decade.

Among their other areas of analysis: how leadership affects physicians' job satisfaction; the levels of burnout and job satisfaction among cancer specialists (they are no more prone to burnout than other physicians); and how burnout varies at different stages of a medical career.

Physicians in the midst of their careers were shown by Mayo research to suffer the most, as they often work more hours and take more overnight calls. Mid-career doctors were least satisfied with their specialty and their work-life balance; had the highest burnout rates; and were more than twice as likely to plan to quit medicine for reasons other than retirement.

Now, working with others -- including Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association -- Shanafelt and West have expanded their scope from Mayo to include doctors across the U.S. Their first national survey, published in 2011, found that approximately 45 percent of physicians reported at least one symptom of burnout. Their latest study, published in 2015, showed that the percentage now tops 54 percent.

The findings undercut any notion that burnout is purely a personal problem, West says, and that doctors who are struggling with it aren't cut out for medicine.

"If you have a problem that affects over half the physicians in the country, how could you possibly argue that it's an individual issue?" he says. "This isn't something that's going to be fixed by sending physicians to stress management seminars."

Mayo and other organizations have begun to investigate ways to restructure physicians' roles and working environments to reduce burnout rates. Among other things, they're focusing on improving leadership, expanding recreational opportunities and enhancing flexibility to offset long hours and being on call.

Hospital leaders also have focused on changing the way they structure health care services to take some of the pressure off physicians. Some health systems, for instance, distribute tasks among members of a care team so that visits are planned, lab tests are done in advance and health providers take care of patients collaboratively rather than individually. Assistants help document cases and order prescriptions, tests and procedures.

In 2002, Mayo created a special sanctuary for physicians and scientists who are experiencing distress. Called the Office of Staff Services, it is intended for the exclusive use of physicians, scientists and senior executives. They can obtain peer counseling, referrals for mental health services and other resources.

"A client coming in the door could be coming to see someone for retirement or financial planning or personal services, without stigma," says Dr. Deborah Lightner, former director of the office, which is now headed by Shanafelt. "We see 5 percent to 7 percent of the staff in at least one face-to-face visit each year. There's no doubt that the panel [of peer counselors] has seen an awful lot of people with burnout problems."

The panel includes a psychiatrist and a psychologist, but most of its members are not mental health professionals, Lightner says. They safeguard physicians' identities and mask the nature of their needs by referring to them as "clients" rather than "patients." Panel members also do not disclose clients' names, and notes of their encounters are not entered into the clients' personnel or medical files to keep them absent from legal proceedings.

Sometimes the remedy may be as simple as coaching someone on how to raise a concern with a department head. In other cases, perhaps involving extreme distress or substance abuse, professional help is required.

"We've walked people over to the emergency room," Lightner says. "We've called the police in the middle of the night to do a wellness check."

Fortunately, she says, most clients get the help they need and stay on the job. "There are definitely people who move in and out of burnout," she says. "If burnout were a terminal event for everybody, we'd be in really bad straits."

Just one satisfying patient encounter, she says, can be enough to put a "highly impassioned, superfunctioning" physician back on track.

"You can have 25 patients in a day and only one that grabs you," Lightner says. "And that's enough."

Steve Sternberg is a senior writer for U.S. News and a data journalist covering health care performance, health policy, clinical medicine and public health. You can follow him on Twitter (@stevensternberg), connect with him on LinkedIn or email him at ssternberg@usnews.com.