Physician burnout is an epidemic that has resulted in 400 suicides a year.
Attention: We have an epidemic. Close to 400 physicians a year are committing suicide. (Wall Street Journal, 2018)
This headline should get our immediate attention and motivate us to create and support interventions to help physicians. Why physicians are so susceptible to suicide will be explored in this article. Healthcare workers, although not the primary focus here, share some of these same factors.
Below are 10 reasons physicians need Emotional Intelligence (EI) leadership training and coaching to combat burnout.
1. Burnout: The National Academy of Medicine noted that more than half of U.S. physicians exhibited signs of burnout, a syndrome marked by “a high degree of emotional exhaustion…and a low sense of personal accomplishment.” They cited links between doctors’ disaffection and the care they gave patients, with studies suggesting “a significant effect on quality and risk of malpractice suits.”
We know now physician burnout is a root cause of medical errors, malpractice lawsuits, and patient complaints, as well as physician depression/drug use/suicide and so much more.
Although the main focus here is on physicians, studies of nurses report a similarly high prevalence of burnout and depression. A subsequent study of approximately 68,000 registered nurses in 2007 reported that 35 percent, 37 percent, and 22 percent of hospital nurses, nursing home nurses, and nurses working in other settings had a high degree of emotional exhaustion.
2. Pressure: Physicians are making life and death decisions all day long. This is a lot of pressure where vital decisions have to made in the moment. A mistake can mean death. In most professions, a mistake doesn’t have these severe consequences. There are only a few other professions with as much in-the-moment pressure, such as the armed service, policemen, firemen, air traffic controller, and pilots.
3. Underdeveloped EI: To be in the top 1 percent year after year in school and get into medical school and then residency programs, students have to focus on their cognitive development, such as memorizing, studying causes and effects, and building associative skills. There isn’t also the time or focus on emotional development such as self-awareness, knowing your patterns and triggers, emotional regulation, managing difficult conversations and building their empathy.
4. Blind Spots: We all have blind spots but if you don’t know what they are, they will continue to undermine your success. Marshall Goldsmith, one of the top executive coaches with Fortune 100 executives, says from his experience 70 percent of people think they are in the top 10 percent. This is a major blind spot. Using EI coaching, assessments, 360-degree feedback and interviews you can establish what are your blind spots and begin to shed light on them.
5. Hero Complex: To become a physician, individuals had to make significant self-sacrifices over the years. The average physician has had up to 10-12 years of schooling and residency. They have had to be in the top 1 percent of their class throughout schooling and are used to being the smartest person in the room. They take pride in being very smart and confident about their intelligence and problem-solving. As a consequence, it is hard to feel fallible and examine their assumptions and decisions. It is easier to assume that their decisions are the right decisions. Reinforced during the school years that their answers are usually the correct answers. When operating from burnout though, they may no longer be the smartest in the room at those critical moments.
6. Disillusionment and Cynicism: A crushing identity crisis (CIC) occurs usually for physicians in their forties. After delaying gratification, fun and socializing for decades for their idealized career; the reality of the day to day existence is depressing. Add to that less time with their family and the resulting rising family tensions leads to dissatisfaction and questioning, “Is that what I signed up for?”
7. Old School Training: The training for physicians has not incorporated new learning and neuroscience research, where people learn best when they take breaks, are not sleep deprived, and focusing on how they best recharge. A program director from a well-respected resident’s program stated: “We have a beat down environment.” Physician’s mentors have had to tough it out with long hours, limited sleep, and expect their new residents to tough it out just like they did. Lunch is eaten on the elevator ride to a meeting or meeting patients. An hour or two should be a sufficient amount of sleep if on call. Physician training is just starting to see some changes where some residencies are learning about emotional intelligence and resilience strategies.
8. Environmental Factors and Pajama Time: Today, with electronic records, physicians are putting 60-90 minutes of extra time after hours completing their records. They get automatic tardy notes if they are late with their notes. One surgeon said 18 hours after surgery he was getting multiple notifications to complete his records.
In Physician Burnout, El-Aswad, Nadler, and Ghossoub (2017) present the top environmental factors that physicians have identified, and rated them on a scale of 1-5 with 5 being the most important below:
- Having too many bureaucratic responsibilities (4.96)
- Spending too many hours at work (4.29)
- Income not high enough (4.04)
- Feeling like just another cog in the wheel (3.96)
- Increasing computerization of practice (3.81)
- Too many difficult patients (3.74)
- Too many patient appointments in the day (3.64)
9. Physician as the Team’s “Emotional Thermostat”: The physician’s mood and temperament influence everyone on the team more so than can be imagined. Gallup (2015) has found that managers account for up 70 percent of the variance in employee engagement surveys.
Research has shown from the Korn Ferry Hay Group that the leader has 50-70 percent over the climate of the team. If they are calm and collegial, so is the team; if they are impatient, stressed, and irritable, so is the team. In the hospital hierarchy, the physician may even have higher influence over the climate of the surgery team, or in the emergency room. The physician’s mood is the most contagious mood with others.
10. Decision Fatigue impacts Decision Quality: In today’s world we are all “crazy busy.” Some people call this a VUCA environment, which means Volatile, Uncertain, Complex, and Ambiguous. To be outstanding, an individual needs to be able to make effective decisions in the moment with as much information and knowledge as they can gain. It is a matter of getting accurate input to improve the output. The EI input is knowing about yourself and assessing others quickly so the decisions can be better. This kind of strategic intelligence is highly valued by the military. It is also a critical skill for any executive that is making thousands of decisions a day. To be a top performer you must quickly assess and adjust in this VUCA environment.
Our formula for top performance that we share with physicians and leaders is:
Empathy X Insight X Clarity = Top 10 Percent Performance.
Whether it is training or coaching the focus is to gain more clarity into your strengths and weakness and those of your direct reports or your teams. Making micro-initiatives about yourself and others can have a macro-impact and help make great decisions in the moment.
What we know about Emotional Intelligence Interventions.
- Research has shown promise in advocating the use of EI-based education systems to develop and improve the art of professional development and communication skills. (Cherry et al., 2014)
- A study of 2,800 physician “star performers” showed that 75 percent of a high-achiever’s success is a function of emotional intelligence; only 25 percent of success reflects technical competency (El-Aswad, Nadler, Ghossoub, 2017).
In a critical review of the literature performed by Arora et al. in 2010, the authors identified a total of 485 articles that have looked at EI in medicine. The authors discussed the importance of EI with respect to the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME). They noted the EI is inherently linked to empathy, effective communication, leadership, stress management, teamwork, and academic performance. EI’s inherent characteristics are such that they warrant further research.
- In a study with my colleagues Dr. El-Aswad and Dr. Ghossoub with program advisors, we found that:
Training directors using the unique combination of emotional intelligence, self-care techniques and leadership skills may be an effective intervention against combating burnout in residency programs. It was sustained for 9 months after the intervention.
In summary, Emotional Intelligence training and coaching can help physicians address these 10 areas that lead to burnout with self-management and developing others strategies. Some of these strategies have been addressed in past posts and will be addressed in future ones.
Arora S., Ashrafian H., Davis R., Athansiou T., Darzi A., Sevdalis N. (2010) Emotional intelligence in medicine: a systematic review through the context of the ACGME competencies. Medical Education. 44, 749-764.
Balch C.M., Freischlag J.A., Shanafelt T.D. (2009) Stress and Burnout Among Surgeons: Understanding and Managing the Syndrome and Avoiding the Adverse Consequences. Archives of Surgery. 144(4): 371-376.doi:10.1001/archsurg.2008.575
Dyrbye, L.N., Shanafelt T.D., et al. (2017) Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care. Discussion Paper
McHugh MD, Kutney-Lee A, Cimiotti JP, Sloane DM, Aiken LH. (2011) Nurses’ widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care. Health Aff;30:202-10.
Cherry, M.G., Fletcher, I., O’Sullivan, H., Dornan, T. (2014) Emotional intelligence in medical education: a critical review. Medical Education. 48(5), 468-78.
Ghossoub, G., El-Aswad, N. Nadler, R. (2018) Effect of Using Emotional Intelligence, Wellness, and Leadership Training on Lived Experiences of Medical Program Directors Burnout, Universal Journal of Public Health 6(5): 298-305, 2018 Vital Signs Vital Skills, L.L.C., Texas, USA
Ghossoub, Z., El-Aswad, N. and Nadler, R. (2018) Targeting physician burnout through emotional intelligence, self-care techniques, and leadership skills training: A qualitative study. Mayo Clinic Proceedings: Innovations, Quality & Outcomes
El-Aswad, N., Nadler, R., and Ghossoub, Z., (2017) Physician Burnout: An Emotionally Malignant Disease. Texas: Vital Signs Vital Skills
Nadler, R.S. (2011) Leading with Emotional Intelligence: Hands on Strategies for Confident and Collaborative Star Performers. New York; McGraw-Hill