“Something very alarming is going on in the American healthcare system nowadays. Doctors aren’t happy, and neither are patients. The proverbial admonition, “Happy doctors make for happy patients” comes to mind with the caveat that the reverse is also true.” Thomas Murphy
With the advent of managed care and the Affordable Healthcare Act in the U.S., primary healthcare providers have become a critical component of the healthcare system. Unfortunately, there is a marked shortage of these providers. It is estimated that in the U.S. there are over 9,000 fewer primary care physicians than needed. The shortages are not just due to training insufficient numbers of healthcare providers but also due to high turnover rates. In part because of the shortage and high patient loads, primary healthcare providers experience high stress and burnout. They experience a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment.
In a recent survey 46% of all physicians responded that they had burnout. Currently, over a third of healthcare workers report that they are looking for a new job. Nearly half plan to look for a new job over the next two years and 80% expressed interest in a new position if they came across the right opportunity. Since there is such a great need to retain primary healthcare providers, it is imperative that strategies be identified to decrease stress and burnout.
Burnout is not a unitary phenomenon. In fact, there appear to be a number of subtypes of burnout. The overload subtype is characterized by the perception of jeopardizing one’s health to pursue worthwhile results, and is highly associated with exhaustion. The lack of development subtype is characterized by the perception of a lack of personal growth, together with the desire for a more rewarding occupation that better corresponds to one’s abilities. The neglect subtype is characterized by an inattentive and careless response to responsibilities, and is closely associated with inefficacy.
Doctors appear to vary in resilience, in their ability to withstand the stress of practice and not burnout. They also vary in mindfulness which has been shown to be effective in preventing and treating healthcare professional burnout (see http://contemplative-studies.org/wp/index.php/category/research-news/burnout/). In today’s Research News article “Mindfulness, Resilience, and Burnout Subtypes in Primary Care Physicians: The Possible Mediating Role of Positive and Negative Affect”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681844/
Montero-Marin and colleagues investigate the relationship of resilience, mindfulness, and emotions to burnout in 622 Spanish primary care physicians. Using sophisticated statistical techniques, they found that the three types of burnout were highly positively associated, with high levels of each associated with high levels of all the other types. They also found that mindfulness and resilience were highly related, with higher levels of mindfulness associated with higher levels of resilience.
The overload type of burnout was directly associated with both negative emotions and mindfulness. In addition, both mindfulness and resilience appeared to affect overload indirectly by reducing negative emotions and thereby reducing overload burnout. The lack of development type of burnout was negatively associated with positive emotions and resilience was positively associated with positive emotions. So, resilience appeared to affect lack of development burnout by increasing positive emotions which in turn decrease lack of development burnout. Thereby, high levels of resilience were associated with low levels of lack of development. Finally, they found that resilience was negatively related to neglect burnout such that the higher the levels of resilience, the lower the neglect burnout.
These are complex interrelationships. But in general they suggest that the mindfulness and the resilience of the physicians were highly related and worked in consort to reduce all types of primary care physician burnout and they do so, at least in part, by affecting the positive and negative emotions of the physicians. They may do so by different mechanisms, mindfulness by reducing the psychological and physical responses to stress and resilience by increasing the ability to withstand the stress.
Regardless, burnout doctor burnout with mindfulness.
“The benefits of mindful practice extend beyond the practitioner to his or her patients. It is not only that mindful practitioners can listen attentively, but that their patients are empowered to make their voice heard in areas that matter to them.” – Mary Catherine Beach
CMCS – Center for Mindfulness and Contemplative Studies