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Burnout High Among Podiatrists

Discussion in 'General Issues and Discussion Forum' started by admin, Nov 23, 2004.

  1. Dieter Fellner

    Dieter Fellner Well-Known Member

    Thanks Bill! I'm glad to report I graduated in June this year, from residency with the three year PMSR/RRA residency certificate. Stephen's plight will strike a chord with many NHS staffs, I'm sure.

    There is a trend here for more Podiatrists to join hospital staffs. The clinics get crazy busy with 50-100 patients booked and the doctor having no time to complete the notes until later. Another 2-3 hours of work, 8am start, 8-9pm finish. Maybe get lunch. The commute to & from work 1-2 hours.

    I saw that all too often. And not only in Podiatry. I had a three month rotation with the Orthopedic Foot & Ankle guy. Often he would have 3-4 patients booked in the same time slot. He would be a blur on the floor, flying from room to room. But still find time to yell at the residents. All of this in addition to rounding on the floors, educational commitments, Grand Rounds etc etc.

    I'm planning to read the monkey book to know how we might squeeze 48 hours from a 24 hour day.
     
  2. davidh

    davidh Podiatry Arena Veteran

    In all fairness Mark - do you buy that any pod has to stay in work untul 8.30pm on a Friday?
    Nursing is of course totally different.

    Bill, hats off to anyone who genuinely does have to work incredibly long hours for additional qualifications.
    I'm not doubting the OP had burnout (or whatever). I'm doubting he had to stay at work until 8.30pm on a Friday evening. Of course, as he rightly says, I wasn't there……...
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    It's likely he didn't "have" to stay, but felt a burden of responsibility & duty to do so. I agree that a burn-out victim doesn't always objectively evaluate their actions and implicit contribution to their situation. But they absolutely must re-evaluate their working life to see what changes must be made to remain functional. Time management and coping strategies are essential. Prioritize, and learn to say "no". Clock in and out as required by the contract. He would also need to reconsider if it is "essential" to maintain 3-4 areas of specialist interest. There is only so much time in the working day. And ultimately, if the working conditions are so dire, the final solution is indeed, to get out. Life is short ...
     
  4. For the last ten years of Dad's career in the NHS - he would spend four or five hours every Sunday in his clinic, sorting out staff rota, management reports, orders etc. Of course he didn't need to do it - just like my sister doesn't need to work until 8.30pm most nights. She is supposed to have time in lieu - but the number of hours you can take is very limited. I suspect the same can be said for Stephen - what we don't know is the reasons why someone is "motivated" into working extra hours - but motivation can be coerced under pressure or duress or neglect. Sometimes there really isn't a choice - or at least a realistic one. I agree with Dieter's comments above - but when you're in the midst of an unpleasant situation, it is sometimes difficult to make a rational decision and that is really when you need someone of experience to give you the most appropriate advice. A role for professional bodies? You bet - but clearly not ours!
     
  5. davidh

    davidh Podiatry Arena Veteran

    OK - makes no sense to me, and my last NHS post involved, amongst other things, screening 27 patients in a three-hr session on a regular basis. I was treating a damn sight more than eight patients a session too. In private practice we saw a patient every 20 minutes - that's 21 patients a day in a full clinic, which they generally were (+ emergencies).

    Mark - In the NHS there's always a choice. In general podiatry there are very few life-threatening emergencies.
    The penultimate choice of course is to see the Union Rep. The ultimate choice is to leave.
    I'm thinking extreme bad time management. If you are running the Department that's different, maybe he is?
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

  7. davidh

    davidh Podiatry Arena Veteran

    Dieter,
    I read the Guardian article when it was published.
    I'm fairly up-to-date with podiatry diabetes care in the uk, being involved with several current litigation cases.

    Yes, everything has changed. No, it doesn't need to be stressful all the time - unless you are in a management position which you cannot afford to leave because you have a big car and bigger mortgage - and you're being dumped on from a great height. Even then, there are ways out.

    Bottom line - why would anyone stay in a job which was causing health issues?
    Beats me.
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    Consensus ... change can be scary, and that might cause a person to feel trapped. Possessions, family, familiarity, change in pay, change of status etc etc. Ultimately you gotta figure that out ....
     
  9. Stephen Warner

    Stephen Warner Welcome New Poster

    Thanks folks for in the main helpful comments. As correctly pointed out one doesn't have to work late. Also correct is the point that it is sometimes in the situation one doesn't see things objectively and until there is a problem nothing is done, because you can't deal with something you cannot see is there. There seems to be a ridiculous amount of animosity being stirred up here over a simple observation made about a previous thread. Whilst I possibly could or should have handled the situation differently at the time it was what it was. What I do object to however is someone casting doubt on the veracity and integrity of my statement. I think it is time to draw a line under this now.
     
  10. I think your post is extremely valuable, Stephen - and I'm sorry if you feel I've doubted your word - far from it. It is interesting how readily this profession fragments and descends into the arena of self destruction every time someone raises an issue like that you have. Perhaps it's just represents the mood of wider society and the general intolerance that is so apparent these days, but your account amply demonstrates that even this small and relatively insignificant profession is just as susceptible to moronic behaviour as any other.

    Take care.
     
  11. Dieter Fellner

    Dieter Fellner Well-Known Member

    Stephen,

    It's not always easy to understand another's predicament unless you can walk in their shoes. I'm sure you'll figure out what to do. Hindsight can provide for wonderful clarity of vision.

    Best,
     
  12. Stephen Warner

    Stephen Warner Welcome New Poster

    Your comments were generally helpful and I didn't feel you were questioning what I had said, thanks Mark. As I said I think it is best to close this now.
     
  13. Admin2

    Admin2 Administrator Staff Member

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    Press Release;
    PHYSICIAN HEAL THYSELF: SIMPLE COPING STRATEGIES
    A study in 2016 found that female physicians were at greater risk of professional burnout than their male counterparts. Almost 50 percent of practicing obstetricians and gynecologists are women.

    6/26/2017

    The proverb, “physician heal thyself,” is probably more relevant today than it was in biblical times with the fast pace of life, the impact of multitasking and the unending bombardment of information, which have made emotional exhaustion almost certain. And this is especially true for obstetricians and gynecologists who experience professional burnout rates between 40 to 75 percent.

    While these numbers may provide a very dismal view of this vital medical specialty, a professor in the Charles E. Schmidt College of Medicine at Florida Atlantic University provides reassuring advice that several simple strategies can blunt, if not eliminate, the risk of professional burnout. Although his advice is targeted to physicians, who have a natural tendency to place the needs of their patients above their own, anyone in any profession can benefit from his insight, which is published in the journal Obstetrics and Gynecology Clinics of North America .

    “Burnout is physical or mental collapse that is caused by overwork or stress and all physicians are at risk,” said Roger P. Smith, M.D., an obstetrician and gynecologist who is the assistant dean for graduate medical education and a professor in the Department of Integrated Medical Science in FAU’s College of Medicine. “Professional burnout is not new, but what is new is the wider recognition of the alarming rates of burnout. Physicians in general have burnout rates that are twice the rate of working adults.”

    Unlike stress, burnout is characterized by exhaustion, lack of enthusiasm and motivation, and feelings of ineffectiveness, with the added dimensions of frustration or cynicism, resulting in disengagement, demotivation, and reduced workplace efficacy. Burnout is more gradual, progressive, and insidious than stress, making it more likely to go undetected until further along its continuum. It also is associated with an increased risk for physical illness.

    Among the medical specialties that experience burnout rates of 40 percent or more are anesthesia, dermatology, emergency medicine, family medicine, internal medicine, obstetrics/gynecology, radiology and surgery. Burnout is associated with poor job satisfaction, questioning career choices, and dropping out of practice, which impact physician workforce and shortage concerns and patient access.

    In the article, “Burnout in Obstetricians and Gynecologists,” Smith points out that physician burnout is not just an issue in the United States, it is a global issue. Those at highest risk are younger clinicians doing their medical residencies who have burnout rates closer to 75 percent.

    Furthermore, unlike earlier studies, a study in 2016 found that women were at greater risk of professional burnout than their male counterparts. Smith cautions that this is of concern because almost 50 percent of practicing obstetricians and gynecologists are women.

    “It isn’t exactly clear what is driving the gender difference. Other studies suggest that women may experience more family pressure, work-life imbalance or sleep disorders,” said Smith. “Sleep disorders are prevalent among physicians, especially among women, in whom rates are between 35 and 40 percent.”

    So what to do? Well, for starters, when it comes to fatigue, Smith says the solution is easy: sleep. Physicians tend to sleep fewer hours that those in the general population and what is achieved is often not the type that is restful and restorative. Just reducing the number of hours worked is not sufficient as several studies have previously shown. Rest must result in relaxation and renewal.

    “In reality, there are several simple approaches that can be used to reduce stress,” said Smith. “Alter it through direct communication, problem solving and time management; avoid it by delegating, know your limits, or simply walk away; and finally, build resistance by changing your perceptions.”

    Among the helpful tips Smith provides to reduce or eliminate burnout include taking short breaks to rest, singing, or take stock. Vacations, laughing, skilled counseling, exercising as well as hobbies and activities that are enjoyable, all can help to promote resiliency.

    “Early diagnosis and intervention are key. Awareness of the symptoms, and some simple stress and fatigue reduction techniques, can reduce the risk of being trapped in the downward spiral of burnout,” said Smith. “Whatever route is taken, no physician should feel immune, no physician should feel ashamed or alone, and no physician should feel that reversal isn’t possible to escape the personal and professional collapse that is burnout.”
     
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  20. BEN-HUR

    BEN-HUR Well-Known Member

    There are a few "burnout" related threads on Podiatry Arena. The following (recent) article I've found has put a differing perspective on this issue of "burnout"... "moral injury": (https://www.statnews.com/2018/07/26...m_source=twitter&utm_campaign=twitter_organic)

    Physicians aren’t ‘burning out.’ They’re suffering from moral injury
    By Simon G. Talbot and Wendy Dean
    July 26, 2018

    "Physicians on the front lines of health care today are sometimes described as going to battle. It’s an apt metaphor. Physicians, like combat soldiers, often face a profound and unrecognized threat to their well-being: moral injury.

    Moral injury is frequently mischaracterized. In combat veterans it is diagnosed as post-traumatic stress; among physicians it’s portrayed as burnout. But without understanding the critical difference between burnout and moral injury, the wounds will never heal and physicians and patients alike will continue to suffer the consequences.

    Burnout is a constellation of symptoms that include exhaustion, cynicism, and decreased productivity. More than half of physicians report at least one of these. But the concept of burnout resonates poorly with physicians: it suggests a failure of resourcefulness and resilience, traits that most physicians have finely honed during decades of intense training and demanding work. Even at the Mayo Clinic, which has been tracking, investigating, and addressing burnout for more than a decade, one-third of physicians report its symptoms...


    … Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury...."


    - Full article here: https://www.statnews.com/2018/07/26...m_source=twitter&utm_campaign=twitter_organic
     
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    Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction
    A Systematic Review and Meta-analysis

    Maria Panagioti et al
    JAMA Intern Med. Published online September 4, 2018. doi:10.1001/jamainternmed.2018.3713
     
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    NEWS RELEASE 6-MAY-2019
    Five things to know about physician suicide

    Physician suicide is an urgent problem with rates higher than suicide rates in the general public, with potential for extensive impact on health care systems. A "Five things to know about ..." practice article in CMAJ (Canadian Medical Association Journal) provides an overview of this serious issue.
    Five things about physician suicide:
    • As the only means of death more common in physicians than nonphysicians, suicide is an occupational hazard for physicians.
    • Firearms, overdose and blunt force trauma are the most common means, with benzodiazepines, barbiturates and antipsychotics being the most commonly used drugs.
    • Increased suicidal ideation begins as early as in medical school, with nearly 1 in 4 students surveyed reporting suicidal ideation within the last 12 months.
    • Complaints to regulatory bodies are associated with higher rates of suicidal ideation.
    • Suicidal physicians face unique barriers to care, including concerns regarding confidentiality, and fears of stigmatization and discrimination from peers, employers and licensing bodies.
     
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  26. eddavisdpm

    eddavisdpm Active Member

    Stressors of work do not just affect the practitioner but his or her family. Long hours, high stress levels and financial uncertainty are not isolated to the workplace but taken home.

    Third party interference with medical care, onerous regulations, demands for documentation and paperwork are bigger issues, in my opinion, than the practice of podiatry. Our profession gives comfort and improved function to many, often in short order, so it can be gratifying when we can actually do what we are trained to do.
     
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    Perceptions of Burnout, Personal Achievement, and Anxiety Among US Podiatric Medicine and Surgery Residents: A Cross-Sectional Pilot Study
    Calvin J. Rushing et al
    JFAS: May 30, 2020
     
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    NEWS RELEASE 25-FEB-2021
    Health professional societies address critical care clinician burnout

    Feb. 25, 2021 - A new paper published online in the Annals of the American Thoracic Society provides a roadmap that critical care clinicians' professional societies can use to address burnout. While strongly needed prior to the COVID-19 pandemic, the roadmap has taken on even greater urgency due to reports of increasing pandemic-related burnout.

    In "Professional Societies' Role in Addressing Member Burnout and Promoting Well-Being," Seppo T. Rinne, MD, PhD, of The Pulmonary Center, Boston University School of Medicine, and co-authors from a task force created by the Critical Care Societies Collaborative (CCSC) describe a rigorous process they used to document 17 major professional societies' efforts to address burnout among health care professionals working in critical care, such as ICU physicians, physician assistants and nurses. The task force explored perspectives on the role of these societies to address burnout and developed a "roadmap" that the societies can use to guide their efforts to promote critical care clinicians' well-being.

    The CCSC, which has taken a number of actions to raise awareness of and address clinician burnout, consists of four major U.S.-based critical care professional societies: American Association of Critical-Care Nurses (AACN), American College of Chest Physicians (CHEST), American Thoracic Society (ATS) and Society of Critical Care Medicine (SCCM).

    "The ATS has focused on clinician well-being for several years now," said Karen Collishaw, CAE, executive director of the American Thoracic Society and a co-author of this study. "Activities have ranged from holding live and virtual sessions discussing the problem and encouraging people to share experiences and ideas, hosting a wellness center (with dogs!) in the exhibit hall at our international conference, and collaborating with our peer critical care societies on projects such as this one looking at the role professional societies can play in tackling this issue."

    ATS President Juan Celedón, MD, DrPH, ATSF, added, "The COVID-19 pandemic has only exacerbated the need for more of these activities and the ATS is committed to helping the pulmonary and critical care community stay well wherever we can."

    Previous studies have explored individual and organizational solutions to address burnout, which is common among clinicians who deal with the many stressors of the critical care environment. This is the first peer-reviewed paper to discuss the role of professional societies in preventing or reducing burnout.

    "High clinician burnout rates threaten the quality, safety and efficiency of clinical care, and research has shown that critical care clinicians are especially at risk," said Dr. Rinne. "Professional societies can play a key role in addressing burnout by promoting practices, policies, and norms that value clinician well-being."

    He added, "Promoting clinician well-being is good for patients, and it is also the right thing to do. Clinicians suffering from burnout have higher rates of substance abuse, depression and suicidal ideation. The health and well-being of patients is directly tied to the health and well-being of clinicians and the health system at large."

    The researchers conducted a multi-phased project from March to December 2019. First, they identified professional societies in critical care-related fields and documented their existing well-being initiatives. Next, they conducted interviews with representatives of selected societies in order to explore their perspectives on the role of professional societies in addressing burnout. Finally, they reviewed results from the first two phases and engaged all task force members in a group discussion in order to develop a strategic roadmap that could guide critical care professional societies and inform professional societies in related fields. The task force attempted to relate all findings to a framework of factors influencing clinician burnout and well-being developed by CCSC and the National Academy of Medicine. The roadmap created based on this research includes the following recommendations:

    1. Professional societies should acknowledge the problem of burnout among their members. In order to do this, the societies should first conduct internal research to assess the extent of burnout and any unique factors affecting members.
    2. Leadership of each society must determine how well-being initiatives fit into their organizational structure and strategic priorities. Organizational leadership may want to embed well-being efforts into other strategic initiatives, or may focus separately on well-being.
    3. Partnerships with other organizations--national and local professional societies, health care organizations, academic institutions, advocacy groups--working in the same field may help promote member well-being and provide useful resources. The National Academy of Medicine and other organizations can help facilitate these partnerships.
    4. Professional societies can play an important role in educating and supporting members, and advocating for change. Members' health care institutions do not consistently address burnout, and may not even be supportive of such efforts; professional societies can meet this need.
    5. By encouraging research focused on improving clinician well-being, societies can help foster innovation and collaboration.
    6. Recent scientific literature has identified effective organizational and individual solutions to reduce clinician burnout, and these remedies should be supported. While both types of solutions are valuable, professional societies should emphasize the importance of organizational approaches, as these methods tend to be more effective at reducing burnout.

    "We have outlined a number of steps that societies can take to address burnout, based on a rigorous process that led us to these targeted recommendations," concluded Dr. Rinne. "The first and most important step is that leadership must acknowledge the burden of burnout and promoting clinician well-being through taking measures that can contribute to a culture shift that supports well-being and values the humanity of clinical care."
     
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    Feeling the Burnout: Perceptions of Burnout, Anxiety, Depression, and Personal Achievement in US Podiatric Medical Students
    Elizabeth Ansert et al
    March 05, 2021
     
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