Personal Resiliency in
Tina Runyan, PhD, ABPP
Department of Family Medicine & Community Health
No relevant financial relationships during
the past 12 months.
I am the current president of the board for
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• Clinician Burnout
– Define, Prevalence, Why It Matters, Causes
• Antidotes to Burnout (and the evidence)
• Organizational Approaches
• Personal Strategies
• Skills Practice Throughout
"There is a pervasive form of modern violence to which the
idealist...most easily succumbs: activism and over-work. The rush
and pressure of modern life are a form, perhaps the most
common form, of its innate violence.
To allow oneself to be carried away by a multitude of
conflicting concerns, to surrender to too many demands, to
commit oneself to too many projects, to want to help everyone
in everything is to succumb to violence.
The frenzy of the activist neutralizes his (or her) work... It
destroys the fruitfulness of his (or her)...work, because it kills the
root of inner wisdom which makes work fruitful."
~ Thomas Merton
Over the past 10 years, there has been a surge of literature on the emerging trend towards an increasing rate of burnout in faculty, particularly in primary care. Burnout has been defined as “a loss of emotional, mental, and physical energy due to continued job-related stress (Fortney). It has also been defined as the absence of so-called “wellness”, having several key components: emotional exhaustion and loss of empathy/compassion, depersonalization and personal accomplishment.
A 2013 review in the Family Practice Management journal reported that half to one-third of physicians at that time met burnout criteria. Interestingly, they noted a trend where female physicians were 1.6 times more likely to experience burnout than their male counterparts (Nedrow). Primary care physicians have been noted to be at the highest risk for burnout amongst physicians (Fortney), which has dire consequences on the health care system through poor quality patient care and safety, higher attrition rates and inefficiency.
There is growing understanding that medical culture, which starts to be ingrained in physicians during medical training, plays a significant role in physician burnout. Trainees may adapt maladaptive characteristics during training under the impression that it is time-limited, often have difficulty un-learning these habits, and may need support as they move out of training to re-learn self-care and work habits/characteristics that will foster their well-being
& Personal Accomplishment
2011 study: 51% med students, 36% residents, up to 81% interns.
2014 survey: 54% had 1 sx of burnout, and 51% of FM docs
BURNOUT IS NOT THE SAME AS STRESS. What starts as burnout
burnout has been linked with increased medical error and cost, and decreased patient satisfaction.
For physicians themselves, burnout is associated with an increased risk of substance abuse, unprofessional behavior, and suicide.
Suicide accounts for 26% of deaths in physicians aged 25-39 years, compared to only 11% in the general population of the same age group. Being a physician has been called by some “an occupational work hazard”.
is extensive and growing
with 54% of US physicians
reporting at least one
symptom of burnout in
2014; up from 46% in
Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in
burnout and satisfaction with work-life balance in
physicians and the general US working population
between 2011 and 2014. Mayo Clin Proc.
Source: Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in
physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13.
Burnout is Associated With …
Decreased Job Satisfaction and Attrition
Suboptimal Patient Care
Increased Medical Errors
Decreased Patient Adherence
Decreased Patient Satisfaction
Linzer et al. Annals of Internal Medicine 2009;151:28-36
Dyrbye, JAMA 2011;305:2009
Murray et al, JGIM 2001:16,452
Landon et al, Med Care 2006;44:234
Bodenheimer, Sinsky, Ann Fam Med 2014;12:573.
Burnout is EXPENSIVE
• Malpractice Risk
• Part Time Providers
• Physician and Staff Turnover
• Costs about $250,000 - $300,000 to replace
The Doctor: 1891
Continuous Partial Attention
The Doctor Now
The “big 4” factors contributing to
stress and burnout:
1.Lack of control over work conditions
3.Chaotic workplaces / visits
4.Lack of alignment of values (around
mission, purpose and compensation)
between providers and their leaders
Primary Driver of Physician Satisfaction
is Delivering High Quality Care (RAND Corp) …
When that is threatened or
compromised, satisfaction dwindles.
“Burnout is an erosion of the soul.”
Not being given adequate time to provide excellent care to
patients, but expecting me to provide "exceptional care without
exception", increases my burnout. – PGY3 FM Resident
“I suspect that the most basic and powerful way to connect to another person is to listen. Just listen. Perhaps the most important thing we ever give each other is our attention. And especially if it's given from the heart. When people are talking, there's no need to do anything but receive them. Just take them in. Listen to what they're saying. Care about it.”
~ Rachel Naomi Remen
Summary Risk Factors for Burnout
Individual – The Vulnerability Side of
Perfectionism & Overachievement –
Type A, fear of failure/inadequacy
Lack of control & autonomy – decisions,
Compulsiveness (Need for control) Difficult work – nature, volume
“Physicians don’t have needs”
“Emotions = weakness”
Lack of feedback/validation – “feeling
Introversion Relationship & work-home strain
Rigid thinking Sleep deprivation
Reluctance to ask for help Lack of mentorship & support
Being Female (OR 1.29) Culture of medicine
Uncertainty – patient management,
personal & professional future
Today’s generation of family medicine residents have many of these:
mostly female, perfectionist personality traits, risk for decreased perception of control of work/life schedule, and others.
Of note, working hours has been consistently shown as NOT to be an independent risk factor for burnout – instead, it’s perceived control over the time spent working.
Integrated BH Clinicians
Measured by making other’s lives better
We don’t get the mental health equivalent of an
We are supposed to know how to do this ... This is
what we teach, right?
Services for support focus on MDs
• Maslach Burnout Scale ($)
• Jefferson Empathy Scale ($)
• Physician Well Being Index
• Physician Wellness Inventory
• Mini Z Burnout Assessment (AMA)
• Self-Compassion Scale (public domain)
• Copenhagen Burnout Inventory (public domain)
• Compassion Fatigue Scale (public domain)
• Mindfulness Attention Awareness Scale (public domain)
• Five Facet Mindfulness Questionnaire (public domain)
Reflection: Your relationship to your work
Early warning signs and Prevention
How have you changed because of your work?
What are some ways that caring about people who have been hurt affects you?
Are there ways in which your sense of commitment and responsibility to