As experienced clinicians and mentors, mid-career physicians are some of the most productive on staff, but their employers face huge losses when they cut back or leave due to burnout, said Liselotte N. Dyrbye, MD, FACP, MHPE, co-director of the Mayo Clinic department of medicine's Program on Physician Well-Being. Since such seasoned veterans often don't receive much career support, she and colleagues tested whether professional coaching could reduce their rates of burnout.
Physicians were eligible for the randomized trial if they had been in practice for five to 30 years. Participants were primarily general internists, family medicine doctors, pediatricians, and internal medicine subspecialists practicing in inpatient and/or outpatient settings. Of 764 eligible physicians, the first 88 to sign up were enrolled: 44 were randomized to receive the coaching intervention, and 44 served as controls.
How it works
The intervention consisted of an initial one-hour coaching session followed by five 30-minute sessions. The goal was to complete the shorter sessions every two to three weeks over five months. “Sessions were scheduled at the convenience of the physician. This also helps to make it generalizable,” said Dr. Dyrbye, professor of medicine and medical education at Mayo in Rochester, Minn. All sessions were performed over the phone with credentialed professional coaches, provided by Bluepoint Leadership Development Inc., which has experience coaching physicians as part of a longstanding relationship with Mayo Clinic.
While a customized coaching template was used, the sessions were self-directed by physicians. “This sort of individualized coaching allowed people to address the topics that were on their mind, rather than forcing them to talk about certain topics which may not be as relevant to them,” said Dr. Dyrbye, who is also associate chair of staff satisfaction, faculty development, and diversity for the Mayo Clinic department of medicine.
After the intervention, rates of overall burnout decreased by about 17% in the intervention group and increased by about 5% in the control group, according to results published online in August by JAMA Internal Medicine. Quality-of-life and resiliency scores also improved significantly more in the intervention group compared with the control group. However, there were no significant differences in depersonalization, job satisfaction, engagement, or meaning in work between groups.
“It's not some perfect panacea, but it really was able to reduce burnout and improve quality of life,” said Dr. Dyrbye.
The study did not include a cost-effectiveness analysis; however, Dr. Dyrbye is confident that it compares well to the expense of physician burnout. The annual cost associated with burnout related to turnover and reduced clinical hours is about $7,600 per employed physician, according to a study by Dr. Dyrbye's group, published in June by Annals of Internal Medicine. “Our intervention cost about $1,400 per physician, so it's really just a small amount of what burnout is likely to be costing employers per physician,” she said.
It wasn't a challenge to find physicians who were willing to participate, but it took effort to get them to respond to their surveys, Dr. Dyrbye said. In addition, the study would not have been possible without funding from the Mayo Clinic Program on Physician Well-Being and the Physician Foundation, she said. “There's very little external funding for any sort of research study in the physician well-being space, and that's really limiting our rate of learning.”
The pilot study did not look at duration of effect beyond six months, so Dr. Dyrbye is interested in assessing the longer-term impacts of the intervention. She is also interested in seeing if professional coaching works for other clinicians and for other physician specialties, such as surgery. “We have to remember that burnout is not a phenomenon that's isolated to physicians in practice, although we probably suffer more with it relative to other health care professionals. . . . I think there are lots of potential directions for research,” said Dr. Dyrbye.
Words of wisdom
Other health systems that want to mitigate the risk of losing physicians to burnout should consider implementing evidence-based strategies, which now include professional coaching by phone, she said. “Physician coaching is one of the things that could be on the menu in addition to other efforts around addressing practice inefficiency, work overload, and the rest of the drivers [of burnout],” Dr. Dyrbye said.