Minimizing Medical Burnout: Kim Templeton On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout

An Interview With Dan Rodrigues

Talk with physicians about what issues they are facing and what workplaces can do to help them. Engaging with physicians in effecting change, rather than initiating efforts that are well-intentioned but without the input of those they impact, can increase the likelihood that program or change will have a positive effect on decreasing burnout risks. This can result in real change to the workplace to make it more functional and welcoming. Efforts such as yoga and mindfulness training can teach coping skills in the short term but do not impact the underlying causes of burnout.

The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example)

What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?

To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Dr. Kimberly Templeton.

Dr. Kim Templeton is Professor and Vice-Chair for Diversity, Equity, and Inclusion in the Department of Orthopaedic Surgery and Associate Dean for Continuing Medical Education at the University of Kansas Medical Center. Dr. Templeton is also past-president of the American Medical Women’s Association and started and continues to lead the organization’s wellbeing initiative, focusing on issues faced by women medical students and physicians.

Thank you so much for joining us in this interview series! I know that you are a very busy person. Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory? What or who inspired you to pursue your career? We’d love to hear the story.

I was not one of those who came to medicine because of parents or a family involved in the professions or education. Neither of my parents went to college, and my father actually dropped out of high school to help support his family and later obtained his GED after returning from fighting in WWII in the Marine Corps. I had a lot of interests growing up, and my teachers encouraged me to go into medicine. I was an athlete (and still think I am), so I wanted to combine interests and pursue a career in sports medicine. That eventually got me into medicine in general and specifically orthopaedic surgery, although my subspecialty turned out to be oncology- somewhat different than sports medicine.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

My work at this point primarily is focused on 2 main areas: a) physician wellbeing, from medical students, to resident trainees, to those in practice; and b) sex and gender differences in health and illness. I’m a member and past-chair of the AMWA Sex and Gender Collaborative; the goal of that group is to improve patient care by increasing understanding and improving education in sex and gender differences. The wellbeing work is intended to help those in training and in practice. Both projects will improve patient care and outcomes: physician wellbeing to assure we have an adequate and healthy workforce to care for patients, education in sex and gender differences is important so that physicians know how to apply evidence to specific patients and to understand that women and men and transgender patients may have different risk factors, presentation, and response to treatment for common health conditions.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

1. Collaboration: Many of the organizations on which I’ve worked have been interdisciplinary and interprofessional. This allows more perspectives to be brought to the table, usually resulting in a better outcome and more support from those involved. I’m a past-president of the US Bone and Joint Initiative, and all of our work was interprofessional, including patient education projects. For example, we developed “Fit to a T”, a bone health and osteoporosis public education program intended to address the rate prevalence of low impact fractures. Fit to a T included input from various medical specialties but also from nursing, physical therapy, and athletic trainers. I especially enjoy the initial work on a collaborative project, as not everyone understands the role that they play. As discussion ensues, however, people start to see the puzzle come together.
2. Inclusion: Inclusion means having diverse voices around the table and making sure that those voices are heard and acknowledged. When working on a project, I want to make sure that everyone’s voice is heard. Some people may have a different point of view that could take a project in a different direction or enhance what is already being developed. They need to be empowered to speak up, and others in the group need to listen. In addition, if someone has concerns that a project is flawed or not feasible, I’d prefer to hear about that early in the process, rather than later when time and resources have been expended on something that could have been improved upon. Several years ago, I co-chaired a meeting between the state medical board (during my presidency of the Board) and the state board of nursing. There were some topics on which we had agreement and others not. At the end, one of the board of nursing members came to me and said “we will likely never agree on this topic, but thank you for allowing me to speak and get all of my points across”. Those types of interactions are useful in building relationships and collaboration.
3. Innovation: Part of being a leader is identifying or helping others to identify initiatives that can help to move a group or organization forward and that will hopefully have an impact. A leader can’t and shouldn’t be responsible for bringing an idea to fruition alone, as this will minimize the quality of the product and its impact. However, a leader should be scanning the horizon for future opportunities and areas for collaboration among groups and then vet these with others. A lot of ideas won’t go anywhere but the rest, with input and modifications from others, can have legs. Most of the areas of innovation in which I’ve worked have been a result of being involved in several organizations and seeing what impacts them and their members and how organizations can work together for the greater good. This provides the perspective of what issues and resources we have in common that we can leverage for new work. For example, I’ve been a residency program director for many years and am a member of the ACGME orthopaedic residency review committee, so I have experience working in the world of graduate medical education. I also work on wellbeing through AMWA and also see the issues that physicians face- and the resources for help- through my work on the state medical board and state medical society. This has led to my suggesting and then working with people involved in each of those areas on a webinar, presented by AMWA, that addresses resident physician well being, how to identify red flags of those who are struggling, how to identify and engage those who can help, and what restrictions are in place through things such as the ADA. The goal is to reprise this panel discussion in other venues and for other groups to continue to spread the message, especially given the additional stressors on residents during the pandemic.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?

Burnout is classically defined by 3 areas: 1) emotional exhaustion, 2) depersonalization, and 3) personal accomplishment. For most people with burnout, increased levels of emotional exhaustion and depersonalization typically trend with lower levels of feelings of personal accomplishment. Physicians are somewhat different, in that even those with high levels of the other 2 markers of burnout can still feel as though they are accomplishing something and that it matters. That can make it more difficult to identify burnout in ourselves or others as physicians, as we are still taking great care of patients and getting the remainder of our work completed yet still be burned out. Higher rates of burnout have been described among women physicians. However, women are more likely than men to manifest burnout as emotional exhaustion, and this is easier to identify than is depersonalization. Even if rates of burnout aren’t higher among women, risk factors are. Burnout was historically related to satisfaction or stressors related to work. However, we now know that responsibilities outside of work also play a role, and these are more common among women. In addition, we know that it is not only stressors related to day-to-day responsibilities at work that contribute to burnout but also do you feel seen, heard, and valued in your workplace? Are you supported in your career? Do you feel that you belong? With the increasing diversity of places of employment, including in medicine, the factors that contribute to belonging and the relationship to burnout are becoming even more important.

How would you define or describe the opposite of burnout?

The opposite of burnout is finding joy and satisfaction in your work and in your personal life. It is the feeling that you are seen and heard and that you belong. It is not feeling that because of various responsibilities, no matter where you are or what you are doing, you think you should be (or others think you should be) somewhere else doing something else.

Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?

Burnout can impact an organization by increasing the likelihood that people will move to another workplace or another career. I think that that can explain some of the attrition during the pandemic, but the pandemic only highlighted pre-existing issues in medicine and healthcare. That means that after the pandemic, we can’t just return to the status quo. Attrition is not only a problem because an organization has lost a well-trained physician but, especially when referring to women and underrepresented minority physician, also means that there is then one less person to encourage and mentor the next generation.

Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.

Confidential mental health resources are available through the institution as well as through contacting the state professionals’ (physicians’) health program. Having readily accessible mental health resources is important in dealing with some of the downstream effects of burnout, such as depression or anxiety. However, decreasing the prevalence of burnout requires departmental/institutional/societal change to address the factors that contribute to burnout. Burnout and mental health issues are linked in some, but not all people, and the former requires broader change, while the latter requires personal interventions.

In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.

Digital transformation can help, as long as those who are the intended users have the opportunity to provide input to assure that what is developed will be of use to them. There is the risk that efforts to improve operational efficiency can make things worse, if their use is not intuitive and increases work complexity or if the assumption is that once these tools are in place and there is increased efficiency, physicians should have time to take on even more responsibilities. While streamlining tasks can help to decrease risks of burnout, the primary issue in decreasing burnout remains understanding the challenges faced by physicians, both in the workplace and their responsibilities at home, and addressing those. Digital transformation will not help if physicians are facing biases and lack of support at work, while facing lifelong family responsibilities. In addition, medicine has been termed one of the “loneliness professions”. Burnout is higher among those who are lonely, and lack of support or networking opportunities at work and limited time for socializing outside of work only exacerbate this. If digital transformation results in physicians spending more time on their computers and even less time interacting with people, that could potentially exacerbate burnout. We have also yet to quantify how much the necessary changes and limitations in interactions during the pandemic contributed loneliness and secondary impacts on burnout.

Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?

1. Talk with physicians about what issues they are facing and what workplaces can do to help them. Engaging with physicians in effecting change, rather than initiating efforts that are well-intentioned but without the input of those they impact, can increase the likelihood that program or change will have a positive effect on decreasing burnout risks. This can result in real change to the workplace to make it more functional and welcoming. Efforts such as yoga and mindfulness training can teach coping skills in the short term but do not impact the underlying causes of burnout. If organizations solely rely on these interventions, it can make it seem as though they are putting the onus on the individual physician to ameliorate their own burnout. Burnout is not a personal failing and cannot be fixed at the individual level.
2. Normalize self-care and being human. Understand that physicians have responsibilities outside of work and accommodate for that. This goes beyond parental leave in early career and extends to career-long demands outside of the workplace. Don’t make physicians and others feel guilty for taking time away from work; encourage them to take the time that they need, as this helps to re-energize them and lessen burnout. In addition, time for self-care, however each person defines that, is necessary to bring our best selves to work and to home and to truly enjoy what we do. This requires understanding from our colleagues and those in the workplace that we need time for exercise, time for family and friends, time for hobbies, and time to just unplug.
3. Opportunities for networking, especially for women or UriM. These groups, in particular, may not feel comfortable or that they belong in the usual gatherings of White men physicians. Physicians tend to be lonelier than those in other professions, and this can exacerbate burnout. In addition, we know that mentoring opportunities can also reduce burnout. Networking opportunities, especially for women and UriM, usually don’t just happen but require intention, planning, commitment, and resources.
4. Change in licensure, credentialing, insurance contract, and Board certification language so that they no longer ask stigmatizing health questions. We know that if stigmatizing questions are asked, physicians are significantly less likely to see help. While those questions are well-intentioned to help identify physicians who might need help, we know from a practical perspective that they have the opposite, and often chilling, effect. Removing those questions can encourage physicians to seek the help that they need, with wording that still provides public protection.
5. Don’t call physicians and other healthcare professionals “heroes”. Physicians are well-trained and work hard. We are dedicated to our profession and our patients. But we are not heroes. While the use of the word “hero” in relationship to healthcare professionals and others is a well-intentioned effort, especially during the COVID-19 pandemic, this does not improve physician well being. We tend to have a mental image of heroes as larger-than-life characters who can run into any situation and fix any problem, save anyone facing danger. Heroes also are never negatively impacted by whatever situation they face. This is not what we see in medicine, especially in a pandemic. At least early in the pandemic, we didn’t understand the virus and despite phenomenal effort, people died. While the trend has improved, people are still dying. And many physicians became ill during the pandemic or were at least concerned that they would become ill or would take the virus home to their families. Heroes can save everyone, despite the odds. Heroes are never at risk, no matter how trying the situation. Heroes can intervene on their own and don’t need the help of others. This is fine for heroes, but this is not what it means to be a physician. When others call us heroes, that makes us start to wonder: what is wrong with us? People are telling us we are superhuman, so we should be; but we all know that we are not. Heroes also don’t need to seek help if they are emotionally impacted by their work; this is the polar opposite of what we hope physicians do: physicians are impacted by their work, they become burned out, they can become depressed and anxious. Unlike the prototypical hero, when that happens, they need to be encouraged and supported in seeking help.

What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?

Talk with your friends, colleagues, family members to let them know how you are doing, and they should similarly be checking in with the physicians in their lives; when checking in, take time to listen to the responses. We need to get beyond the perfunctory “how are you?” in the morning and communicate that we care and are listening carefully. Don’t wait until someone looks depressed or is struggling. It is almost impossible to look at someone and tell that they are burned out or even depressed. We need to be checking in frequently with everyone, including ourselves.

What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?

When people attempt to address burnout on their own, they usually start by trying to ignore it and thinking it is their fault and that they just need to work harder. The opposite is what is needed, but it’s easy to get into the cycle of being burned out so less productive so then thinking you need to work harder to prove that you belong and only getting more burned out so being less productive…. Burnout isn’t a personal failing and doesn’t occur because we’re not working hard enough. It’s OK to take some time away from work, but as physicians we are not trained to always be kind to ourselves. This is especially true for women, who are typically raised to take care of everyone else first before they care for themselves. Just like when you are on a plane- if something happens, you need to put on your own oxygen mask before helping others.

It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?

When I was very early in my career, I had a patient with a large cancer that was going to require extensive surgery, in collaboration with several other surgical specialties (all men surgeons). I was not accustomed to leadership at that point and, in an attempt to gain some respect, came into the operating room before the patient arrived and said, paraphrasing the words of Elizabeth I before the battle in Tilbury in 1588, “I know I have the body but of a weak and feeble woman; but I have the heart and stomach of a [surgeon]”. I thought that I needed to let them know that despite my relative inexperience in leading a large surgical team (and as the only woman on the team), I was in charge and could handle this. Unfortunately, my comments did not get the response I had intended, as no one knew the reference and by the time I finished explaining, the time for the intended impact had passed. I learned 2 things from that experience a) not everyone is interested in 15th and 16th century English history, so know your audience and reference point before you say anything and b) words don’t necessarily lead to respect. Even with age and experience, women need to work harder, especially as a surgeon and in a field that is so predominantly men as is orthopaedic surgery, to gain the respect of others. Unfortunately, when we are earlier in our careers, we aren’t necessarily respected because we may be thought to be too young, but when we are older we also may not gain respect as we are thought to be too old to keep up with current information and technology in medicine. It seems that as women in medicine we are never the “right” age. This can lead to women being “lost” in the middle of their careers, just at the time at which they should be receiving the most support and sponsorship to rise to leadership positions. This is a significant brain drain that requires intentional effort to address. Women earlier in their careers in medicine can’t assume that they will just start receiving respect with time; they need to let people know what they’ve accomplished, what their goals are, and find allies and sponsors.

Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has”, by Margaret Mead. This quote resonates with me because I think that our diverse perspectives allow us to see things differently, and we may identify a problem that, because of that perspective, others have not- or at least had not spoken up. If we wait until those with titles or specific groups or committees to identify and address issues, not much will happen. Progress occurs when individuals see an issue, find allies, come up with potential solutions, and then figure out how to effect change. People can be reluctant to speak up, because they are afraid that others will be critical and/or see them as imposters, without the experiences or abilities to make them worthy of raising concerns. What is the worst that can happen if you speak up? Perhaps finding out that a solution has already been developed for whatever you noticed was a problem? Great! Offer to help by providing your own perspective and then act as an influencer. Or maybe that no one else sees the issue as a problem? If that occurs, at least explore the situation . You (and others) may find that the issue does need to be addressed and can identify a way forward; there may also be other areas of collaboration that develop.

Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.

The movement I would like to inspire is for people to truly see each other, understanding the impacts of race, gender, and social or educational backgrounds, to understand that we share common issues and concerns, as well as common joys. Our differences help us to bring unique perspectives to the world, and we need to understand those differences, but they should help us strengthen our relationships, not be the things that separate us. Unfortunately, there are too many things that divide us during this period of time, and the pandemic further led us to go to our own figurative (or literal) corners of existence. Humans survive as communal creatures, and we can’t make it on our own. However, that means interacting with more than just those in our immediate family/community or with those who think like us but also interacting with those in the broader society. We may have our differences, but we are all striving to fulfill the same basic needs and are stronger together.

How can our readers further follow your work online?

www.amwa-doc.org

www.kumc.edu

This was truly meaningful! Thank you so much for your time and for sharing your expertise!

About The Interviewer: Dan Rodrigues is the founder and CEO of Kareo, a Tebra company, a leading provider of cloud-based clinical and practice management software solutions for independent healthcare practices and billing companies. Rodrigues is known for his visionary leadership in the healthcare technology industry. Rodrigues’ future-forward expertise has led companies such as Scour and Skematix. He is highly committed to providing patients with a seamless, digital experience in healthcare. Rodrigues’ business insights have been featured in publications including Forbes, Fierce Healthcare, and AP News.