Physician Burnout & Mindfulness Training: An Approach That Works

By Floyd Arthur

As virtually every doctor knows, physician burnout is a growing problem in the United States. According to a 2015 Mayo Clinic study, over 54 percent of physicians experienced at least one symptom of burnout in 2014, an increase of nearly 10 percent over 2011. During the same period, the number of physicians who expressed dissatisfaction with work-life balance also grew from 41 to 48.5 percent.

The reasons given for the increasing rates of physician burnout vary, but increased bureaucracy and regulatory demands are high on the list. According to Medscape’s 2016

Physician Lifestyle Report, the top five causes cited by physicians are:

• Too many bureaucratic tasks
• Spending too many hours at work
• Increased computerization of practice
• Income not high enough
• Feeling like "just a cog in the wheel”

Maintenance of certification, the impact of the Affordable Care Act and difficult patients were next on the list.

Issues not included in the survey that were mentioned anecdotally by many physicians included insurance issues, the introduction of the 10th edition of the International Classification of Diseases codes (ICD-10), the threat of malpractice suits and family stress.

The Impact of Physician Burnout

Burnout is a condition marked by emotional exhaustion (loss of enthusiasm) depersonalization (loss of empathy) and a low sense of personal accomplishment (loss of meaning and self-esteem.) Among physicians, the high rate of burnout is a serious public health issue with widespread effects.

Not only are burned out physicians at higher risk for substance abuse, mental health issues relationship stress and suicide, they are significantly more likely to make a critical mistake. Additionally, many early and mid-career doctors are leaving the profession, citing burnout and quality-of-life issues as the cause.

Mindfulness Training & Physician Burnout

Decades of research demonstrate a significant correlation between mindfulness meditation and  the reduction of stress. Additionally, several studies have shown that physicians who receive training in mindfulness techniques show a marked improvement in symptoms of burnout, quality of life measures and mood. More importantly, both intensive training and modified, short-term instruction have achieved similar results.

Intensive Mindfulness Training

In a 2009 study from the University of Rochester Medical Center, Rochester, New York, for example, physicians were enrolled in an intensive program of mindfulness education over a period of 12 months. The training involved:

• Eight weekly 2.5 hour sessions of mindfulness training
• One eight-hour seminar between session six and seven
• Ten additional monthly sessions of 2.5 hours each.

The sessions were structured into three parts:

• A 15 minute didactic session in which specific topics were discussed. Topics included self-awareness, dealing with unpleasant emotions, conflict resolution, setting boundaries and self-care.
• Mindfulness meditation involving four distinct mediation practices: guided meditation, silent meditation, walking meditation and body movement exercise similar to yoga.
• Narrative and appreciative inquiry, in which physicians wrote short narratives that explored ways in which they successfully worked through challenging clinical situations. They then shared their experiences in pairs or small groups.

At the end of the eight and 12 weeks, participants were asked to complete a series of surveys that measured burnout, empathy, beliefs, personality traits and mood. All of the physicians who completed the surveys showed a significant reduction in symptoms of burnout, depersonalization and negative mood states.

Abbreviated Mindfulness Training

In 2013, a study conducted at the School of Medicine and Public Health at the University of Wisconsin in Madison, Wisconsin, evaluated the effects of an abbreviated mindfulness training course on symptoms of burnout in 30 physicians. Participants attended a 14-hour weekend course (Friday evening: 3 hours; Saturday: 7 hours; Sunday: 4 hours) and two 2-hour evening follow up sessions. They were given access to audio CDs and a training website specifically designed for the course, and instructed to practice mindfulness meditation for 10 to 20 minutes each day. 

After completing the course, all of the participants had achieved significant reductions in symptoms of burnout, depression, anxiety and stress. Perhaps more importantly, the reductions were maintained throughout a nine-month post-training period without any further formal intervention.