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Posted February 08, 2016

Physician Burnout and the Loss of Collegial Relationships: A Reversible Trend?

By Richard Rubin, MD, MBA, CPHQ

For me it began in the early ‘90’s. I was new in practice, excited, and eager to meet colleagues. I introduced myself to physicians and nurses in the hospital both to meet them and also let them know that I was available to take on new patients. Most of my relationships in the community were formed in the hospital. I discussed interesting cases and referrals with specialists - all was good. And then, it changed.

If we define collegiality in this context, as the interaction with other clinicians for social and patient care purposes, I believe that there were three periods of change which greatly decreased the opportunity for collegiality; the increasing competitiveness and affiliation with groups and hospitals, the hospitalist “revolution” and the increasing complexity of practice.

In the early ‘90’s the Health Maintenance Organization’s (HMO’s) were rising in prominence, hospitals were buying practices to safeguard referrals (and often giving them back!), and “mega-groups” began to form. The lounge and hallway discussions became more about who was going where, and why, and much less about patients and the practice of medicine. And so it began…

The hospitalist revolution of the early 2000’s in my area was the second and perhaps the most stinging blow to collegiality. Primary care physicians stopped coming to the hospital, which benefitted their office availability and productivity but took away a large source of their socialization with other clinicians. If we wanted to get a “curbside consult” we had to call, (which brings a host of difficulties using that method of communication).

The third blow, which had no discrete beginning, is the increasing complexity of medicine - not the clinical - but the practice of medicine. Electronic medical records (EMR’s), meaningful use, Relative Value Unit’s (RVU’s), Healthcare Effectiveness Data and Information Set (HEDIS) measures, etc., and now ICD-10 increased pressure on clinicians and took time that could have been spent attending grand rounds or conferences, etc.

The result was empty lounges and the hospital hallways that used to be hotbeds of bad jokes and interesting cases. Many physicians were now spending more time in the relatively insulated environment of their offices.

So, you may ask, what is the problem? What is the effect of this loss of contact with our peers?

“Collegiality facilitates more effective communications among physicians regarding patients and their care. It’s also facilitates physicians and nurses working effectively to improve patient safety and to assure that patients get the right care at the right time.”1 Those lounge and hallway conversations served more than social purposes. Clinicians learned and consulted with colleagues and the patients benefitted. Just as important are the benefits of the interactions in and of themselves. We, more than many other professions, have come to feel that only another physicians can understand and empathize with what we are going through. These are our friends, and the benefits of seeing, talking and laughing with friends is obvious!

An encouraging trend is that many forward thinking institutions have established venues for increased collegiality in terms of support groups.2,3 Both to deal with the frequently internalized emotions and reactions to the situations we deal with every day, but also to allow colleagues to talk and laugh with one another again.

Increased engagement and collegiality will go far to heal and prevent burnout, “the loss of energy, idealism and sense of purpose.”4 Sometimes the best way to move forward is to bring back what worked in the past!

REFERENCES

  1. Tom Quinn, “More Than Medicine” blog, http://morethanmedicine.blogspot.com/2008/02/collegiality.html
  2. Physician Health Services, Inc., Massachusetts Medical Society
  3. “Finding Meaning Discussion Groups”, Rachel Remen, MD, http://www.ishiprograms.org/programs/all-healthcare-professionals/
  4. Quint Studer, Healing Physician Burnout, Fire Starter Publishing, 2015

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