Provider Impairment and Burnout

Impairment

when the provider lacks the ability to exercise prudent medical judgement and/or the ability to practice with reasonable skill and safety resulting in jeopardy to patient care or patient safety

causes:
illness (substance abuse/neuropsychiatric)
behavioral concern

burnout

a syndrome characterized by high emotional exhaustion high depersonalization/cynicism and a low sense of personal accomplishment from work

clinical deficiency

a lack of necessary knowledge skills or competencies required to provide effective patient care

causes:
medical knowledge deficiencies
lack of patient care
lack of interpersonal and communication skills
lack of professinoalism
lack of practice-based learning and improvement
lack of interprofessional practice

risk factors

excessive workloads
admin burdens (EHR doccumentation)
inadequate support
workplace environment (rural locations)
personal factors

prevalence of burnout

Physicians:
more than half experience burnout
impairment: 10-15% similar to general population

Nurses:
2007 study:
68k nurses burnout
35% hospital
37% nursing homes
22% other

PA:
total 64-80% prevalence
over 60% specialties:
oncology
EM
FM

relationships

patient:
pt rights and responsibilities
fiduciary relationships:
ethical and legal obligation to act in the best interest of the pt
built on trust
prioritize pt interest over self-interest
ex: confidentiality
informed consent
non-discrimination
competence

physician:
supervisory
team-based

interprofessional team:
shared moral agency
peer reviews

employer organization:
workplace culture
contracts+malpractice coverage

state licensing agency:
verify to the public: education certification+ continuing education
verify supervising physicians

NCCPA:
board certification
continuing education

professional organizations:
education and advocacy

Peer review

process: mutual obligation to hold one another to an ethical and clinical standard of care

purpose:
part of provider+hospital credentialing
required by professional liability insurance
promotes professionalism within interprofessional teams
strengthens the fiduciary relationship with patients
promotes pt safety

involvements:
incident based review:
triggering event of the incident
peer or external committee chart review

routine review:
pre-determined schedule
all providers involved
random selection of charts to review
part of performance evaluation

common barriers

reporting:
genuine concern
fear of retaliation
fear of being wrong
harming the relationship

seeking help:
denial
stigma
job loss
loss of income
loss of license
loss of reputation

management

helping colleagues:
legal and ethical obligations
follow organization policies (whistleblowing/patient safety/peer review)
anonymous report to internal medical staff health committee
contact state PHP (physician’s health program+covers PAs)

healthy workplace culture:

system level:
top leadership: prioritize+reduce administrative burdens
encourage learning environment
enable tech solutions
support research

team/unit:
engage and strategize on local solutions
not “one size fits all”
build community
develop incentives and rewards
value schedule flexibility
integrate self care

individual:
wellness diary
daily mindfulness+gratitude practice
essentials:
social/personal relationships
good food
sleep+physical activity
recognize the warning signs in yourself
lean on support system
contract negotiation