Christine A. Sinsky, MD, FACP is an internist at Medical Associates Clinic and Health Plans in Dubuque, Iowa. Doctor Sinsky serves on the American Medical Association's Advisory Panel on Physician Satisfaction. An expert in and advocate for physician well-being, Doctor Sinsky recently visited Michigan as a guest of Michigan State Medical Society, St. Joseph Mercy Ann Arbor and Washtenaw County Medical Society to present a workshop on physician and team burnout.

MSMS was fortunate enough to have an opportunity to chat with Doctor Sinsky about her passion for physician well-being and reducing burnout. We're pleased to share that conversation with you in today's Medigram.

MM: Why are you passionate about physician well-being and reducing burnout?

CS: I believe that care of the patient is care of the provider. When physicians feel empowered and entrusted and enjoy their work, patients get better care. It's important for individuals who are giving care to be well cared for themselves.

In the bigger picture, about seven years into practice I'd decided that if I was going to stay in medical practice, I needed to organize the way I did my work differently. I really considered what it was patients wanted - as well as what I wanted - and found there was a lot of overlap. I reengineered work to make it more manageable and enjoyable. I found there was an opportunity to spear what I learned into helping other physicians. When my team and I function as well-oiled machine, it's a great feeling to do that work together and give good care -- that's what drove me to this work.

MM: What are your top tips for reducing burnout and working toward physician wellness?

CS: 80 percent of burnout is related to organizational factors. We can address this with process excellence: pre-visit planning, pre-labs and a team-based model. The other 20 percent of burnout is determined by individual factors and can be addressed through mindfulness training and intentionally protecting a work-life balance.

Within organizations, good values should be in alignment with leadership. When physicians and organizations share common values, burnout is less. When physicians know their supervisor cares about their well-being and holds career development conversations, burnout is less. Organizations have the power to structure things around process engineering.

What does process excellence look like?

1. Be proactive, not reactive in patient interactions. Pre-visit planning can help physicians to be better prepared and lead to better interactions. Talking about results face-to-face can be more efficient. Making the time to do all your work in one sitting, rather than proceeding with loose ends is also helpful.

2. Build and maximize a strong team. Move away from the hero model where only the doctor is taking care of the patient. A team-based model is one where all are contributing to the care patients receive. In this model, people can spend more time in the places they are uniquely qualified. Burnout often results when we know we're spending the wrong time on things we shouldn't -- the clerical work that constitutes too much of the work day -- it's work other people can do. As physicians, we can and should spend more time on relationship building and deep thinking. That drives satisfaction. It's not that physicians can't do clerical or clinical tasks - it's that others can so doctors can use their skills more effectively.

3. Enhance the physical environment. A semi-circular desk promotes face-to-face conversations. Co-locate so physician and nurse sit side-by-side, rather than having to create electronic messages that take up time.

MM: What are the impacts of burnout or poor physician well-being?

CS: There are consequences for patients, health systems, physicians and for the U.S. health care system.

On the patient side, physicians who are burned out make more mistakes and are less empathetic and adherent. Quality of care is threatened by burnout.

For the physician, it increases risk of divorce, drug and alcohol use, disruptive behavior and death by suicide. There are roughly 400 physicians who die from suicide in the U.S. every year.

Organizationally, when physicians are burned out, they tend to scale to part time or leave practice altogether. It's estimated to cost $400,000 to replace one primary care physician.

In the U.S., it's possible and probable that costs are higher, since tests and referrals increase, which accelerate costs of patient care.

MM: How can practices embrace physician wellness and reduce burnout?

CS: Many physicians wonder where to start. In addressing burnout and improving well-being, I would start two places. First, improve practice efficiency. This means reducing waste so there is more time for meaningful conversations with patients and more time to get home to family. The low hanging fruit in an outpatient setting is pre-visit planning and prescription management. Prescription management can save 30 minutes per day; pre-visit planning saves 90 minutes per day.

Once you've processed reengineered around those two simple things and mastered them, add team documentation. This is where the team helps with record management, which saves about three hours per day.

Second, on the individual level, make a daily practice of mindfulness and appreciative inquiry. Intentionally leave problems at home so you're fully present. At the conclusion of the day, practice leaving the problems of work so you're fully present at home. Periodically step back and ask what was really good about today? What's the reason I came to work today? At our practice, a nurse identifies one patient a day with whom the interaction was very positive -- that is the reason she came to work that day. We share with one another something that felt good or especially well done, and we celebrate that on a regular basis by institutionalizing the celebration in team meetings.

MM: What else should we know about burnout? 

CS: It's important to recognize that the issue is widespread and growing at an alarming rate. There is research that demonstrates that a powerful way to decrease burnout is to reduce workplace chaos. When the environment doesn't feel disorganized or chaotic, physicians and staff can focus on patients.

I'd also like to add that I think it's terrific that MSMS is addressing this important topic -- I applaud you for it.