Physician burnout continues to be rampant, with recent data suggesting that 44% of US physicians complain of its symptoms: emotional exhaustion, depression, and depersonalization.

As burnout imperils the health and livelihood of many physicians, experts are weighing the value of interventions such as resilience training.

 

Defining resilience

Resilience refers to the personal characteristics that enable a person to successfully adapt to stressors.

Results from a national cross-sectional study published in JAMA Network Open suggest that physicians exhibited higher levels of resilience than other types of US workers.

West CP, Dyrbye LN, Sinsky C, et al. Resilience and burnout among physicians and the general US working population. JAMA Netw Open. 2020;3(7):e209385.

The authors also found resilience was inversely associated with burnout—with exceptions.

 

For instance, although being the most resilient, emergency medicine physicians have high rates of burnout. Conversely, pediatric subspecialists exhibited both the lowest burnout rate and lowest resilience.

 

Early resilience training

Publishing in the Mayo Clinic Proceedings, Stanford University educators presented a career-long model for resilience training that begins in medical school and extends through practice.

Cordova MJ, Gimmler CE, Osterberg LG. Foster well-being throughout the career trajectory: a developmental model of physician resilience training. Mayo Clin Proc. 2020;95(12):2719–2733.

Other models, the authors claimed, are too limited in duration and depth.

 

At the early attending level, resiliency training focuses on skill building—organizational/professional values, equity, communication, team development, and so forth. Resilience training for an ongoing physician is more regenerative, and may involve identifying colleagues at risk for burnout, or engaging in advocacy.

“Resiliency training supports the capacity to advocate for oneself, one’s profession, and one’s patients,” the authors stated. “Having bandwidth for advocacy may rest on skills for assertive communication, boundary and limit setting, and prioritizing advocacy over other activities. Moving to more active, empowered, and engaged advocacy for local and widespread systemic or policy change should be supported by relevant organizational approaches.”

 

Replenishing resources

Resilience also involves the expenditure of resources, as explained by the authors of a qualitative study published in Academic Medicine.

Zwack J, Schweitzer J. If every fifth physician is affected by burnout, what about the other four? Resilience strategies of experienced physicians. Acad Med. 2013;88(3):382–389.

 

“Put briefly,” they wrote, “our findings suggest that whether the stressor in question is a demanding patient, excessive paperwork, or time pressures, a well-diversified pool of social resources and fields of interest, together with realistic expectancies and good self-knowledge, will support sustainable coping. This, in turn, creates experiences of efficacy that confirm health-promoting attitudes and practices."

The authors referred to the Conservation of Resources Theory, which proposes that burnout is a continuous process caused by ongoing, and often low-level, resource depletion. Individuals may resort to various means in an attempt to prevent further depletion, such as social withdrawal, physical inactivity, or fall-back mental and behavioral habits. Unfortunately, these practices do not always succeed in “recharging the battery.”

Instead, the authors recommend that physicians look to which physical, social, and psychological resources are actually available, and shore up any deficiencies. They also suggested that mindfulness-based stress reduction may be useful to combat distress.

According to the authors of the JAMA Network Open study, such changes could target inefficient workplace processes, excessive workloads, and poor leadership.

 

Keeping a positive attitude

Changes to attitude and behavior can promote resilience, according to Gail Gazelle, MD, in an article published on the KevinMD website.

Gazelle G. 7 habits of highly resilient physicians. kevinmd.com. August 2, 2020.

Resilience is boosted when physicians can let go of what they can’t control and practice mindfulness.

 

Resilient clinicians take a gradual approach and are gentle with themselves throughout the process.

“They know that self-kindness is more motivating than self-bullying. They know that resilience is built by being patient with themselves as they learn and grow,” Dr. Gazelle added.