"Burned out with Provider Burnout .. Welp! You might want to skip this episode" with Dr. Michelle LeClaire

Ridgeview Podcast: CME Series

In this special podcast, discussions occur around the impact of physician burnout. Dr. Michelle LeClaire, a critical care physician with Minnesota VA Medical Center, discusses her first hand account of provider burnout, how burnout is measured, how we can affect change with physician champions and wellness programs, moral distress, residue, injury and gender discrepancies in medicine, and discussions occur around the culture, healthcare organizations, patient complexity, and how a pandemic can affect and lead to burnout.

Enjoy the podcast.

Objectives:Upon completion of this podcast, participants should be able to:

• Identify hallmarks of burnout and implications of burnout in clinicians.
• Define moral distress and moral injury.
• Describe gender discrepancies in medicine and burnout rates among gender.

This activity has been planned and implemented in accordance with the accreditation criteria, standards and policies of the Minnesota Medical Association (MMA). Ridgeview is accredited by the Minnesota Medical Association (MMA) to provide continuing medical education for physicians.

CME credit is only offered to Ridgeview Providers & Allied Health staff for this podcast activity. After listening to the podcast, complete and submit the online evaluation form. Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at [e-mail].

Click the link below, to complete the activity's evaluation.

CME Evaluation

(**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.) DISCLOSURE ANNOUNCEMENT

The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics. Any re-reproduction of any of the materials presented would be infringement of copyright laws.

It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented.

Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event.

Thank-you for listening to the podcast.

SHOW NOTES: *See the attachment for additional information.

How do we break the cycle of burnout? Approximately 50% of burnout is present with clinicians prior to COVID.

Mini Z Asks 10 questions: 1. Overall "I am satisfied with my current job." 2. "I feel a great deal of stress because of my job." 3. "Using your own definition of 'burnout', please circle one of the following answers below: a) I enjoy my work. I have no symptoms of burnout. b) I am under stress and don't always have as much energy as I did, but I don't feel burned out. c) I am definately burning out and have one or more symptoms of burnout (e.g. emotional exhaustion). d) the symtpms of burnout that I am experiencing won't go away. I think about work frustrations a lot. e) I feel completly burned out. I am at the point where I may need to seek help. 4. My control of my workload is? 5. Sufficiency of time for documentation is: 6. Which number best describes the atmosphere in your primary work area? 7. My professional values are well aligned with those of my department leaders. 8. The degree to which my care team works efficiently together is: 9. The amount of time I spend on the electronic health record at home is: 10. My proficiency with the electronic health record is:

- Predisposed providers get burned out if you can predict it - you can prevent it.

Predictor factors include the three C's : Control, Chaos, Culture 1.) work control 2) chaos 3) culture which include time pressure and work control 4) controlling our schedule 5) chaos in the workplace 6) teamwork

Maslach burnout inventory/emotional exhaustion. These include reduced personal accomplishment, depersonalization and lack of compassion.

The control model of a job is the teeter-totter that demands control/support. You need to prevent burnout by offsetting the demands with control and support. - Burnout leas to more intent of leaving the job that is three times the odds of leaving. In addition, there are poor patient outcomes. Patient disenrollment, destabilzation of groups on the indiviual side - there is a high rat of alcoholism, suicide, broken relationships and substance abuse.

Items that help with burnout include physician champions, wellness programs and measuring burnout.

Culture is massive. Organizations job is to provide a benue for healthcare providers to treat and help patients.

External and internal factors of the "mini z" include teamwork, work control, sufficient time for documentation, stress, job satisfaction

Gender discrepancies Women have a 60% burnout over their male counterparts. Gender expectations for listening, a phenomenon of attracting more complicated patients, faster work pace, less values alignment with leadership.

Moral distress Situation troubling providers where they know the right thing to do and they cannot. Compromises and patient care due to staffing. Resources and administrative support not in place. This also secondary to social determinants, healthcare disparities, abusive families and patients, not being able to alleviate suffering.

Unresolved moral distress becomes moral injury. Moral injury is a more pervasive issue which leads to cognitive dissidents, depersonalization, bad ethical decision making.

Moral residue leads to unresolved moral distress.

EDM or ethical decision making is dealing with moral injury. Generally secondary to self-reflective providers, empowerment, having a practice - culture - open to multi-disciplinary and reflection, teamwork, mutual respect within the multi-disciplinary team, active involvement of the bedside nurses with end-of-life care, providers active in decision-making, practicing culture of ethical awareness.

Article:Trends in Clinician Burnout With Associated Mitigating and Aggravating Factors During the COVID-19 Pandemic

Thanks to Dr. Michelle LeClaire for her knowledge and contribution to this podcast.

Please check out the additional show notes for more information/resources.