Prepare to become a physician, build your knowledge, lead a health care organization, and advance your career with NEJM Group information and services.
NEW! A digital journal for innovative original research and fresh, bold ideas in clinical trial design and clinical decision-making.
NEW! Peer-reviewed journal featuring in-depth articles to accelerate the transformation of health care delivery.
Concise summaries and expert physician commentary that busy clinicians need to enhance patient care.
The most effective and engaging way for clinicians to learn, improve their practice, and prepare for board exams.
Information, resources, and support needed to approach rotations – and life as a resident.
The most advanced way to teach, practice, and assess clinical reasoning skills.
The authorized source of trusted medical research and education for the Chinese-language medical community.
Valuable tools for building a rewarding career in health care.
Information and tools for librarians about site license offerings.
The most trusted, influential source of new medical knowledge and clinical best practices in the world.
Accelerate innovation.
Address equity.
Increase value.
Clinician burnout is a safety issue both for the clinician and the patient. Health systems must find tactical solutions to support their clinicians and allow the space for self-care.
The CEO for Care Solutions at Optum shares insights about Optum’s efforts toward clinician wellness, and his own views on the matter of burnout and supporting clinicians so that they can bring their best selves to patient care. He shares a number of framing questions, personal stories, and tactics such as electronic health record interoperability and clinical decision support. He also points to the Covid-19 pandemic exacerbating the already existing mental health crisis and stresses the importance of prioritizing self-care and reducing the stigma against discussing mental health.
From the NEJM Catalyst event From Clinician Burnout to Wellness: Three Systemic Steps, sponsored by Optum, June 23, 2022.
Patrick Conway, MD, Chief Executive Officer for Care Solutions at Optum, shares insights about Optum’s efforts toward clinician wellness, and his own views on the matter, with NEJM Catalyst Editorial Director Edward Prewitt, MPP.
Optum frames its work to actively mitigate and prevent clinician burnout by asking, “How do we remove stress from the environment? How do we support our physicians and other clinicians, their mental health, their well-being? How do we support their work environment so they can be productive and generate the results we want for our patients?”
Conway notes that Optum’s burnout rates are 10% lower than average — but still too high. He shares a story of long hours during his residency and the stress of patient deaths leading to him falling asleep at the wheel one day when driving home and crashing his car into a tree. “When I look back on that, I was burnt out, overtired, and almost had a horrible outcome,” he says.
There is ample evidence that burnout in clinicians leads to worse patient outcomes clinically and in terms of patient experience. “We view this as a safety issue, both for our providers — for our clinicians, our physicians — but also for our patients,” Conway says. “That we create an environment where you have clinicians who aren’t burnt out but the opposite: hopefully productive, excited members of the team coming to work every day.”
Turning to that inverse of burnout, Prewitt asks what motivates and satisfies clinicians. “At the end of the day, for most physicians and clinicians, it’s similar for me and other people: you went into medicine because, it’s a calling. You wanted to help people,” Conway responds. He still practices as a pediatric hospitalist, volunteering to attend on weekends for free. “Our goal [no matter the clinician’s specialty] is to support them so they can help the patients, the people, the families they serve,” he says. “That’s why they come to work every day.” He shares the life-changing experience of a geriatrician who left the office environment to conduct home visits instead, and that he has met with Optum’s mental and behavioral health specialists to try to help them, such as avoiding overscheduling, during a pandemic that has exacerbated the already existing crisis in mental health.
We need to give ourselves the time and space to do self-care. We’re sometimes taught as physicians that it’s bad, it’s selfish. It’s in fact the opposite of selfish. It allows us to be the people we need to be to provide the care that the people we serve need.
“This is something we’ve been hearing about and publishing about quite a bit at NEJM Catalyst and is a real theme of today’s show, a comprehensive approach to mental health at health systems, not only for patients, but also for the clinicians,” says Prewitt. He asks Conway to dig into key tactical areas in which support clinicians. Conway points to three: (1) administrative burden and complexity; (2) overall clinical workflow, including the electronic health record; and (3) supporting clinicians’ mental health and well-being.
Eliminating prior authorization, which Optum has done, can greatly reduce administrative burden, says Conway. Other ways to make things easier include improving access to images electronically, reducing endless phone calls, making referrals to specialty care easier, and answering questions within the clinical workflow. Decision support can help in these areas to lessen the burden of constantly looking for the right people and the right care.
When visiting hospitals for the first time as a volunteer, Conway says a big challenge for him is learning their unique electronic health record system. Optum is working to improve records’ interoperability. Optum has also invested in artificial intelligence and advanced data analytics so that clinicians have tailor-made decision support at their fingertips.
Like many clinicians, Conway has had his own struggles with mental health and has experienced mental health care as a patient. He says we must fix the mental health care system for patients and clinicians alike. One step is to reduce the stigma against discussing mental health. “I purposely try to talk about that in town halls with our clinicians,” Conway says. The next part is making sure resources are actually available and providing time off and/or telehealth for accessing that care. Another area is policy change, preventing potential ramifications that clinicians may fear from disclosing personal issues. “It’s not single-bullet solution,” says Conway. “This is a complex problem that clinicians experience probably at higher rates than the general population.”
“We need to give ourselves the time and space to do self-care. We’re sometimes taught as physicians that it’s bad, it’s selfish,” Conway adds. “It’s in fact the opposite of selfish. It allows us to be the people we need to be to provide the care that the people we serve need.”
Burnout has been a problem in health care for a long time, exacerbated over the past couple of years by the Covid-19 pandemic. Hospitals and health systems across the United States are stepping up to care for the many clinicians who haven’t been able to care for themselves, and the national dialogue has shifted. But we have a long way to go. “Our job, going forward, [is to] build a system that really supports people in their everyday life, so they can be as productive, as successful, as holistically healthy as possible. The same as we do for our patients for physical, mental, and social well-being, we need to provide that same level of care to our physicians and clinicians,” Conway says.
Patrick Conway is Chief Executive Officer for Care Solutions at Optum, which sponsored the NEJM Catalyst event “From Clinician Burnout to Wellness: Three Systemic Steps.” Edward Prewitt is Editorial Director for NEJM Catalyst.
Accelerate innovation.
Address equity. Increase value.
How emerging technologies will drive the transformation
Clinician burnout is a safety issue both for the clinician and the patient. Health systems must find tactical solutions to support their clinicians and allow the space for self-care.
A roundtable discussion on effective ways to care for and improve the well-being of the health care workforce.
Clinician well-being is not a fluffy topic, but rather one that requires significant investment by the health care organization.

source