Administrative Award Winner Offers Guidance to Prevent Physician Burnout

Physician “burnout” at all levels—from training to late career—is among the most critical challenges for psychiatric administrators, said Steven Moffic, M.D., at this year’s IPS: The Mental Health Services Conference in Washington, D.C., this past October.

Ellen Dallagher

Burnout is a systemic problem, said Moffic, who received APA’s 2016 APA Administrative Psychiatry Award at the conference. It afflicts clinicians who feel themselves trapped in systems that do not seem to honor—and may actively impede—their professional ethical responsibility to care for patients.

Moffic proposed a radical remedy—the extension of professional psychiatric ethics to include what he called “ethical love” for the systems that administrators oversee and manage and for those who work within the system.

“My idea of ethical love in the leadership of psychiatry, as absurd as it might seem on first glance, boils down to this—love your colleagues and staff, even to the extent that it becomes the first and foremost ethical priority,” Moffic said during his award lecture. “[I]f the organization is the major cause of burnout, the organization really needs to be in the service of the well-being of staff.”

Retired from a long career in academic psychiatry, Moffic is an award-winning clinician, administrator, educator, and writer. His special areas of interest include ethics, culture, and burnout. In 2002 he received an Assembly Speaker’s Award from then Assembly Speaker Nada Stotland, M.D. He was honored with other public psychiatry leaders as “one of the many heroes of public psychiatry, who serve the sickest and poorest, with the fewest resources, and, all too often, the least respect.”

Moffic also helped to craft Ethical Principles for Psychiatrist Administrators, based on the AMA/APA model of ethical principles, that was adopted by the American Association of Psychiatric Administrators in 2000.

In his wide-ranging lecture at IPS, Moffic outlined the history of “love” in psychiatry and medicine from Freud—who described psychoanalysis as “a cure through love”—to Avedis Donabedian, M.D. Donabedian is known as the “father of quality improvement,” who is reported to have said on his deathbed, “Ultimately, the secret of quality is love. You have to love your patient; you have to love your profession. … If you have love, you can then work backward to monitor and improve the system.”

Applying Ethical Love to Physician Burnout

Moffic cited statistics showing an epidemic of burnout throughout medicine and said the issue was a ripe one for the application of ethical love by administrative leaders.

“Who, if anybody, can lead a movement to reverse this trend toward burning out?” he asked. “It appears that individual clinicians can do only so much. … Psychiatrists in particular can understand why clinicians tend to deny becoming burned out because it is so antithetical to their image of being a healer. Instead … health caregivers seem to react with a counterphobic reaction, to deny that we are hurting and that is hurting our patients. We try to work harder and harder, build resilience, and still claim work satisfaction, even with less time to spend with patients.

“So, that dynamic seems to leave the major responsibility to the health care leaders and administrators,” he said. “Given that our systems of care are determined by much larger societal forces, what can administrators and leaders still do?”

Moffic proposed 10 recommendations manifesting ethical love for systems of care that can address the problem of physician burnout:

• Monitor burnout: Burnout can be measured by combining any of the available scales or questionnaires with periodic formal and informal meetings with staff.

• Rightsize productivity: Reducing productivity demands results in better patient outcomes, fewer mistakes, less necessary follow-up appointments, and recouped costs. The best managed care principles can help by providing feedback and monitoring which treatments and management strategies work.

• Empower staff: Involve staff and colleagues as much as possible in decisions. At the minimum, conveying empathy, care, and compassion for what is out of control can be helpful.

• Close the gap between ideals and reality: Given that the gap between physician ideals and reality contributes to burnout, remind caregivers of the awe they originally felt—and can still feel—at helping others to whatever extent practical with their health and life.

• Establish safety and security: Safety and security in the workplace are fundamental to physician well-being. Administrators should help create a safe workplace.

• Require administrators to provide clinical care: Administrators should also do some clinical work, in addition to administrative duties, to feel empathy for the clinicians who work in the system and to better understand their stress.

• Enhance professional development: Love knows when it is time for clinicians to exit the system for their further development, just as children leave home, and to leave with grace, dignity, and inspiration.

• Draw on the expertise of professional organizations: Professional organizations like APA can offer tools and resources for addressing clinician burnout.

• Learn to love: Love, in some challenging situations, needs to be learned. Administrative leaders should look for the strengths and successes that any given staff member possesses, rather than focusing on weaknesses and problems.

• Love is not enough: Realistic expectations, staff development, and outcome monitoring will always be required.

Moffic stated that ethical love extends to the responsibility that administrative leaders have to advocate for societal changes that benefit the health of the population. This may include making their voices heard around such issues as gun control and gun safety, euthanasia of people with mental illness, climate change, basic health care coverage for all, and the election of politicians concerned with the mental well-being of all citizens.

He concluded his remarks by citing a column by the New York Times writer David Brooks in which he quoted the Rev. Richard Rohr, a Franciscan priest and theologian. He said, “You’ve got to love or you’ll never find your soul’s purpose. You’ll never find the deepest meaning of life itself.”

“Whether one has religious beliefs or not,” Moffic said, “I don’t think there are many greater purposes, or deeper pleasures in life than to use ethical love to overcome the difficult challenges and stigma surrounding those needing mental health care for conditions that threaten their very identity and ability to think.” ■