Physician Burnout and Resilience Task Force White Paper

I. Introduction.

In Spring, 2016, the University of Texas System (UTS) launched an initiative through
the auspices of the UTS Faculty Advisory Council to address the growing problem of physician burnout
in the faculty employed at its six academic health institutions and two medical schools based at
academic institutions. By doing so, UTS leadership acknowledged that the national physician burnout
crisis is having a sustained negative impact on our physician faculty, affecting faculty vitality,
productivity and well-being, as well as raising liability concerns regarding patient safety and quality of
care. Instead of a one-size-fits-all set of policies promulgated from the Chancellor’s Office, it was
determined that localized responses tailored to each campus’ unique environment were the optimal
means to effect real change. Presidents of the individual institutions were therefore charged with
assessing the actual extent of burnout and dissatisfaction among their physician faculty and
appropriately addressing the problem. A survey carried out by the UTHealth Interfaculty Council
revealed that nearly 40% of McGovern Medical School (MMS) faculty reported moderate to severe
levels of burnout, prompting the creation of the Physician Burnout and Resilience Task Force
(see below).

The Task Force, led by Associate Dean of Faculty Affairs Kevin Morano, was composed of
administrative personnel, leadership from UT Physicians, and faculty, including several clinical faculty
volunteers from the Faculty Senate. The Task Force convened seven times from February to July, 2018
and reviewed material and information on clinical faculty burnout from local and national sources,
success of interventions recently enacted within the Harris Health System, and weighed insight from
members and department constituents to generate the recommendations incorporated into this white
paper. The Task Force was also careful to note that any recommendations made to institutional
leadership should be impactful, with positive outcomes achievable in a two- to three-year timeframe
with reasonable investment of resources given the challenging financial state of academic medicine.

II. Core findings.

The Task Force felt that there is a general consensus among the MMS clinical faculty
that they love what they do but experience daily frustration in how they do it. Faculty additionally
expressed a sense of decreasing influence on operational control and decision-making in their own
clinical services. Escalating demands to increase productivity from departmental leadership resulting
in greater patient volume and accompanying paperwork amplifies the problem, driving feelings of job
dissatisfaction and burnout. The Task Force also believes that institutional efforts to improve faculty
resilience were either lacking or not well articulated or advertised, leading faculty to feel unrecognized
and unsupported as they attempt to manage their own stress, maintain a healthy attitude and achieve
work-life balance. It was also agreed that there would be no one-size-fits-all set of solutions, given that
MMS clinical faculty work in three distinct environments (Memorial Hermann Hospital (MHH), Harris
Health System (HHS) and UT Physicians) in either centralized or disseminated community sites. Lastly,
as both MHH and HHS are affiliated partners, the ability to effect significant operational changes might
be limited compared to the flexibility afforded by shared leadership between MMS/UTH and UTP.

III. Recommendations.

The Task Force identified two major areas in which to recommend changes to
avoid faculty burnout: Clinical Operations and Faculty Resilience.

Clinical Operations

a. Operations and Faculty Input. As the Task Force deliberated, it became abundantly clear that
variable inefficiencies in service lines and clinics as well as major policies and practices that were
considered sub-optimal were major contributors to job dissatisfaction. While this theme was echoed
across worksites and specialties, the specifics of each were unique, effectively precluding
recommendations that would be universally transferrable and effective. Additionally, clinical faculty
feel a loss of professional autonomy and voice in their worksite operations, also a common driver of
burnout nationwide. To begin to address these issues, we recommend the creation of Provider
Advisory Committees(s) (PAC) at individual clinic sites, locations or by specific service line. These PACs,
chaired by a clinical faculty, would be composed of a small number of rank-and-file clinical faculty with
clinic or service managers and other administrative staff participating. PACs would serve as a conduit
for granular details regarding clinic operations and provide greater faculty participation in operational
decision-making. We additionally recommend the formation of SuperPACs at each major affiliate:
MHH, HHS, UTP. SuperPACs would be composed of delegates from the respective PACs and the senior
ranking MMS dean and would integrate information, analysis and recommendations from the PACs to
affiliate leadership for implementation as appropriate.

b. Electronic Health Record Management. A significant driver of physician dissatisfaction for MMS
clinical faculty echoed in national surveys is the amount of time spent on EHR generation and visit
documentation. The problems vary by specialty, but common complaints include a change of focus
during a visit from the patient to the computer terminal, challenges in identifying proper codes for
actions, and the additional uncompensated (or at least unrecognized) time required at the end of every
workday to complete and submit EHR. It has been noted that physicians are vastly overpaid to be data
entry specialists, resulting in lost revenue, clinic inefficiencies and significant job dissatisfaction. In
specialties with significant patient encounter/information intake loads, we recommend the inclusion
of medical assistants (MA) or scribes to partner with faculty during visits for information capture.
National studies suggest that the cost of a standard scribe ($15/hr) can be offset by increased provider
productivity.

Faculty Resilience

a. Implementation of Faculty Ombuds and Departmental Wellness Leadership Positions. There is a
nationwide trend to create C-suite level positions in Faculty Wellness that oversee programming and
distribution of resources to combat faculty burnout. However, MMS is fortunate to have an active
Faculty Assistance Program (FAP) housed within the UTHealth Employee Assistance Programs (UTEAP).
Additionally, the Task Force was of the opinion that experiences may vary among specialties, favoring
a decentralized approach to first-line burnout prevention and intervention. To this end, we recommend
that departments create part-time (5% effort) leadership positions focused on wellness, faculty
resilience and faculty development, including but not limited to Vice-Chair appointments. These
individuals would help design department-specific programming to enhance wellness as well as
coordinate with PAC members to identify touch points driving dissatisfaction. It is envisioned that they
would also communicate with each other among departments to identify shared issues and to
coordinate programming. These local solutions would be complemented by creation of a central MMS
or UTHealth Faculty Ombuds position. It is rare for an institution of our size and breadth not to have
ombuds services, as they play unique roles in mediation, dispute management and informal advising
by virtue of their independence from leadership structures. This would also be a part-time (10-15%)
appointment filled by a knowledgeable and empathic individual who would receive Ombuds training
to effectively fulfill institutional expectations. The responsibilities of this position would extend beyond
faculty wellness, but the positive impacts on morale, the evidence of institutional concern and the
tangible benefits provided by such an appointment to combating burnout should be significant.

b. Improved Faculty Assistance Program Awareness and Offerings. The Faculty Assistance Program
(FAP) was created as an extension of the existing UTEAP in 2016 and is a partnership with the Office of
Faculty Affairs and Development (OFAD). A second collaboration between OFAD and the HR Office of
Learning and Development was also launched in 2016. Together, these offices provide a range of
resources including counseling, personal coaching, life skills development, leadership training and
traditional wellness activities (Attachment 2). However, it was clear to the Task Force that awareness
of all these resources and opportunities is low among clinical faculty. We therefore recommend a
comprehensive effort to increase faculty assistance awareness consisting of advertising, branding
efforts, and encouragement from school leadership to utilize these important resources to their
greatest effect. We additionally endorse the creation of additional programming through FAP to
specifically address burnout prevention and intervention, including online evaluation tools, resilience
seminars and workshops, and tailored department-specific visits to gauge and address clinical faculty
mental and emotional health.

c. Improved Faculty Recognition. Faculty frequently are rewarded for their clinical productivity via
salary incentives and medical leadership positions. In contrast, there is little tangible benefit to faculty
who spend time and effort contributing to the “academic” missions of the school. One of these benefits
is the reward of academic rank, and the MMS Office of Faculty Affairs (OFA) has already successfully
implemented (initiated 2017) a revision to the non-tenure clinical faculty track to make promotion
more accessible. The Task Force recommends the creation of service awards to be managed through
individual departments to recognize their hard-working faculty in a more formal way. Additionally, we
recommend school-wide versions of some or all of these same awards to be managed by the OFA or
the Faculty Senate – for example “Clinical Faculty of the Year.” It may not be necessary to have cash
prizes linked to these honors, but if modest resources can be found it could enhance their impact.

IV. Conclusions.

Successfully reducing faculty burnout will not be an easy or quick task. If the majority
of these recommendations were implemented in FY2019, the Task Force expects that major shifts in
measurable outcomes on an institutional scale would not be assessable until FY2022. However smaller
departments or worksites could experience changes in faculty attitudes and perceptions in a shorter
time frame of 12-18 months. As stated above, the Task Force focused their recommendations on fiscally
realistic solutions – we find it unlikely that 20% reductions in patient panel size or a universal shift to
one academic work day for every four clinical days can be achieved. Our suggestions therefore focus
on making it easier for our clinical faculty to reduce wasted effort and time, to work more efficiently
and effectively (thereby creating time for academic pursuits), and to re-emphasize the value of one of
our most core assets, our doctors.

MMS Physician Burnout & Resilience Task Force
Dr. Kevin A. Morano, Ph.D., Chair

• Gurur Biliciler-Denktas, M.D., Pediatrics-Cardiology
• Andrew Casas, CEO, UT Physicians
• Robin Dickey, Ph.D., Faculty Assistance Specialist, HR/EAP/FAP
• Rhashedah Ekeoduru, M.D., Anesthesiology-Pediatric
• Tracy Fry-Longoria, Chief Ambulatory Care Officer, UT Physicians
• Syed S. Hashmi, M.D., Ph.D., Pediatrics-Research Center
• Zi Yang Jiang, M.D., Otorhinolaryngology-Head and Neck Surgery
• Iram Kazimi, M.D., Psychiatry and Behavioral Sciences
• Gus Krucke, M.D., Internal Medicine
• Ann Marshburn, M.D., Pediatrics
• Nancy O. McNiel, Ph.D., Senior Associate Dean for Administrative Affairs
• Julie Page, CPA, Senior Associate Dean for Clinical Business Affairs
• Kenya Parks, M.D., Pediatrics-Community and General
• Bela Patel, M.D., Internal Medicine, Vice Dean for Healthcare Quality, Regional CMO MHH
• Gary C. Rosenfeld, Ph.D., Integrative Biology and Pharmacology, Associate Dean for Educational Programs
• Keely G. Smith, M.D., Pediatrics, Division Chief, Ped Hospital Medicine
• Mahalia D. Smith, M.D., Internal Medicine, Hyperbaric Medicine
• Monica Verduzco-Gutierrez, M.D., Physical Medicine and Rehabilitation, Chair, Faculty Senate
• Mohammad Zare, M.D., Family and Community Medicine, Chief of Staff, Community Health Program

Sample Wellness Initiatives Funded through EAP/FAP/Wellness (ATTACHMENT 2)

MMS – Arts & Resilience
• Bring prominent Houston artists to campus for monthly performances, reading, conversations
and screenings to address and reduce the effects of burnout and stress among the UTHealth
community.

SOD – Enhanced Physical Wellbeing
• 10 in-house chair massage sessions to reduce stiff necks, tight backs and shoulders due to
providing dental care and sitting behind a desk all day.
• Financial support for Weight Watchers to reduce individual cost.

SON – Mindful Wellness Project
• Monthly educational lunch and learn seminars to raise awareness about healthy lifestyle
choices.
• Twice-monthly sessions of yoga. Funding will cover instructor cost, yoga mats, sanitary wipes,
printing costs, and small incentives.

SPH – Garden for Health Project
• 10 Garden for Health workshops at the holistic garden and demonstration kitchen to increase
knowledge of health benefits of eating fruits and vegetables, composting, and cooking skills.
• Funds will support the purchase of garden pots, labels, planting mix, fertilizer, seek packs,
garden gloves, cages, bamboo stakes, twine, shears, trowels, insect dust and spray, class
materials, etc.

SBMI – I am Healthy
• 2 sessions per month: yoga, weight training, stretching, etc.
• Purchase up to fifty Fitbits as rewards for completing initial survey, attending kick-off lunch
meeting, and participating in three wellness sessions.

GSBS – Mental Wellbeing
• Purchase assessment tool to determine the current state of mental wellbeing and specific
needs for future response for the GSBS population.
• Two in-service training sessions to learn about recognition of signs and symptoms of mental
distress, including the manager’s role in exacerbating or abating stress in the workplace
• Two trainings on mental health awareness and mental health self-care for the purpose of
incorporating this training to new staff orientation at GSBS.