Over his 28-year career as a psychiatrist, AMA member Tom Zaubler, MD, MPH has always had an administrative leadership role in various departments. And throughout his career in medicine, Dr. Zaubler has personally faced—and addressed—burnout at different levels. Each burnout roadblock allowed him to find ways to improve personal well-being and address the systemic drivers in psychiatry and across every discipline.
When Dr. Zaubler was a residency program director in the late 1990s, there wasn’t much talk about physician burnout, but he was concerned about the emotional and social well-being of residents. That’s because he recognized that you couldn’t function adequately as a psychiatrist in training if you weren’t attending to your own basic needs. Then as a psychiatry department chair, Dr. Zaubler was very focused on what he could do—and what his health system could do—to help mitigate and manage burnout.
It's also one of the reasons Dr. Zaubler began introducing the AMA’s “Coping with COVID” survey to the health system he was in at the time. It was distributed in all five hospitals.
But “the antidote for me personally has been recognizing when I was getting to a place where I was starting to feel that my work was becoming rote, when I started to feel a little bit disconnected from my work because I always knew that was a red flag,” said Dr. Zaubler, who runs a private psychiatric practice, Pegasus Psychiatry Associates, in Morristown, New Jersey, and is chief medical officer for NeuroFlow, a technology company focused on increasing access to—and integrating—behavioral care across a full continuum of clinical services.
It “was to recognize that, understand it and think about ways that I could use that to help others. And that becomes immensely cathartic and therapeutic,” he said, noting that as psychiatrists, “when we’re with a patient, we recognize how we’re responding to that individual and that can help to hone in prognostically with therapeutic interventions.”
“I did a similar process and recognized things in myself and thought about how are people who I’m working with—colleagues and people reporting to me—experiencing burnout?” Dr. Zaubler added. “And that, in and of itself, became exhilarating and rejuvenating to think about ways that I could introduce interventions to manage burnout.”
During a Q&A, Dr. Zaubler discussed initiatives to improve well-being and how surveys about physician burnout can be helpful.
AMA: Stemming from your personal experience, how do you help address burnout?
Dr. Zaubler: We all overcome challenges throughout our lives and to be able to learn from those challenges and to be able to channel the emotions and the learning in a productive way not only is gratifying, but also is synergistic. It leads to a sense of feeling that there’s growth and change for the positive and that’s an antidote to burnout.
One of the things about burnout is that there’s a sense that you’re in a factory line—there’s no meaningful benefit and no personal gratification. You’re detached from what you’re doing, the exhaustion, all the stuff that we all know.
Physicians are in a tough spot. Most physicians are employed now. For better or worse, we are still in a fee for service world where productivity is mission critical. The emphasis on RVUs [relative value units], seeing as many patients as possible, is a huge driver of burnout where physicians feel disempowered, disengaged, like cogs in a wheel.
Yet there are other ways to determine how productive physicians are. And anything that you can do to help physicians to feel that they can truly make a difference—not only with their patients but also in how they practice—in how medicine gets practiced on a larger level in their health systems is important.
That’s why, for me, it was so gratifying to be able to feel that I could actually make a difference. When I went to the AMA to introduce the “Coping with COVID” survey at my health system, I was exhilarated by that. It was a ton of work I was adding to my workload, but it was a positive stress for me.
It was invigorating because I felt that I was engaged in a process that would lead to positive outcomes, and I was really making a difference. I could have sat back and said: I’m a department chair. There are others who have responsibilities for employee wellness across the system, so it is not my role. And that’s not the healthiest thing for any of us to feel disempowered, disengaged.
But as a population, physicians find themselves in these places where they feel disempowered, where they’re not the decision makers. So many forces are at play, and they feel that they’re on a treadmill because they have to see patient after patient after patient and they may have some glimpse—if they even have the energy to think about that—of how things can be done better.
One of the challenges is helping to empower people. It’s super important. If you’re going to empower someone, whatever system they are in has to recognize the voice of the physician. That’s why the “Coping with COVID” survey was great because it gave a voice to physicians. And an antidote to burnout is helping people to feel that they can make a difference and have a say in what they’re doing and how they’re doing.
AMA: Is it the system that needs to change rather than relying on the individual?
Dr. Zaubler: I’m always a little skeptical when health systems highlight self-care, resilience and the individual things that one can do. There is a role for that. I don’t in any way want to suggest that it’s not meaningful and important, but it’s not enough. It’s not sufficient.
Get the latest news on physician well-being
Subscribe for insights and real-world solutions delivered straight to your inbox.
We have to recognize that our system is designed to function in a certain way. And people talk about the system being broken—and it probably is broken—but it’s also purposely designed to function in the way that it does. Health care has become highly commoditized and commercialized, sometimes with a blinding focus on a financial margin.
So, we have to recognize the forces contributing to this commercialization and address ways to help physicians feel that they are not just commodities in our health systems. And it’s not just health systems, it’s payers. It’s everyone in the health care ecosystem that can help to create environments where physicians can make a difference for their patients and have a voice in the way that health care gets delivered.
That involves structural changes, and it behooves physicians, health systems and payer leadership to work collaboratively with all parties having a seat at the table to facilitate constructive change that, most importantly, will lead to better health care for patients.
AMA: Does surveying physicians about burnout help?
Dr. Zaubler: It helps, and it hurts. I say that because we absolutely need to do these surveys to determine the drivers of burnout. But my concern is that the surveys themselves can become window dressing to demonstrate a commitment to address burnout without resulting in meaningful structural changes in the delivery of health care.
For example, focusing on things like creating rooms for meditation for staff near medical units can be helpful, but not sufficient to address burnout. A focus on self-care should not eclipse ways to balance productivity with physician satisfaction and robust quality outcomes or provide physicians with a voice in terms of leadership and governance in health care systems.
AMA: How does being chief medical officer at NeuroFlow help?
Dr. Zaubler: For several reasons, I was drawn to NeuroFlow because it is a brilliant platform leveraging technology to improve access to the right behavioral health care for the right patient at the right time. Access to behavioral health is incredibly limited and untreated psychiatric illness drives increased patient utilization and poor medical and psychiatric outcomes which is a huge source of frustration for physicians in every specialty and contributes to burnout.
Well, with NeuroFlow, we have this platform that facilitates the integration of psychiatry and behavioral health into different medical settings in a seamless and automated way that unburdens physicians. Using NeuroFlow’s technology to scale population-focused models of behavioral health care in primary and specialty care and across the clinical continuum of acuity including care in inpatient units and emergency departments, patients get better psychiatrically and medically, excess utilization of medical services decreases, and physician satisfaction improves immensely. By contributing to the 4th pillar of health care—physician satisfaction—NeuroFlow becomes a piece of the puzzle of creating antidotes for burnout.
Adopting new technology sometimes can seem daunting especially in the context of burnout. It requires exercising principles of change management, but in our experience at NeuroFlow, given the ubiquity of mental illness and dearth of psychiatrists and behavioral health providers, unburdening physicians of delivering or accessing behavioral health care for their patients is a huge satisfier.
Because NeuroFlow’s platform has AI-curated self-care content on resilience and positive psychology—in addition to being a resource for patients—it is used by employee assistance programs as a tool for health care to manage burnout. For example, at Jefferson Health, a client of NeuroFlow’s, every employee has access to NeuroFlow to surface undetected psychiatric illness as well as facilitating well-being and mitigating the impact of burnout.
AMA: What else is important to know?
Dr. Zaubler: It is important to recognize that no one is immune to burnout. I was reminded of that during a recent vacation. It can be challenging for me personally to unplug from work for more than a few days. I took a week off with my kids and went skiing. It was great to get away from work to do something that I love with people whom I love. The message here is we’ve got to recognize that we all need a break. We all need time to restore and rejuvenate.
We need to help physicians to recognize that there are so many reasons to be thoughtful, hopeful and optimistic about the future of medicine. The challenge is: How do you manage the status quo? How do you get physicians to take a step back from the status quo to recognize that? And how do you help them to feel empowered to lead the way to make change?
We have to help physicians to recognize their own voice, to recognize their own power. The reality is that health systems cease to exist if physicians are not there and that sometimes get lost. And we have to remind physicians of that and make sure that we have the voice that we need.
