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Burnout or control.

This quote is reflected by work in Australia, where clinical leaders have backed their psychiatrists in making good plans with patients, and not gone hunting for faults when things, inevitably go wrong.

What conditions are making physicians feel that they have lost control, and how do these conditions differ from the past? Previously, many physicians worked in solo or small group practices and dictated their own working conditions. However, as large health care systems have taken an increasing share of the market, many physicians have sought shelter by joining these systems. Unlike most private practice settings, large health care systems tend to be impersonal and controlling, leaving little room for individual autonomy to decide what tests to perform, what treatments to administer, and how much time to spend with patients. Physicians often feel frustrated by the broad array of mandated regulations, required computer entries, and performance expectations imposed by insurance companies, government agencies, and hospital administrators. These conditions leave many physicians feeling overwhelmed and relatively powerless.

Resilience research reveals that the most effective approaches for dealing with stress involve active or proactive coping mechanisms. Active coping refers to goal-directed behaviors such as gathering information, acquiring skills, problem solving, making decisions, confronting when necessary, and seeking social support. These strategies are associated with greater resilience to adversity and better stress tolerance compared with passive or reactive coping styles, such as denial of the problem, avoiding or withdrawing, using illicit substances, repetitive negative venting, and blaming someone or something else. High levels of perceived control and autonomy are consistently associated with high levels of job performance, job satisfaction, and well-being, as well as low levels of work-related stress.

How can physicians actively take control of their work lives and reduce burnout? We recommend that health care organizations adopt a distributive leadership model that encourages physicians to actively participate in governing and improving the systems in which they work. Modern health care is highly complex and interdependent, and it is crucial to effective service provision that physicians share administrative and policy leadership positions with nonphysician health care administrators. With their clinical expertise and training in the scientific method, physicians bring invaluable experience to administrative teams and can contribute to improvements in every process that affects patient care.

Southwick FS, Southwick SM. The Loss of a Sense of Control as a Major Contributor to Physician BurnoutA Neuropsychiatric Pathway to Prevention and Recovery. JAMA Psychiatry. Published online May 16, 2018. doi:10.1001/jamapsychiatry.2018.0566

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