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continued from page 21 scrubs because they are too busy, it's hard not to snap," she said. Women ophthalmologists are probably even more likely to experience burnout as they usually take the lead role in caring for children and aging parents, said Sandra Yeh, MD, Springfield, Ill. She recently has wrestled with feelings of guilt as she tries to balance the management of a busy practice with caring for children entering their teen years and putting her mother with Alzheimer's disease in an assisted living facility. 10 steps to prevent physician burnout Institutional metrics 1. Make clinician satisfaction and well-being quality indicators. 2. Incorporate mindfulness and teamwork into practice. 3. Decrease stress from electronic health records. Work conditions 4. Allocate needed resources to primary care clinics to reduce healthcare disparities. 5. Hire physician floats to cover predictable life events. 6. Promote physician control of the work environment. 7. Maintain manageable primary care practice sizes and enhanced staffing ratios. Career development 8. Preserve physician "career fit" with protected time for meaningful activities. 9. Promote part-time careers and job sharing. Self-care 10. Make self-care a part of medical professionalism. From "10 Bold Steps to Prevent Physician Burnout in General Internal Medicine"6 "You especially see young women academics feel burnout due to unrealistic expectations of scholarly activities, caring for children, struggling to make ends meet on an academic salary, and the demand to put in long hours to teach residents and fellows," Dr. Akpek said. Prior work from Dr. Linzer's team also shows higher levels of burnout among women physicians overall.5 Preventing burnout One important reason to help prevent burnout is to avoid the high cost of turnover—an average of $250,000 for a primary care physician, Dr. Linzer said. One solution to help prevent burnout is to recognize its symptoms, Dr. Pfifferling said. Another is letting go of unrealistic expectations. Dr. Pfifferling said it can be helpful for physicians to participate in a retreat where members discuss what they do to handle the often unrealistic pressures that they feel they are under. Talking to other ophthalmologists about their unique challenges can help, Dr. Pfifferling believes. Creating an office environment that is collegial and enthusiastic also goes a long way toward preventing burnout, Dr. Pfifferling said. He has even helped to hire family and marriage therapists for physicians at practices to work out their differences and get along better. . A recent article coauthored by Dr. Linzer found 10 key ways to help prevent burnout (see sidebar for the 10 steps).6 Although the article focused on general internal medicine, Dr. Linzer believes they can apply to ophthalmology as well. In addition to the tips shared in the sidebar, Dr. Linzer encourages physicians to spend at least 10% of their time doing what they feel most passionate about at work—be it teaching, patient care, or something else. Physicians who do not have 22 Ophthalmology Business • December 2013 that outlet are much more likely to experience burnout, he said.7 Dr. Yeh believes that finding a family-friendly hobby and connecting with friends on vacations can help relieve stress and prevent burnout. "Really though, my greatest source of energy is the happiness of my patients," Dr. Yeh said. "We are so fortunate to be in such a great field—we touch the blind and make them see. On postop days, I hug my patients, we laugh, and I feel that wave of their gratitude and amazement at a whole new world, which is theirs after a wondrous surgery." OB References 1. Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172:1377-1385. 2. Viviers S, Lachance L, Maranda MF, Menard C. Burnout, psychological distress, and overwork: The case of Quebec's ophthalmologists. Can J Ophthalmol. 2008;43:535-546. 3. Cruz OA, Pole CJ, Thomas SM. Burnout in chairs of academic departments of ophthalmology. Ophthalmology. 2007;114:2350-2355. 4. Babbott S, Manwell LB, Brown R, et al. Electronic medical records and physician stress in primary care: Results from the MEMO study. J Am Med Inform Assoc. 2013 Sept 4 [Epub ahead of print]. 5. McMurray JE, Linzer M, Konrad TR, Douglas J, Shugerman R, Nelson K. The work lives of women physicians results from the physician work life study. J Gen Int Med. 2000; 15:372380. 6. Linzer M, Levine R, Meltzer D, Poplau S, Warde C, West CP. 10 Bold Steps to Prevent Burnout in General Internal Medicine. J Gen Int Med. 2013 Sept 4 [Epub ahead of print]. 7. Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169:990-995. Contact information Akpek: esakpek@jhmi.edu Babbott: sbabbott@kumc.edu Linzer: mark.linzer@hcmed.org Pfifferling: cpwb@mindspring.com Yeh: syeh2020@aol.com