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To avoid physician burnout, broaden life's scope


Increasingly, the danger of physician burnout is gaining recognition. A report in the Journal of the American Medical Association (Vol. 288, No.12) cites initiatives developed to help doctors deal with stress, including a mandate from the Joint Commission on Accreditation of Healthcare Organizations developed to address physician well-being — outside of any disciplinary actions.

Ten and 15 years into a career, stress and burnout are particularly dangerous for physicians - when stressed-out doctors may leave dermatology. Burnout is often related to poor job performance and health problems, such as headaches, sleep disorders, high blood pressure, anxiety and depression, among other symptoms.

On Call wondered if dermatologists ever feel they could be facing burnout and what they do to stave off stress. We talked to doctors around the country and found straightforward approaches to coping with stress, along with an understanding of contributing factors of burnout.

Dr. Ackerman, in practice for 13 years, has exercised all her life. "I know working out helps relieve stress. I'm a firm believer that any type of exercise - running, stretching - is beneficial. Even if I have to go to the Y and do a bicycle machine, I feel it makes that much of a difference."

Dermatologists who have been in practice longer say they have seen the face of burnout, but have found ways to overcome it.

Establishing a practice Peter Accetta, M.D., in Orchard Park, N.Y., says he thinks he copes with stress now better than he had in the past. "Maybe it's because you get more comfortable in your own skin. You are established in your community. You've shaped your practice to your liking. You're no longer out there to prove yourself to referring doctors. Hopefully, by this point, you enjoy a good reputation and move beyond all of those pressures, so you can enjoy what you're doing."

After 18 years in practice, Dr. Accetta says, "The empire-building phase of my practice is over. I'm a solo practitioner, and I limit my hours."

Dr. Accetta says that change in attitude allows him to have more fun with the staff and his patients.

Location as a factor In Tulsa, Okla., Earl U. Brachenberg, D.O., who used to practice in New Jersey, says his change of location has helped lower stress.

"(Now,) my office is five minutes from my house, I have no traffic jams and road rage doesn't figure into the bigger equation," he says.

Even so, with 34 years experience, Dr. Brachenberg says he's faced burnout.

"I think everybody reaches that point - tired of seeing just acne or some dermatoses you treated for 30 years. For me, the critical time came in my 50s. I think that's fairly common. It's that midlife crisis time. You think about becoming a plastic surgeon, or going on and becoming a businessman and just getting out. I think that's the highest time for burnout."

Dr. Brachenberg says a variety of factors play into the feelings of burnout.

"The patients grind you down because you have to see quite a few of them to make ends meet. Malpractice has always been a big problem in the medical profession - the escalating price and now its way out of control."

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