The Impact of Combined Mindfulness-Based Interventions and Nutritional Counseling on Physician Burnout
The Impact of Combined Mindfulness-Based Interventions and Nutritional Counseling on Physician Burnout
This study is designed to tackle the issue of physician burnout via a wide-lens approach,
 integrating both mindfulness-based training and nutritional counseling in the management of
 professional burnout. The investigators will evaluate the effects of mindfulness training and
 nutritional counseling interventions through assessment of changes in physiological and
 biochemical parameters known to be adversely affected in burnout, in addition to the
 standardized Professional Fulfillment inventory scores at 3-6 months post-intervention.
There is a preponderance of data to support the detrimental effects of burnout on physicians'
 health and wellbeing. Physician burnout is defined as severe emotional exhaustion,
 depersonalization towards others and reduced sense of personal achievement. Burnout is often
 accompanied by feelings of moral distress, loss of interest and energy, and detachment from
 patients, colleagues and personal relatives. With the recent rapid expansion in global
 healthcare systems in response to societal changes, rates of physician burnout have been on
 the rise. It is estimated that 54% of physicians in the United States suffer from
 professional burnout, a 2-fold higher prevalence than that estimated for the general working
 population of 28%.

 Burnout has serious negative implications on the physical health and wellbeing of
 individuals. In recent studies, burnout was associated with higher incidence of coronary
 heart disease and hospitalization from cardiovascular causes. Additionally, burnout was found
 to be an independent risk factor for type 2 diabetes mellitus and hypercholesterolemia (total
 cholesterol ≥220 mg/dl). Higher incidence of musculoskeletal pain and pain-related disability
 were also reported amongst subjects with high burnout. Excessive fatigue, insomnia,
 headaches, gastrointestinal and respiratory issues were all positively correlated with
 burnout level. More strikingly, burnout was found to be a significant predictor of mortality
 in those below the age of 45-years.

 Burnout carries its repercussions on mental health as well. In a study of 2,555 dentists,
 burnout was a significant predictor of depression occurrence during the 3-year follow-up
 period. Increased psychotropic and antidepressant use was associated with high burnout, with
 a stronger correlation observed for men than women. High level of burnout was also linked to
 increased risk of anxiety, substance abuse, alcohol abuse, and even suicidal ideation.

 Burnout is a serious threat to the medical profession at large. With more than half of the US
 physicians suffering from professional burnout, its implications ripple through the entirety
 of the healthcare system. Burnout decreases both patient care quality and physician
 productivity. Increased sickness absences have been reported in high burnout. In a recent
 report, severe burnout independently accounted for 52 sickness absences in a 2-year follow-up
 period. Additionally, burnout has resulted in more physicians leaving practices or reducing
 their work hours. A healthcare system loses on average $500,000 to $1,000,000 with the
 departure of a physician, in addition to the ever-increasing workload of physicians who
 remain in practice. Most significant of all, burnout leads to major medical errors. With the
 estimated 250,000 deaths in the United States occurring due to medical errors, developing
 effective strategies to eliminate physician burnout has become an ever-present priority.

 A number of prospective studies and clinical trials have been conducted to assess the
 efficacy of different interventions on mitigating physician burnout. A major cluster of these
 studies have focused on behavioral interventions, more specifically, mindfulness-based
 approaches aimed at reducing the mental and emotional repercussions of burnout. Such
 behavioral interventions included practices of contemplation-meditation exercises,
 discussions on enhancing self-care and intensification of present-moment awareness. Efficacy
 in the latter studies was mostly assessed via quantification of change in burnout and
 stress-related scores, most notably the Maslach Burnout Inventory score, a well-established
 tool for assessment of burnout in the occupational setting. The majority of these studies
 reported favorable effects on burnout scores. However, limited to no-data exist on the
 physiological and biochemical effects of mindfulness-based interventions on physician
 burnout.

 A second cluster of studies implemented lifestyle changes, more specifically, incentivized
 exercise programs and nutritional counseling for burnout. However, studies examining the
 effects of physical activity tended to be short in duration, of small magnitude, and lacked
 adequate assessment of the physiological and biochemical effects of exercise on burnout [23].
 Additionally, a significant lack of research on nutritional and dietary interventions in
 physician burnout exist in the literature, despite the vitality of good nutrition in the
 health and wellbeing of physicians.

 Therefore, this study intends to tackle the issue of physician burnout via a wide-lens
 approach, integrating both mindfulness-based training and nutritional counseling in the
 management of professional burnout. The effects of the interventions will be evaluated
 through assessment of changes in physiological and biochemical parameters known to be
 adversely affected in burnout, in addition to the standardized Professional Fulfillment
 Inventory, at 3-6 months post-intervention.
Inclusion Criteria:

 -  Physician employed by Cleveland Clinic

 -  Located in Ohio

 -  Must anticipate remaining employed for at least 6 months post-enrollment

 Exclusion Criteria:

 -  Non-MD or non-DO healthcare providers

 -  Unable to commit to intervention sessions

 -  Current diagnosis of uncontrolled hypertension, and/or uncontrolled diabetes mellitus
 (defined as hemoglobin A1c ≥9%)

 -  Current or previous history of Cushing's disease or pheochromocytoma/paraganglioma