In this episode I’m offering my take on why we haven’t budged the needle on physician burnout.
We have clear evidence of the causes of burnout—but we don’t have effective action. Why are we so stuck?
My observations fall into 4 areas:
1. Weak, bureaucratic language that fails to put a spotlight on the problem of burnout:
People who have the podium, the authority, and the data are using their indoor voices— when what’s called for is a bullhorn! Why is undue restraint and bureaucratic gobbledygook the preferred language when talking about crumbling physician careers?
I’ll talk about research that shows 20% of physicians intend to reduce hours or leave their current position within 24 months—and all this voluntary attrition will make it impossible to meet the future demand for doctors. Why are docs bailing out? I’ll take a deeper dive into the data that should have CFOs racing to their spreadsheets to calculate the ROI of fixing the burnout issue.
2. Data disconnection:
We know the proximate causes of career dissatisfaction among practicing physicians. The evidence shows that two of the biggest issues are physicians being thwarted—not supported—in their attempts to provide high-quality patient care, as well as the frustrating time-sink EHR.
And yet the burnout literature continues to be filled to the brim with studies about resilience training, small group work, and mindfulness training.
Leaders, researchers, and wellness experts fall prey to running studies and pushing interventions that are easy to set up and easy to fund. Unfortunately, addressing the “in-your-face” causes of burnout (like the dysfunctional EHR) isn’t easy or cheap. And the root causes of physician disaffection—lack of physician leadership and autonomy—require interventions that are politically dicey.
The huge 2019 National Academy of Medicine (NAM) study titled Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being is a deep dive into burnout. The authors acknowledge the inexplicable lack of studies looking at system solutions to burnout. The co-chairs explained that they wished they could make recommendations for organizational interventions but due to lack of data—they couldn’t.
3. Substitution of the term “well-being” for the term “burnout”:
The well-being and wellness proponents are missing an important point—well-being and burnout are not opposite ends of a continuum.
The opposite of burnout is not well-being; it’s absence of burnout. You can have no elements of burnout but not be in a state of well-being and vice versa.
In the article One More Time–How Do You Motivate Employees? Herzberg describes hygiene factors and motivating factors. Hygiene factors are comparable to those elements in the workplace that cause burnout and motivating factors are comparable to drivers of well-being.
When you address hygiene factors–you just get up to neutral with workplace satisfaction. And—if you don’t get up to neutral by fixing the broken hygiene factors—don’t bother with motivators.
Adding motivators–-or wellness initiatives—doesn’t fix hygiene or burnout factors.
So if the number of clicks, pre-authorizations, and clerical tasks are exhausting or even disgusting—wellness interventions aren’t going to help.
An excellent March 2020 JAMA article titled Professional Dissonance and Burnout in Primary Care, with lead author Sumit Agarwal, used focus groups to identify sources of burnout. The solution-orientation of these authors was refreshing. This study helps underline the fact that what doctors need is help overcoming the organizational barriers to taking excellent care of patients.
In too many cases the temptation to veer toward well-being initiatives results in this weird communication disconnect:
What is said is “Administrative work overload, barriers to taking care of patients, and the EHR are huge problems.”
And what is heard is “We need a wellness program, more studies about resilience—and for sure a chief wellness officer.”
4. Leadership failure to tackle the difficult issue of addressing burnout:
Leaders issue position papers, declare commitments, create new infrastructures, and foster robust research careers all based on looking in the wrong place for answers to what’s destroying medical careers. Whether it’s the head honchos of organizations with dwindling physician membership like the American Medical Association, or the CEOs and presidents of healthcare organizations, the response to physician disaffection has been anemic.
Advocacy and auxiliary medical organizations are perceived by a lot of physicians to be not so much advocates as adversaries. There is no love lost for organizations like the AMA; National Board of Medical Examiners with their “oversight” of the United States Medical Licensing Examination (USMLE) and its controversial Step One medical student exam; and the American Board of Medical Specialties and its obstinacy (and some say extortion tactics) regarding Maintenance of Certification (MOC). They appear to have been corrupted by their own BSMs (business school mindsets) as they drive to increase their organizational bottom lines and perks rather than serving the medical profession.
Ten prominent healthcare system CEOs and the CEO of the AMA put their heads together and published Physician Burnout is a Public Health Crisis: a Message to our Fellow Healthcare CEOs in Health Affairs early in 2017. They presented this call to action by saying: “Addressing the issue of burnout is a matter of absolute urgency.”
In this podcast episode, I walk through this downright cringe-worthy “call to action” which doesn’t have a real action item on the list. I even offer up a few suggestions that are better suited to be on a list regarded as a “matter of absolute urgency.”
In conclusion, I make some recommendations that are pointed at the known structural and proximate causes of physician despair and shattered physician careers.
So what do we need to get physicians from being commoditized assembly line workers who pose a real flight risk—to well-supported professionals in fulfilling careers serving patients?
New leadership courage, new leadership philosophy and understanding, and new leaders—preferably with an MD or DO behind their names.