Physician Burnout: Time to Stop Failing Our Doctors
In the fall of 2018, as I was preparing to retire as CEO of WellSpan Health, I was invited to reflect upon “lessons learned” in a Q&A session for aspiring physician leaders by the Leadership Institute. During that session, I was asked what I considered my greatest failure (among many I presumed) in my almost 40-year career.
My answer? The fact that on my watch as CEO, we experienced a significant decline in morale and a loss of joy in clinical practice among our physicians. Like almost all healthcare organizations around the country, we as leaders were neglecting to listen to our doctors, failing to support them optimally, forgetting to communicate their value to the organization and couldn’t seem to consistently translate their input into effective workflows to optimize their clinical practice.
The occurrence of our situation today, where as many as 50% of doctors experience symptoms of burnout, is mind boggling. Physicians are indeed the engine of the modern healthcare system. They are the critical cog at the point of care, the attachment point for patients and the glue that keeps patients engaged and loyal. They are the leaders of quality care and advancement in clinical programs. Primary care physicians are the heart, face and voice of our organizations in the growing number of communities we serve, and specialists play the same role for advanced care, distinguishing one system from another. How in the world did we as leaders fail to maintain the needed dialogue, understanding and care for critically important members of our team?
Leadership attention to physician health is critical. Physician burnout is not a problem to be solved with an intervention or a classic consulting engagement. Instead, it is a longitudinal issue requiring an ongoing change in organizational listening and support of individuals who are undergoing significant disruption and stress. Changing organizational habits will take time. We need to learn how to stop exacerbating the problem caused by inattention to the impact that organizational decision making has on this unique profession.
Without proactive attention, it can be easy for leadership to become desensitized to the value of their doctors’ work, writing it off to diva status or an excuse for clinical variation (“my patients are different”). Doctors are experiencing unprecedented changes imposed by governmental, regulatory, and yes, their own practice organizations which impact their ability to optimally care for their patients. We’re also seeing diminishment in their voice and the ability to affect the changes. Their work has changed, their environment has changed, expectations for access, documentation and care have changed, and the physician social network has changed. Meanwhile, the resources and support available to them to complete their complex work and balance their lives typically have not changed.
In fairness to healthcare organizations, this should not be totally unexpected. We’ve had hospitals and ambulatory centers as part of our organizations for many more years than physicians. As physician organizations have become much larger and geographically spread, communication, especially in the direction of doctor to leadership, can be a challenge. Time pressures make meeting attendance difficult. Leaders of groups numbering hundreds, or even thousands of doctors cannot have a personal interaction with each doctor frequently enough to identify individual needs and situations. Organizations struggle with the dilemma of how much to treat physicians differently from other employees, thus often lumping them into general employee satisfaction surveys which are not designed to address their unique circumstances.
In addition, leaders themselves are dealing with rapid change in priorities and expectations, which can result in dissonance between leaders and doctors, especially in compensation methodologies. Every payer (including the government and the organization’s ACO) has a unique set of quality indicators and incentives which can significantly impact the increasingly stressed bottom line. Since so much of clinical care runs through the physician, unintentional but damaging piling on can occur, leading to suffocating documentation requirements of the doctor during their 15 or 20 minutes with complex patients. Only at the point of care is the sum of all these factors understood.
Our doctors are resilient people (give residency a try if you don’t believe it), in fact almost too resilient. They will tend to do what is necessary for their patients, even at great personal cost. Healthcare leaders need to understand these dedicated people will often sacrifice their personal well-being to accommodate the non-patient care waste placed upon them, thus preserving what they give to their patients. Physicians are trained in patient care, not self-care.
For CEOs and healthcare leaders, this is not for the faint of heart. The stakes are high. At heart, this is a human issue. Doctors who are burned out are at high risk for suicide, divorce, family issues and mistakes. They need our support and special care to thrive and recover their joy in practice. We owe that to them for the many hours of work and effort they provide caring for our communities. Organizationally, burned out physicians have lower patient satisfaction and loyalty, more medical errors, are less productive and more likely to either retire or leave the organization. The cost of burnout is extraordinary.
Resolution is a journey and will take significant vision, time, resources and organizational energy. When we start asking the doctors for their thoughts, we will need to be prepared to listen and act. Investments may be needed in staff, training and other support at a time when finances are getting tighter. We need to design compensation plans that not only encourage productivity, access and quality, but also self-care. Doctors must be equipped with strategies for maintaining healthy personal lives to keep balance with work stress. I would argue that the financial resources are there, but currently hidden in the cost of replacing doctors who are leaving or retiring early, malpractice litigation, lost patients, diminished productivity and other areas.
This area need not be an area of personal leadership failure. The opportunity to support incremental change in an organization with happy, healthy, engaged physicians functioning at the top of license is right in front of us. SE Healthcare, working with nationally renowned expert Dike Drummond, MD, have built a powerfully scalable program of tools for listening to your doctors and prioritizing actions while providing access to simple, easy to learn tools for physician self-care.