Why is There So Little Progress in Physician Burnout?
We certainly have proven that burnout is a major issue for physicians. Hardly a day passes without a new study demonstrating nearly half of doctors will experience symptoms of burnout, and a significant number are considering leaving the profession.
Many organizations have measured levels of burnout repeatedly with consistent results. Lists of stresses and causes have been developed, and the considerable cost, quality and patient satisfaction ramifications defined and calculated
Yet, in the years since this dilemma has come into the open, little evidence exists that the situation for our physicians is improving. Few doctors believe that the joy of practicing medicine has returned. In fact, there are signs that the pandemic has worsened the stress, either from the pressure of treating patients in the hospital, or the financial and patient care pressures created by the temporary closure and subsequent diminished patient capacity of practices.
We have observed several common barriers and misperceptions observed in organizations that impede effective prevention, management and improvement in physician burnout. Developing a strategy and program to avoid these pitfalls is essential if we are to begin making progress toward a healthy, productive and joyful physician workforce.
Here are a few ways organizations can address burnout in a more effective way to finally begin to achieve progress.
Viewing Burnout as a Static, not a Dynamic issue
As my colleague, Dr. Dike Drummond is fond of saying, “Burnout is not a problem to be solved, it is a dilemma with strategies”.
Burnout is a complex, multifactorial state that has evolved over years, and will take a persistent, dedicated journey to resolve. Contributors to burnout will vary by organization, specialty and location. Organizations need to design a program to continuously address this issue and look for results over time. There is no quick fix.
Here are a few misperceptions that impede effective management.
Using Measurement Tools That Provide Little Guidance or Priority of Intervention
Most of the currently utilized surveys on burnout were designed to measure the presence of burnout but are unhelpful in guiding organizational strategy. Some organizations use a standard employee engagement survey administered to all employees, which is even less informative as to primary stressors unique to physicians.
All of these surveys are static, unchanging from year to year, and thus doctors answer the same questions year after year without seeing progress in their professional lives. If we are to engage our doctors in this process, the survey results should be transparent to the physicians, and the doctors should be able to see a strong link between their feedback on the survey and the organizational priorities for change.
Not Creating Rich, Useful Physician-Organization Dialogue As Organizations Grow
Modern healthcare organizations employ hundreds, if not thousands of physicians and are spread out over increasingly large geographies. It is simply impossible for senior leadership to personally meet with and listen to a sizable sample of physicians.
Physician committees have their place but are a poor proxy for hearing from a larger base of doctors. Meaningful listening requires openness to open questions, and iterative dialogue using survey methodology not exclusively based on a five-point Likert scale. Broad based feedback is a significant challenge in today’s organizational structure. Without rich listening tools, organizations risk implementing solutions based on top down, simplistic thinking that are disconnected from the physician’s reality.
Missing the Iceberg Under the Electronic Health Record
Documentation has tormented physicians for a long time, and certainly the advent of the electronic health record has exacerbated the situation. Tempting as it is to believe the entire burnout dilemma would disappear if we reverted to dictation and paper, such a simplistic focus on one issue can cause a lack of action by both clinician and organization.
Behind the actual software lies a host of organizational decisions adding complexity and time, many of which are optional and unnecessary. Burdensome and complex billing codes, ubiquitous data collection driven by value-based purchasing, and ever-increasing regulatory requirements exacerbate the issues.
When organizations buy into the idea that doctors are just “struggling with the computer”, they miss opportunities to streamline work and requirements, as well as neglecting training and continuous system improvement.
Physicians are extremely resilient people. One does not survive the rigor of medical school and residency without inner strength and strong coping mechanisms. Focusing entirely on building resilience in an already highly resilient group through traditional methods ignores the documented fact that most contributors to physician burnout are under organizational control.
Arming doctors with strategies to proactively manage their work and career are helpful and necessary. Telling them they need to learn to be more resilient is not helpful. Relieving them of unnecessary stress generated by organizational decisions and policies is critical to the long-term management of this crisis. The strategy must be dual; support, equip, and give permission to doctors to care for themselves while identifying and remediating organizational stressors.
This includes investment in practice redesign which allows the doctor to focus on her craft of caring for patients.
Failing to Equip Doctors To Be Part of The Solution
Medical school curriculum rarely has included training on burnout. Not only should doctors be trained to understand what burnout is and how they can prevent it in themselves, they need to learn how to recognize signs of burnout in colleagues, how to best approach those colleagues and be equipped with knowledge of resources to recommend. Doctors can be our eyes and ears to help peers who are struggling prevent full blown burnout.