Imagine you’re a CEO of a specialty shoe manufacturer. Suddenly, for an unknown reason, a rapidly escalating number of your workers develop work-related injuries: carpal tunnel syndrome, back strains, limb fractures, rotator cuff tears. Healthcare costs escalate due to physician visits, imaging, surgery, and physical therapy. Disability payouts soar. Production grinds to a halt, with fewer healthy workers available to handle the orders. Long-term clients turn elsewhere when your company fails to meet order deadlines.
Given that your top revenue generators are compromised, wouldn’t your primary objective be finding the underlying causes of the injuries and taking active steps to prevent them?
As burnout researcher, Christina Maslach, PhD, professor emeritus in the Department of Psychology, University of California Berkeley, said in an interview for our book:
One of the biggest challenges is that people tend to think of burnout in terms of individual factors and individual responsibility. They tend to blame the individual. Despite research that shows the importance of the environment, background, and situation, people still think, “too bad that person can’t handle it.” A harder message to hear, or a more overwhelming one, is that the problem is more than the individual.
Professional burnout is not reflective of individual weakness or susceptibility, and burnout among physicians is not simply a matter of “whiny doctors” complaining about changes in the practice environment. Burnout manifests in the individual but is caused by systemic stress in the workplace.
Seeing the Big Picture
The systems problems that create the toxic clinical workplace are driven in large part by new and overwhelming external factors—the increasing focus on cost containment; federal mandates regarding electronic health record utilization; payments that are partially tied to metrics of quality and patient experience; the explosion of medical information, which threatens to outpace physicians’ ability to read and process it; and the increased prevalence of chronic conditions. These external factors, which are not directly controlled by either administrators or physicians, have tremendously changed the daily work experience of clinicians at the front lines of care. In many cases, they have also driven a wedge between administrators and physicians.
As stated by Dr. Maslach, too often administrators (and physicians themselves) see burnout as an individual problem and attempt to address it with individually focused solutions alone, such as by offering wellness classes, personal coaches, and mindfulness training. While these strategies are useful for building resilience to stress, they do nothing to fix the source of the stress—the toxic workplace.
What physicians need is an improved work environment—one with fewer daily frustrations, fewer instances of requiring “workarounds” to get the job done, fewer barriers to spending time on direct patient care—in short, a workplace with fewer “pokes,” as one physician interviewed for our book described the inefficiencies.
Physicians—and other clinicians, healthcare professionals, and paraprofessionals—also need to be treated with respect. Disrespect erodes organizational culture and deflates morale. When queried about the factors that foster engagement with their organizations, physicians’ No. 1 response is “respect for my competency and skills,” according to a 2013 survey. a
What does respect for physicians entail? One example comes from Vancouver Clinic, where physicians’ input is actively pursued as part of strategic decision making. The organization uses the nominal group technique to understand the work experience, needs, and values of the physicians and to solicit their ideas for solutions. As Sharon A. Crowell, MD, an internist and the clinic’s board chair, said in an interview for the book, “The process was so successful that we use it for every big decision now.”
Physician burnout is not a problem with a quick fix nor one that either physicians or administrators can solve on their own. Physicians and administrators must work collaboratively to mitigate the effects of the external factors that are driving the record-high prevalence of burnout among physicians.
Although many organizations are beginning to tackle the problem, the endeavor is in its infancy, and evidence is lacking regarding the effectiveness of specific interventions in addressing the current systems problems. One overarching conceptual solution—and a good place to start—is team-based care with co-location of team members.
Team care surrounds a physician with support staff who can perform most of the administrative tasks that frustrate physicians. Patients benefit because the physician can focus on the unique needs of the patient, rather than on administrative minutiae. Physicians and their families benefit from the reduction in busywork that adds hours of work to a doctor’s day and to his or her after-hours time. b
Burnout among physicians and other clinicians is a growing, urgent problem that threatens the viability and performance of healthcare organizations. Clinician burnout reflects systems problems that require systems solutions rather than simply wellness programs. Administrators must work collaboratively with physicians—within a culture of respect—to address the true drivers of burnout and avert the negative consequences for their organizations and the patients they serve.
Paul DeChant, MD, MBA, practiced family medicine for 25 years and has 30 years of healthcare management experience. He now serves as an executive coach and senior advisor with Simpler Healthcare.
Diane W. Shannon, MD, MPH, left clinical practice because of burnout. She is a freelance healthcare writer based in Boston who focuses on healthcare improvement, patient safety, and prevention of physician burnout.
a. VITAL WorkLife, “ VITAL WorkLife and Cejka Search Physician Engagement Survey,” 2013.
b. Sinsky, C., Colligan, L., Li, L., et al., “ Allocation of Physician Time in Ambulatory Practice: a Time and Motion Study in 4 Specialties,” Annals of Internal Medicine, Dec. 6, 2016.