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The burnout burden: Why doctors need help from leadership

This article by Steve Jackson, President, NRC Health, was featured in “The Doctor Weighs In”


 

By now, it’s not news to anyone that physicians are feeling burnt out. But the scale of the problem may be worse than you think.

“Burnout” describes the cluster of cynicism, depression, and exhaustion that overcomes people who struggle in their work. While burnout appears in every profession, physicians experience the worst of it: 54% of them are currently experiencing at least some burnout symptoms.

This is not a new issue. Physician burnout has been a well-documented phenomenon since 1981. Despite that, researchers and healthcare organizations have made little progress in curbing it. In fact, the burnout rate has been consistently rising every year.

What toll does this take on healthcare organizations? And what should leaders do about it?

The Uncounted Cost of Burnout

Taken together, the costs of physician burnout can be staggering. The most obvious financial drain is from turnover—burnt out physicians tend to quit.

Christine Sinsky, MD, FACP, is the Vice President of Professional Satisfaction at the American Medical Association. She points out that replacing just one physician costs an organization between $500,000 and $1 million. This means that, if a health system with 500 physicians in its roster experiences average yearly rates of burnout (54%), they will have to spend $12 million every year recruiting new doctors.

For any organization, $12 million is a significant loss. But Dr. Sinsky clarifies that the financial fallout is more complicated than that.

That’s because doctors all express burnout differently. They may not always quit their jobs; some scale back to part-time work, which, while expensive, is more tolerable than a resignation.

However, other doctors will simply grit their teeth and push through their burn out—and that’s not always a good thing. Burnt-out doctors see a consistent drop in their productivity, and even worse, their care quality tends to suffer.

As Dr. Sinsky puts it, “[Doctors with burnout] may respond by providing less-safe care. We know that care is safer when physicians are satisfied with their work.”

Healthcare organizations should note how this can affect care volumes. Patients notice when care quality dips, and they’re not afraid to switch providers over it.

But the far more important implication is to patient safety. The research is clear: burnt-out doctors put patients at risk.

Misdirected Burnout Cures

Because burnout’s symptoms can be so private and emotional, interventions for it—like mindfulness meditation—tend to focus on individual physician behavior. In theory, these boot-strap approaches promote physician “resilience.”

While there’s some evidence that these interventions can help, they also put the burden on doctors to restore their own work-life balance. That overlooks burnout’s structural causes, over which physicians have little control.

Dan Ariely, PhD, and William L. Lanier, MD, described three of these forces at work:

– Asymmetric rewards. While doctors enjoy a prestigious and remunerative career, they’re also exposed to tremendous risk in the event that they ever make a mistake. The fear of the pain and expense involved makes many doctors unable to enjoy their work.

– Loss of Autonomy. Doctors are micro-managed continuously, and often have little say in how they spend their days. One colleague of Dr. Ariely’s confided that he wasn’t even allowed to take unscheduled bathroom breaks. That would be hard for anyone to stomach—let alone a highly trained professional.

– Cognitive Scarcity. Doctors have to carefully weigh every choice they make against its alternatives and consequences. That’s the essence of clinical work. But it takes a toll. Researchers have found that a stream of difficult decisions induces a cognitive deficit, one roughly equivalent to losing a night of sleep, being slightly intoxicated, or losing about 13 IQ points.

Doctors have next to no ability to change these pernicious influences on their work. No amount of “resilience” can overcome them. The implication that doctors should be solely responsible for resolving these issues, then, is worse than ineffective—it’s insulting.

What Organizations Can Do

But while the pursuit of individual resilience is almost a farce, improving institutional resilience can be an effective strategy. Systematic solutions can succeed where small-scale interventions cannot.

It’s up to healthcare leaders to cultivate the kind of culture that responds to physicians’ needs, and prioritizes their health. Here are some good first steps for healthcare leaders to take:

(1) Learn.

Burnout is a complex and evolving problem. It’s important for leaders to understand the latest developments, which means reviewing the clinical literature on the subject. (The links in this article are a good place to start, but are by no means exhaustive.)

But as mentioned above, burnout is also a highly personal experience. The literature won’t tell leaders how their workforces go through it. Leaders should therefore spend time listening to how physicians feel about their work.

(2) Measure.

Some healthcare leaders hesitate to measure how burnout has affected their organizations—perhaps because they’re not sure what to do about it. But Dr. Sinsky observes that measuring burnout’s impact is an important step toward resolution. “First measure,” she says, “and then, second, weigh the costs of burnout to your organization.”

This will not only show leaders the true extent of the problem, but will also point the way toward the most promising solutions.

(3) Rethink.

Finally, resolving workplace burnout demands a shift in approach to clinical work. Larry McEvoy, MD, president and CEO of LCI Group, points out that organizations must make physician vitality and wellbeing an explicit institutional priority.

Once this becomes a staple of C-suite discussions, opportunities for intervention emerge—like giving physicians extra time to maintain their certifications, taking efforts to reduce clerical workload, finding new practice models that ease pressure on physicians, or improving processes for efficiency.

The solutions, of course, will vary by institution. But leaders will go a long way toward resolving burnout if they embrace a considerate attitude toward their clinical staff.

“Physician, heal thyself” is not a tenable stance to take against physician burnout. But leaders can heal institutions—and promote wellbeing for their doctors, their patients, and their organizations along the way.

To hear more about Larry McEvoy’s work on creating organizations of vitality, join us at this year’s 24th Annual NRC Health Symposium in San Diego, August 26–28.