Burnout is a tragedy. It terminates careers, friendships, marriages and sometimes lives, prematurely. It threatens the well-being of individuals, families, patients, organizations and our society. The current media focus on the crisis of physician burnout is appropriate and timely, but the industry itself needs a reality check. While burnout is experienced by the individual, it is the manifestation of a dysfunctional environment that only we as physicians and leaders in health care can fix.
We can’t fix something we don’t understand. While many studies have focused on measuring the incidence of burnout among doctors themselves, there is little in the literature about the perspective of health care leaders.
Curious about the understanding of physician burnout at the level of senior leadership, I sent a survey to the CEOs, COOs and CMOs of health care organizations across the country. The findings were both reassuring and alarming. Reassuring, in that 80 to 90 percent of senior leadership reported recognition that physician burnout is a problem in their organization.
Alarming, in that only a little more than half reported having sufficient understanding of the causes and effects of physician burnout, only about 20 percent reported having measured burnout in their organizations and/or bringing in resources to address the problem, and only somewhere between 6 percent to 23 percent felt their organizations were doing enough to address the problem, depending on which type of officer was responding (23 percent of CEOs but only 6 percent of COOs). While this was just an informal survey, it provided a useful insight into the state of affairs and understanding at the highest level of leadership in health care.
According to this survey, the resources brought in by organizations to address the problem of physician burnout primarily focus on improving wellness. Teaching mindfulness and resiliency to health care workers is an excellent idea. Learning techniques to manage frustration, anger, and disappointment in this rapidly changing environment is valuable. Teaching people to be better swimmers may indeed prevent more drownings, but swimming in class IV rapids is hazardous to most, and changing the swimming environment itself would likely result in fewer drownings. Therein lies the problem. The environment of care delivery has become so complex and fraught with barriers to providing the excellent care we were trained to give, that it is overwhelming to imagine where to begin.
The physician engagement-burnout (or satisfaction-dissatisfaction) continuum is related to the ratio of work demands to the resources available to achieve success in that work. The demands of being a physician are many and varied. The nature of the work itself, that of caring for the sick and dying, can contribute to stress, emotional exhaustion, and eventual burnout. Care providers, from physicians to ICU nurses to hospice workers, must recognize the potential hazards of the essential nature of their work and ensure adequate personal resources are in place to support that work. This is where support through mindfulness, resilience, reflection, friends and family plays an important role. But this is nothing new, as the burden of dealing with human suffering has always been part and parcel of the physician experience and those that chose medicine as a career likely recognized that element at the outset.
More recently, a different type of job demand has emerged. Dealing with barriers to providing patient care, be it regulatory processes, electronic documentation or increasing paperwork, have changed the balance of the demand/resources ratio in a way that has tipped the physician experience toward the “burnout /dissatisfaction” end of the continuum. Ask a room full of frontline physicians what they see as contributing to their unhappiness with the practice of medicine and the list provided will likely fall into this category. The nature of the work has changed, but the nature of the people doing the work has not. Many feel that the fundamental work of the physician has been disrupted by these hindrances and that patient care is suffering because of them.
So what to do? We can’t easily change the demands of being a doctor in the current evolving health care environment. For most physicians and leaders, the belief that the only way to improve the current state is to eliminate these barriers paralyzes and makes us feel powerless. The electronic medical record is here to stay. Increasing regulatory oversight is just that, increasing. How can organizations address the problem of physician dissatisfaction?
The answer is to understand and to focus on the resources required to meet the demands; the denominator of the demands/resources ratio. Research suggests that the general categories of work-life resources include the following: the quality of the relationships between people at work, the amount of control an individual can exert on how the day unfolds, the fairness, transparency and accountability of leadership, the rewards an individual experiences, and whether or not core values are honored in the work being done. These are high level and rather abstract concepts, but deficiencies in any of these areas result in a diminished resource “denominator” and a greater likelihood of work burnout/dissatisfaction.
On a more concrete level, improving the resources needed to meet the demands of modern day physician work requires leadership interest and inquiry as well as frontline physician involvement. Every organization, and likely every department within that organization, will have a different set of hindrance demands requiring specific resources to meet those demands. The role of senior leadership is to communicate to physicians that decreasing dissatisfaction is a priority, to assess the environment and inquire earnestly so as to identify the barriers then, with the help of physicians, to create specific and targeted interventions to remove those barriers and provide resources to meet the demands.
Easily said, not so easily done, but we have no choice. We must reject the “us vs. them” mentality; frontline physicians and leadership need to work together to address dissatisfaction and burnout.
Karen Weiner is a physician, chief medical officer and interim CEO, Oregon Medical Group, Eugene, OR.
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