Fixing burnout among hospitalists is a leadership challenge

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“Happiness is when what you think, what you say and what you do are in harmony.”
– Mahatma Gandhi

Burnout among physicians is at an epidemic proportion. National data suggests that more than 50 percent of our workforce is burned out, and this trend has been across the board from physicians in training to practicing physicians. Some of the specialties are more affected than others. Repercussions of provider burnout on health care organizations are massive and not only this negatively affects patient quality and safety but also increases health care cost significantly. Burnout is a job-related syndrome which is characterized by emotional exhaustion, cynicism and lack of self-accomplishment. Burnout and depression overlap but what differentiates it from depression is its sole association with work. A hospitalist job profile has been inherently more prone to burnout and is turning out to be a major challenge for leadership to deal with irrespective of the size or location of program.

Most of the hospitalist programs are busy, and hospitalists are burdened with high-patient volume, productivity goals, administrative work, long work hours, electronic medical records. Hospitalist programs have been dealing with never seen attrition rates. There is no denying that increased work-related stress results in burnout. If not addressed in a timely manner, burnout drives hospitalists toward depression, suicide, drug abuse, divorce. Studies have recognized that harnessing power of leadership has a positive effect on burnout. Leaders in health care have a very critical role to play in addressing this issue.

Of course, that’s easier said than done. Finding joy and happiness at work seems like a farfetched dream for physicians in this challenging health care environment. Burnout among physicians is at its worst, and concern of its epidemic proportion has been raised by multiple recent studies.

National data suggests that more than 50 percent of our workforce is burned out and this trend has been across the board from physicians in training to practicing physicians. Some of the specialties are more affected than others. A recent study from a large academic center suggested that neurology, general surgery, family practice, internal medicine residents have higher risks of burnout when compared to specialties like dermatology and rheumatology.

Repercussions of provider burnout on health care organizations are massive. Not only is this negatively affecting quality and safety within the hospital but also increasing health care cost significantly.

Burnout is a job-related syndrome that is characterized by emotional exhaustion, cynicism (depersonalization) and lack of self-accomplishment. Burnout and depression overlap but what differentiates it from depression is its sole association with work.

A hospitalist’s job profile has been inherently more prone to burnout and is turning out to be a major challenge for leadership to deal with irrespective of the size or location of program. While discussing this with our colleagues, one statement which stuck with me is, “Hospitalist programs are burnout factories.”

Unfortunately, no major studies have been done to look at the extent and prevalence of burnout in the hospitalist community. Out of curiosity, when we decided to do an in-house burnout survey, the results were an unexpected eye-opener. The survey was designed with a questionnaire from the Maslach Burnout Inventory (MSI), which is considered to be a gold standard for measuring burnout. Out those who participated in our survey, more than 65 percent said, “They feel burnout more than once a week.” Forty-five percent of them felt that “they are callous toward others more than once a week.” Both questions have high sensitivity and specificity for measuring burnout. Talking with other hospitalist leaders, it appeared to me that extent of burnout in our program is a mere reflection of what happening in hospitalist programs across the country. Most of the hospitalist programs are busy and hospitalists burdened with high patient volume, productivity goals, administrative work, long work hours, electronic medical records, lack of control or autonomy and an uncooperative work environment — one of the reasons why hospitalist programs have been dealing with never seen attrition rates. There is no denying that increased work-related stress is resulting in burnout which if not addressed promptly, will drive hospitalists toward early retirement, depression, suicide, drug abuse, divorce.

Studies have recognized that harnessing power of leadership has immense positive effect on physician burnout. There is clear evidence to support that physicians who are spending 20 percent of their professional time in the area of work they found meaningful tend to experience symptoms of burnout at a significantly lower rate with a ceiling effect at 20 percent. Thus, finding meaningful work for and maximizing the skill set of each team member should be a top priority for health care leaders.

Studies also suggest that supportive leadership has a positive impact on provider burnout, which makes the reasonable argument for including burnout as a part of the quality measure of every health care organization and something that should be assessed at regular intervals. Leaders have an opportunity here to support a productivity model which promotes physical health and wellness for hospitalists. It’s getting clear that a hospitalist can increase productivity by doing only three things:

1. Increased patient volume.
2. Ordering more labs and radiology and involving more consultants for help.
3. Increased work hours.

The first two will lead to poor patient care and increase health care costs, and the third will lead to burnout. So, it’s the utmost vital for leaders to discourage a culture where workaholics are incentivized and praised. The other area where leaders can contribute will be convincing organizations to invest in physician wellness programs to keep the workforce healthy because it’s not just a nice thing to do, but it’s good business. Periodically measuring the extent of burnout and making the needed change should be another priority for the leader. Another example of effective leadership in dealing with burnout will be allowing a flexible work schedule, collegial work environment to their hospitalist team.

Last but not least, listening to your team members is a priceless source of information and a great way to generate trust. Burnout is not an individual issue but a sign of organizational malaise. And thus, any change at the organization level will have a maximum impact compared to initiatives directed at individuals. U.S. Department of Health and Human Services projects that by 2025, there will be a shortage of approximately 45,000 to 90,000 physicians with poor working conditions and high levels of stress being a few of reasons deterring people from entering the profession. One of the areas where work can be done to improve this shortfall is around physician burnout. Leaders in health care have a very critical role to play in addressing this issue.

Rahulkumar Singh is a hospitalist.

Image credit: Shutterstock.com

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