Hello, health care organization leader, are you listening? [PODCAST]

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“Physicians, nurses, advanced practice providers, medical assistants, and other health care workers are a finite resource. They don’t grow on trees. And, though we all seem to deny it, they are human.

The physicians I coach often wonder what they are doing wrong that their lives feel impossible. They are baffled by their inability to finish work on time, get the number of open charts down, clear their in-basket. They worry about the effects on their families and on their health and about whether they will later regret the long hours at work or charting at home when their children are hoping to engage with them. Poor work-life integration, when the needs of work and personal life collide, is a contributor to clinician burnout.”

Diane W. Shannon is an internal medicine physician and physician coach and can be reached at her self-titled site, Diane W. Shannon.

She shares her story and discusses her KevinMD article, “Hello, health care organization leader, are you listening?”

Reflect and earn 1.0 AMA PRA Category 1 CME for this episode.

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today we welcome back on the show Diane Shannon. She is an internal medicine physician and a physician coach, and she wrote the KevinMD article “Hello, health care organization leader, are you listening?” Diane, welcome back to the show.

Diane W. Shannon: Thank you so much, Kevin. It’s a pleasure to be here today.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today, for those who do get a chance to listen to our first episode?

Diane W. Shannon: Yes, certainly. I practiced as a primary care physician for just a few years, and then I just had to leave. At the time, I could not have articulated why; I just knew it was something I had to do. I didn’t see a lot of other options for making what felt like an exhausting, stressful experience better. So I moved into writing. I worked at a communications company for a few years and then started a freelance writing business, and I have worked in health care writing for 20-plus years.

In the course of that, I was writing an article and stumbled across the definition of professional burnout, and it was like a light bulb went off. I had a word to describe what I had experienced. That led to physicians contacting me after I shared my story in an NPR blog post, and from there, I’ve been so motivated to do something about physician burnout. So I worked on a book, wrote a book with another physician, and now am also a coach. I coach women physicians on work-life balance and confidence, and on creating lives that are actually joyful and doable.

Kevin Pho: We were talking offline about how many physicians now are coming to you with symptoms of burnout, and by the time this episode comes out, we’re going to be in the midst of the latest Omicron variant of the COVID pandemic. So paint us a picture of what you’re seeing in your physician coaching practice today.

Diane W. Shannon: Right. When I started coaching a couple years ago, a lot of the questions were about work-life balance: “I’d really like to be spending more quality time with my kids, and how do I do that?” And working on the tweaks within work, the places where someone might have perfectionistic tendencies that are causing them to create notes that are much longer than they need to be, things like that, and also adding in self-care.

What I have seen, especially over the last, I’d say, three months, has been this huge exodus, where physicians are now coming to me saying, “I cannot do this. I cannot go on. I have made it through the pandemic. It has been incredibly stressful, but I am seeing the physical and mental effects of this, and I simply can’t go on.” So we work from that place. Sometimes, again, it’s a little bit of working on the burnout. There may be places where they can get a break; they may go back to clinical. But there are an awful lot of physicians who are looking for non-clinical work now.

I think part of my writing this article, when I did a number of months ago, was to say, hey, we need to wake up, and organizational leaders really need to take this into account. Yes, we’re in the middle of a pandemic, but if we don’t get resources, support, and help to physicians in their workplace, we’re going to have more and more of an exodus. So yes, the Great Resignation, as they call it, has certainly affected physicians.

Kevin Pho: For those physicians who come to you saying they can’t do it anymore, any general demographic information in terms of what kind of specialties, inpatient versus outpatient, or is it simply across the whole section of physicians?

Diane W. Shannon: Well, I work primarily with women physicians. I would say the ones coming to me have children, generally young children. Often they’re in the first, let’s say, 10 years of practice, so they’ve spent time building up their career at the same time when they were potentially having children, going back to work after having children. So that tension is part of it.

But I think, honestly, with the ones who are coming to me, it’s often the numerous places where they don’t have the resources they need. Granted, we know there’s understaffing in support, but there are other things that are occurring. I was just speaking with a physician this morning, and she said, “Why is it that they’re asking us to make decisions about whether or not we have scribes and whether or not we pay for them? And we have to make this decision between December 16 and the end of the year, and there are a lot of implications for this decision, and a lot of things happen in December.”

So there’s that lack of awareness. Yes, there’s this option to have scribes, and the physicians are now going to have to pay for it, but there’s the lack of awareness about what it means to ask that question of them at this point in the year, with so little time to make the decision. She also talked about how her organization changed from one video visit vendor to another one without any time for training or learning on that new platform. So that’s something, again, that physicians have to take on. They have to try to find the time, when they have the bandwidth, to understand the new system, and this is happening overnight. So those are just a few examples.

In terms of specialty, it’s pretty much everyone. I would say the ones I’m seeing right now are pulmonary, intensive care, and hospitalists, I would probably say the most, or primary care physicians as well, but some of those specialties that you’d expect with what’s going on with COVID.

Kevin Pho: All right, let’s transition into the KevinMD article that you wrote. It’s titled “Hello, health care organization leader, are you listening?” Now, for those who didn’t get a chance to read your article, you just walk my audience through it and share the story of why you decided to write it?

Diane W. Shannon: Well, again, so much of it is talking with the physicians that I work with and hearing their stories and what their daily life looks like. And I just thought, I’ve also spent 20 years writing about the health care system, and inefficiencies, and how it can be improved, and leadership, and so much of this is, in my opinion, coming down to: Do organizations, the C-suite and the boards, value the health care workforce? And in my world, that’s about physicians. Do they value physicians? There are so many instances that I am hearing that really are examples of: No, they’re not valuing this incredibly precious resource.

When you think about what goes into the physician’s time, why is that not being protected? Because that is so incredibly valuable. When you are expecting physicians to be the scribe and the data entry clerk and the documentation specialist and all of those things, that’s taking away from that incredibly valuable patient care time that they could be providing. So it doesn’t make sense on a financial basis.

And the other piece is, the more and more there is this burnout, it’s just a vicious, incredible, snowballing effect, right? Because we have more physicians who are leaving or are cutting back on clinical time, and then the ones who are left are holding more of the burden. So it’s something that I felt I needed to call out and say, “OK, in the past, you may have been taught in business school to look at the next quarter, or to look at the next six months, and to look at certain metrics, but you have to expand the metrics you’re looking at to include well-being. You have to put that into the compensation for leaders, that this is something they’re being tracked on: What is the well-being of all the clinicians?” And so I just think that’s incredibly important.

Kevin Pho: I’ve had a lot of health care administrators on the show, and they of course write on KevinMD, and if you ask them, “Do you care about physician burnout?” every one of them is going to say yes. And I think physician burnout has been at the forefront, especially during the pandemic. What are some actions they can do, or what more can they do to back up their words?

Diane W. Shannon: Right. Well, honestly, I think a big part of it would be being more visible. There’s a great program that they started at Mission Health in North Carolina called Immersion Day, where they’d have leaders come in, and they would basically shadow the doctor or nurse for an entire shift. When you do that, and in my case, I ask, “What does your day look like?” and I hear this day that honestly is not sustainable. So if they were to see that firsthand, and see what it looks like to be this nurse, to be this physician, and then begin to ask, “What are the biggest pebbles in your shoe?” And they may not be what they expect, right? Some of those are relatively easy to fix.

One of the things that came out in this: I did a series of interviews in 2020 with women physicians about their challenges, and I was really surprised at how often lactation support came up as an issue. That is something that can be addressed, right? But for someone coming back after having a child, they’re not sleeping due to having a newborn, they’re trying to pump, and they’re given no time, space, or compensation for doing that. It’s an additional stressor. Now, that was true before the pandemic, but I think it’s just a matter of really understanding. Put yourself in those shoes, and then ask the question: What are those pebbles? And then look for the ones where you actually can make a difference.

And again, going back to it, if leaders’ compensation were tied to some of these metrics that are important, and actually important and impact other metrics that the organization cares about, then we would see more of a difference, and more of a prioritization of the resources they need.

There’s this paradigm shift that I think would be incredibly helpful, which is to go from kind of sink or swim, “Let them take care of themselves, let them get through this,” to “What would we do if our primary focus was retaining and advancing physicians and making the workplace sustainable?” Asking that question, “What would we do?” and then beginning to take those actions.

Kevin Pho: You know, that’s the first time I’ve heard of physician wellness potentially being a metric for a hospital CEO or a hospital administrator. To your knowledge, does any place do that?

Diane W. Shannon: I have heard of organizations that are doing that now. I think it’s something that’s just starting, and part of that may be moving into having the chief wellness officer, especially if they’re given the responsibilities and budget that they need to make a difference in terms of wellness. But yes, there are organizations that are beginning to do that.

Kevin Pho: To be fair to health care administrators, a lot of hospitals are undergoing financial pressure, and in our primarily fee-for-service system, a lot of the fixes for clinician wellness, whether it’s adding scribes or having clinicians see fewer patients, are generally going to negatively impact the bottom line. So from the viewpoint of a health care administrator, how can he or she thread that needle to address clinician wellness while also maintaining the bottom line?

Diane W. Shannon: You know, Kevin, this is a really sticky problem. I completely understand that. I guess two things. One is, if you think about, if you understand, the lean perspective, right? There are a lot of places where there’s still a lot of waste in the system. What about looking for those places where there’s waste, to make everything more efficient and actually move patients through in a way that’s less energy-depleting to the clinician?

The other piece of it, I think, is to really be thinking more about prevention. I know that is difficult in the current financial situation that most organizations are in right now, but this is really about preventing extreme costs in the future. We know that it is very expensive to replace the physician, right? Half a million to a million dollars in recruitment and onboarding and all the rest of it, getting that panel size back up. And you’re also losing potentially a more experienced physician than you might be able to hire. So there are these downstream costs.

I think part of it is connecting the dots, to say that that recruitment cost is something that is coming, and can we prevent it now? I know that doesn’t make for an easy trade-off, because that’s saving money in the future and having to invest it now. But in the end, I believe it’s got to be more cost-effective to retain those physicians than to continue burning them out and having them leave.

Kevin Pho: We’re talking to Diane Shannon. She is an internal medicine physician and physician coach. She wrote the KevinMD article “Hello, health care organization leader, are you listening?” So, Diane, we do have a lot of health organization leaders listening to this podcast, so you have a platform now. You mentioned things in generalities, of course, scribes or support, but if you were to give these health organization leaders specific, actionable suggestions that they can do to improve physician wellness, what would those things be?

Diane W. Shannon: Right. Well, first of all, I want to mention that in the article, I cite an article by some researchers, some of them at Stanford and some of them at Mayo Clinic. It’s the Daniel Tawfik article, and it has a number of specific actions that organizations can take to begin to improve clinician well-being. I just want to talk about one of them. So, just looking at the list here, one of them is addressing gender disparities in compensation, retention, and promotion. This is an area that, as I said, I work with women physicians, and this is a place where there are specific actions that they can take. I mentioned one in terms of lactation support, and there’s more. I’ve written about this, and there are organizations that are actually compensating with RVUs for periods of time for breaks, when women physicians can go in and have that time to pump and continue with lactation.

So in terms of other ideas, that’s a place to look for some of those specific action steps. There are a number of organizations that are looking into group coaching and individual coaching. While burnout is caused by excessive stress in the workplace, there are also places where the individual has a role, and that’s where I see my work as a coach. In my writing, I focus on highlighting the system issues that drive burnout, and then in my coaching, I support the individual in the places where they have agency to make some changes that improve their daily life experience.

Some of it may be looking for expanded opportunities for clinicians to have group coaching. I finished a program recently for women faculty, and the thing that was most valuable to them was the ability to have their stories and their experience validated, and to be with other peers. Physicians today are so busy, they have so little time to connect with peers and have their experience validated, and I think especially with COVID, it has been so isolating. So looking for some of those opportunities to support that connection, I think, is another way to address burnout right now.

Kevin Pho: And my final question, what are some of your take-home messages that you want to leave with the KevinMD audience?

Diane W. Shannon: Right. Well, I’ll just speak for myself, in my journey, and that has been: We are human. I think so much of medicine, and my medical training, was about just keep going, right? “You don’t have any human needs. You don’t need to attend to them. So you don’t need sleep, you don’t need to eat well, you don’t need exercise. Just keep going.” I think it’s so easy to continue with those kinds of ways of thinking and ways of being that worked well and were rewarded in training but really don’t make for a well-balanced life going forward. I think that was a big lesson for me in my experience of burnout, and now I try to support others in having that more well-balanced life, and in rethinking some of those messages in how we live.

Kevin Pho: Diane, thank you so much for coming back on the show and sharing your time and insight.

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