American Association for Physician Leadership

Problem Solving

Leaders Must Make a Difference in Burnout

Karen Weiner, MD, MMM, CPE

November 8, 2019


Abstract:

Burnout is a tragedy. It prematurely terminates careers, friendships, marriages, and sometimes lives. It threatens the well-being of individuals, families, patients, organizations, and our society. The current attention being paid to the physician burnout crisis is appropriate and timely, but the industry itself needs a reality check. While individuals experience burnout, it is the manifestation of a dysfunctional environment that only we as physicians and leaders in healthcare can fix.




Burnout is a tragedy. It prematurely terminates careers, friendships, marriages, and sometimes lives. It threatens the well-being of individuals, families, patients, organizations, and our society. The current attention being paid to the physician burnout crisis is appropriate and timely, but the industry itself needs a reality check. While individuals experience burnout, it is the manifestation of a dysfunctional environment that only we as physicians and leaders in healthcare can fix.

We can’t fix something we don’t understand. Although many studies have focused on measuring the incidence of burnout among doctors, little in the literature is from the perspective of healthcare leaders — their understanding of burnout and how (or if) they are addressing the problem.

Curious about the understanding of physician burnout at the senior leadership level, I sent a brief survey to the chief executive officers, chief operating officers, and chief medical officers of healthcare organizations across the United States. I asked about their understanding of the causes and effects of physician burnout, whether they felt their organizations were struggling with the problem, and if they thought they were doing enough to address it.

The findings were both reassuring and alarming. Reassuring in that 80–90 percent of senior leaders reported recognizing 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, about 20 percent reported having measured burnout in their organizations and/or bringing in resources to address the problem, and 6–23 percent believed their organizations were doing enough to address the problem (23 percent of CEOs but only 6 percent of COOs).

Although informal, this survey provided useful insight into the state of affairs at the highest level of leadership in healthcare.

According to the survey results, the resources organizations introduce to address the problem of physician burnout primarily focus on improving wellness. Learning techniques to manage frustration, anger, and disappointment in a rapidly changing environment is valuable, as is teaching mindfulness and resiliency.

Teaching people to be better swimmers might indeed prevent more drownings, but swimming in Class IV rapids is hazardous to most; 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.

Know the Potential Hazards

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.

This is where support through mindfulness, resilience, reflection, friends, and family plays an important role. However, this is nothing new. The burden of dealing with human suffering has always been part of the physician experience, and those who chose medicine as a career likely recognized that at the outset.

More recently, a different type of job demand has emerged. Barriers to providing patient care — including 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 their responses will likely fall into this category.

What to do? We can’t easily change the demands of being a doctor in the current evolving healthcare environment. For most physicians and leaders, the belief that the only way to improve the current state is to eliminate these barriers 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 by Christina Maslach and Michael P. Leiter suggests that the general categories of work-life resources include:

  • 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 from work.

  • Whether 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.

The Role of Senior Leadership

On a more concrete level, improving the resources needed to meet the demands of modern 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 hindrances that require specific resources to meet those demands.

The role of senior leadership is to communicate to physicians that priorities are to improve satisfaction, to assess the environment, and to inquire earnestly to identify the barriers. Then, with the help of physicians, the senior leaders must create specific and targeted interventions to remove those barriers and provide resources to meet the demands.

As physician leaders, we need to approach this as we have been trained to approach patient care:

  1. Understand the pathophysiology. Understand that the crisis of burnout and chronic dissatisfaction of our workforce is not because of individual failure, but rather because of the demands of difficult work chronically outstripping available resources. Both personal resources (resiliency, family support, etc.) as well as organizational resources (collegiality, autonomy, fairness, rewards, honoring core values in work) can be enhanced to meet the demands of the current physician experience.

  2. Take the vitals. Measure burnout in your organization. Identify a baseline from which to make improvements and open dialogue with your physicians. While the Maslach Burnout Inventory is not meant to be a diagnostic tool for the individual, it can be a powerful catalyst that allows physicians to reflect on their level of exhaustion, cynicism, and sense of personal accomplishment.

  3. Take a history and do the diagnostics. This is the essential work of the leader. As mentioned, burnout and chronic dissatisfaction occur when work demands exceed personal and professional resources. Identifying the specific hindrance demands and resource deficiencies requires assessment and inquiry. Assessment tools such as Maslach and Leiter’s AWS (Areas of Worklife Survey) or the American Medical Group Association’s Provider Satisfaction Survey can identify specific problem areas for an organization. But nothing substitutes for in-person leadership inquiry.

  4. Target specific interventions based on your findings. Various departments and even individuals might have dissimilar pain points that need to be addressed. Hiring scribes for physicians who are struggling with burnout due to a lack of community/collegiality, poor organizational transparency, or frustration with a lack of control in their daily work likely will not generate the improvements intended. Although leaders must facilitate the interventions, it is essential that the physicians themselves participate in the necessary improvement processes.

Based on the findings of multiple recent national surveys, half of all physicians are chronically frustrated with their work life, reporting at least one symptom of burnout. This is affecting our patients, our organizations, and our society. We must look at this problem as an existential crisis of our profession and recognize it as the essential focus of our leadership. Using the above approach, frontline physicians and organizational leadership can work together to address chronic dissatisfaction and burnout.

Karen Weiner, MD, MMM, CPE

Karen Weiner, MD, MMM, CPE, is chief executive officer of Oregon Medical Group based in Eugene, Oregon. kweiner@oregonmed.net

Interested in sharing leadership insights? Contribute



This article is available to AAPL Members and Subscribers of PLJ.

Log in to view.

For over 45 years.

The American Association for Physician Leadership has helped physicians develop their leadership skills through education, career development, thought leadership and community building.

The American Association for Physician Leadership (AAPL) changed its name from the American College of Physician Executives (ACPE) in 2014. We may have changed our name, but we are the same organization that has been serving physician leaders since 1975.

CONTACT US

Mail Processing Address
PO Box 96503 I BMB 97493
Washington, DC 20090-6503

Payment Remittance Address
PO Box 745725
Atlanta, GA 30374-5725
(800) 562-8088
(813) 287-8993 Fax
customerservice@physicianleaders.org

CONNECT WITH US

LOOKING TO ENGAGE YOUR STAFF?

AAPL providers leadership development programs designed to retain valuable team members and improve patient outcomes.

American Association for Physician Leadership®

formerly known as the American College of Physician Executives (ACPE)