Imagine a future where it is difficult to see your physician, as a result, you must go to an overcrowded emergency room and then wait weeks, perhaps months, to get a specialty appointment. That future is Now.
A significant problem exists in healthcare amplified by the consequences of the pandemic. As a healthcare consultant, I have observed this rise up during the pandemic and increase post pandemic, various stages of burnout among our physicians. They are overwhelmed and exhausted. Their own “well-being” gets set aside to take care of patients and endless administrative work. Our health care system is complex to navigate and comes with a range of challenges and limitations. Over time, despite physicians’ best efforts to keep up, I have observed them get caught in the spiral of our health care system where eventually things fall apart, and the center can no longer hold.
I work closely with physicians and many are my close friends and colleagues, who I have observed struggle with increasing demands of our healthcare system. It is difficult to witness how hard they are working and the scarcity of resources that exist to address the challenges they grapple with.
How can we be more intentional in our approach and address this problem?
Let’s explore:
What is the impact of physician burnout?
Physician shortages and they are here to stay.
It is increasingly difficult to access care and physicians as there are fewer of them. The most recent survey shows an alarming 62.8% of physicians experienced symptoms of burnout in 2021, up from 38.2% the previous year.
One of every five physicians intends to leave practice within two years, while one in three plan to cut back their hours.
You probably heard many stories where someone needed to see a specialist and it took several months. Access is going to continue to be more difficult. The pandemic exacerbated the problem of physician shortages and induced many physicians into early retirement or to significantly reduce their workload by shifting to part time or hospital employment.
What are the causes of physician burnout?
The healthcare system is the main cause of physician burnout.
According to the American Medical Association, 80 percent of the causes of physician burnout are system issues and the remaining 20 percent is impacted by choices and things done as individuals.
The immense pressure physicians face are driven by demands of the business of medicine and this interferes with attention to, and relationship to, patients including administrative/paperwork, EHRs, insurance related, staffing shortages, declining reimbursement rates not keeping pace with the cost to deliver care, loss of alignment and control. The list of asks for information in the form of labs, emails, and radiologic studies with no time to respond. On average a physician needs to get in and out of up to seven systems daily to get their work done. Physicians also have the looming fear of making a mistake despite best intentions as causing harm to a patient can lead to being sued.
Additionally, there are the economic and social barriers of our broken system, patient present with advanced disease that could have been preventable or curable at an earlier stage of the disease. Covid exasperated this public health issue as evidenced by our elevated mortality in the U.S as compared to other high-income countries.
Physician burnout permeates many aspects of healthcare. According to Mayo Clinic research, it impacts quality of care, leading to increased medical errors, decreased productivity, less compassionate care and on a personal level distress (e.g. broken relationships, depression, substance abuse, suicide). Some signs of burnout among physicians, according to studies conducted by Dr. Tait D. Shanafelt at Stanford Medicine, are emotional exhaustion and having a lost sense of meaning in their work, feelings of cynicism or helplessness.
It is important for those of us in the business of medicine to recognize these symptoms and offer help and support. We are all in this together. Our physicians are a critical engine to healthcare transactions and without them there is no healthcare business.
Effective and proven strategies to mitigate burnout.
We are making strides and what works is still experimental, some strategies have proven successful to mitigate burnout. We need to be proactive and treat burnout as a system issue. A stronger emphasis and high level investment is necessary to mitigate the problem as past efforts have failed. We need to remember, when a physician becomes burned out, the problem is NOT the physician, it is the system they work in and neither is it lack of resilience on the physician’s part, but failure of the system to support the physician adequately. There is a critical need for administrative and physician leaders to partner with a focus on caring and connecting.
- Conduct surveys and in person listening sessions to tease out what the real challenges are. Gather data to understand as a baseline where you are and then from there determine where you want to be and set metrics to achieve it. When gathering information make it safe to allow for transparency and honesty. Have mutually respectful conversations and candor to understand and identify where the challenges exist under the sphere of influence, so as to develop solutions to make meaningful change.
- De-implementation of unnecessary tasks and staff engagement to handle non physician work. For example, build technology with seamless integration of digital tools with a user centric design. Recognize that what seems like a simple “extra” step can lead to additional hours of work for physicians and their staff.
- Develop leadership programs to support physicians taking on these roles to influence change and boost physicians understanding of the business of healthcare.
- Determine achievable goals for patients around clinical outcomes, accessibility, patient experience, etc. This helps set direction and work parameters for physicians to support the goals for patient care. In this process, we can provide physicians with the where withal to move easily and comfortably through their workday and set expectations for how staff can support them.
- Provide physician coaching and build peer support groups. As a coach, I have seen physicians benefit from coaching programs and more of these are emerging in healthcare as proven successful to improve physician well-being and mitigate burnout. The coaching process involves applying thoughtful inquiry and evidence-based techniques to help individuals make intentional shifts to navigate challenges impeding growth and empower them to make changes to achieve their well-being, professional fulfillment, and overall goals.
Studies from JAMA show that professional coaching for physicians makes a significant difference on reducing emotional exhaustion and burnout and improves overall well-being.
- Attention to self-care. I recognize this maybe difficult to carve out time and physicians have a tendency to take care of and prioritize patients first before themselves but activities like exercise, family time, or pursuing a hobby have tremendous health benefits.
- Share stories. Find the courage to share your stories and be vulnerable and humanize the profession. The more we share stories of our experiences it can have a powerful impact. My recent article on “The Art of Storytelling” was inspired by physicians I have partnered with over the years who have shared their stories in their efforts to humanize the business of medicine to improve how we practice medicine and therefore the system.
There is no one-size-fits-all approach. Each organization is different culturally and carries different strengths and dynamics. Several health systems have created a wellness officer to give the needs of physician wellness the attention and support it needs and view it as foundational value and a core organizational strategy.
Many interventions are experimental; however, some have proven effective and are worth trying. Even when a new approach is not immediately effective, it should be viewed as an iterative process, building on the “lessons learned” to eventually effect the desired outcome. Prioritize and commit to two or three areas, advance those, gain momentum, and reassess and then shift focus on the next two or three things. Don’t try to take on all things at once as there is a high probability you will not move the needle in a timely manner.
We are in a complex environment, as leaders we need to come together work jointly with our physicians and take care of each other and continue our efforts to establish the leadership, structure, and process to promote the well-being of our physicians.
At an individual level, we have some tools, coaching is an excellent example, to fortify ourselves to show up and find ways to navigate the challenges of healthcare. Let’s continue to commit to improve the work lives of our physicians and support them to practice in a way that brings the joy back to medicine and to the patients they serve.
In writing this article I reached out to chief wellness officers at several health care systems, physicians who serve on wellness committees, my physician colleagues and combed through many research articles and read many books. I appreciate the enthusiasm and the responsiveness on these efforts to improve the well-being of our physician community. I am grateful for your input. I am hopeful that these interventions will continue to get support as know the work you are doing will have a positive effect for the long road ahead of us.
In closing, I leave you the reader with an important question as we look to the future.
Who will take care of me and my loved ones when I need a physician?
