Show notes
In this episode I’m offering my take on why we haven’t budged the needle on physician burnout.
We have clear evidence of the causes of burnout—but we don’t have effective action. Why are we so stuck?
My observations fall into 4 areas:
1. Weak, bureaucratic language that fails to put a spotlight on the problem of burnout:
People who have the podium, the authority, and the data are using their indoor voices— when what’s called for is a bullhorn! Why is undue restraint and bureaucratic gobbledygook the preferred language when talking about crumbling physician careers?
I’ll talk about research that shows 20% of physicians intend to reduce hours or leave their current position within 24 months—and all this voluntary attrition will make it impossible to meet the future demand for doctors. Why are docs bailing out? I’ll take a deeper dive into the data that should have CFOs racing to their spreadsheets to calculate the ROI of fixing the burnout issue.
2. Data disconnection:
We know the proximate causes of career dissatisfaction among practicing physicians. The evidence shows that two of the biggest issues are physicians being thwarted—not supported—in their attempts to provide high-quality patient care, as well as the frustrating time-sink EHR.
And yet the burnout literature continues to be filled to the brim with studies about resilience training, small group work, and mindfulness training.
Leaders, researchers, and wellness experts fall prey to running studies and pushing interventions that are easy to set up and easy to fund. Unfortunately, addressing the “in-your-face” causes of burnout (like the dysfunctional EHR) isn’t easy or cheap. And the root causes of physician disaffection—lack of physician leadership and autonomy—require interventions that are politically dicey.
The huge 2019 National Academy of Medicine (NAM) study titled Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being is a deep dive into burnout. The authors acknowledge the inexplicable lack of studies looking at system solutions to burnout. The co-chairs explained that they wished they could make recommendations for organizational interventions but due to lack of data—they couldn’t.
3. Substitution of the term “well-being” for the term “burnout”:
The well-being and wellness proponents are missing an important point—well-being and burnout are not opposite ends of a continuum.
The opposite of burnout is not well-being; it’s absence of burnout. You can have no elements of burnout but not be in a state of well-being and vice versa.
In the article One More Time–How Do You Motivate Employees? Herzberg describes hygiene factors and motivating factors. Hygiene factors are comparable to those elements in the workplace that cause burnout and motivating factors are comparable to drivers of well-being.
When you address hygiene factors–you just get up to neutral with workplace satisfaction. And—if you don’t get up to neutral by fixing the broken hygiene factors—don’t bother with motivators.
Adding motivators–-or wellness initiatives—doesn’t fix hygiene or burnout factors.
So if the number of clicks, pre-authorizations, and clerical tasks are exhausting or even disgusting—wellness interventions aren’t going to help.
An excellent March 2020 JAMA article titled Professional Dissonance and Burnout in Primary Care, with lead author Sumit Agarwal, used focus groups to identify sources of burnout. The solution-orientation of these authors was refreshing. This study helps underline the fact that what doctors need is help overcoming the organizational barriers to taking excellent care of patients.
In too many cases the temptation to veer toward well-being initiatives results in this weird communication disconnect:
What is said is “Administrative work...
We have clear evidence of the causes of burnout—but we don’t have effective action. Why are we so stuck?
My observations fall into 4 areas:
1. Weak, bureaucratic language that fails to put a spotlight on the problem of burnout:
People who have the podium, the authority, and the data are using their indoor voices— when what’s called for is a bullhorn! Why is undue restraint and bureaucratic gobbledygook the preferred language when talking about crumbling physician careers?
I’ll talk about research that shows 20% of physicians intend to reduce hours or leave their current position within 24 months—and all this voluntary attrition will make it impossible to meet the future demand for doctors. Why are docs bailing out? I’ll take a deeper dive into the data that should have CFOs racing to their spreadsheets to calculate the ROI of fixing the burnout issue.
2. Data disconnection:
We know the proximate causes of career dissatisfaction among practicing physicians. The evidence shows that two of the biggest issues are physicians being thwarted—not supported—in their attempts to provide high-quality patient care, as well as the frustrating time-sink EHR.
And yet the burnout literature continues to be filled to the brim with studies about resilience training, small group work, and mindfulness training.
Leaders, researchers, and wellness experts fall prey to running studies and pushing interventions that are easy to set up and easy to fund. Unfortunately, addressing the “in-your-face” causes of burnout (like the dysfunctional EHR) isn’t easy or cheap. And the root causes of physician disaffection—lack of physician leadership and autonomy—require interventions that are politically dicey.
The huge 2019 National Academy of Medicine (NAM) study titled Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being is a deep dive into burnout. The authors acknowledge the inexplicable lack of studies looking at system solutions to burnout. The co-chairs explained that they wished they could make recommendations for organizational interventions but due to lack of data—they couldn’t.
3. Substitution of the term “well-being” for the term “burnout”:
The well-being and wellness proponents are missing an important point—well-being and burnout are not opposite ends of a continuum.
The opposite of burnout is not well-being; it’s absence of burnout. You can have no elements of burnout but not be in a state of well-being and vice versa.
In the article One More Time–How Do You Motivate Employees? Herzberg describes hygiene factors and motivating factors. Hygiene factors are comparable to those elements in the workplace that cause burnout and motivating factors are comparable to drivers of well-being.
When you address hygiene factors–you just get up to neutral with workplace satisfaction. And—if you don’t get up to neutral by fixing the broken hygiene factors—don’t bother with motivators.
Adding motivators–-or wellness initiatives—doesn’t fix hygiene or burnout factors.
So if the number of clicks, pre-authorizations, and clerical tasks are exhausting or even disgusting—wellness interventions aren’t going to help.
An excellent March 2020 JAMA article titled Professional Dissonance and Burnout in Primary Care, with lead author Sumit Agarwal, used focus groups to identify sources of burnout. The solution-orientation of these authors was refreshing. This study helps underline the fact that what doctors need is help overcoming the organizational barriers to taking excellent care of patients.
In too many cases the temptation to veer toward well-being initiatives results in this weird communication disconnect:
What is said is “Administrative work...
