Physician burnout is an often talked about topic, but what can really be done to solve it? The AMA
defines burnout as:
“A long-term stress reaction characterized by depersonalization, including cynical or negative attitudes towards patients, emotional exhaustion, a feeling of decreased personal achievement and a lack of empathy for patients.”
According to the latest Medscape burnout report
, 51 percent of physicians are burned out. When Medscape first asked about burnout back in 2013, only 40 percent of physicians said they had experienced burnout. The causes of burnout are varied but generally fall into these categories:
- Too many bureaucratic tasks
- Spending too many hours at work
- Feeling like just a cog in a wheel
- Increasing computerization of practice (EHR)
- Income not high enough
- Too many difficult patients
The signs of burnout varies
The signs of burnout are varied as well and could include any combination of the following:
- Apathy to work and colleagues
- Indifference to patients
- Loss of joy in the practice of medicine
- Feeling overwhelmed and frustrated
- Increased mental health concerns.
Often healthcare administrators don’t realize that physicians are burning out or that they even can burnout. Advisory Board
quotes one healthcare executive saying:
“It’s impossible to burn physicians out. These are people that are workhorses. They get up earlier than anybody. They stay up later than anybody. They work weekends…It’s hard to burn them out. It’s much easier to piss them off and to make them dissatisfied and disilluioned and upset and angry."
But the reality comes from another Advisory Board quote, this time from a physician:
“Every day I go home depressed, and I don’t even enjoy the patient interactions the way I used to. I feel like nothing more than a ‘means to an end’ for not only my patients (who seem to get more demanding every day), but also the hospital system that owns our practice. To them, my only value is how many patients I can see in a day.”
One of the biggest misconceptions about burnout is that it comes from disengagement or dissatisfaction. Those are both issues that physicians could suffer from but they don’t necessarily indicate a physician is burned out. Often it is the high level of engagement that a physician has that leads to burnout.
Burnout is found everywhere
Burnout is not limited to a particular specialty or setting or based on the tenure of the physician. Some of this is due to the culture that has traditionally surrounded physicians and medicine. The idea that physicians are so focused on helping others they never stop to care for themselves. There is also an attitude of never showing weakness. During a recent interview CompHealth held with a physician in his mid-60s, he expressed, “burnout is just a figment of young doctor’s imaginations.” This seems to still be a prevalent attitude that is hurting medicine.
Burnout also effects patients. It can lead to an inconsistent patient experience, impact the quality of care, and lead to physician turnover. According to Advisory Board, “Medicine is not a commodity like soybeans or widgets. Administration needs to be in the business of making it easier, not harder, for clinicians to treat patients.”
When a physician leaves a practice or hospital it can cost the facility $150,000 to $300,000 just to replace that one physician. This doesn’t include the revenue lost by not having that physician working. Even worse than this is where continual burnout can lead — depression and even suicide.
Create an environment of listening
Burnout is a huge problem with no easy solution regardless if you are a small group practice or a large healthcare system, all have equal potential for burned out physicians or staff.
There are a variety of ways to address burnout, but one of the most effective is by creating an environment of listening.
Disengagement and the potential for burnout sets in when people don’t feel like their opinions are being heard or matter. This is especially true of physicians in large health systems. According to the Advisory Board, one physician said “I have no idea who makes decisions about physicians or what the process is…I feel as though I have almost no voice here.”
Using the “Listen-Act-Develop”
model is a good way to start listening. It is a formal plan where feedback is gathered from physicians and staff, changes are then made to address pressing concerns learned in that feedback, and new policies or procedures are developed to make long-term improvements.
Physicians are surrounded by negative feedback
The feedback environment physicians traditionally find themselves in is inherently negative and can make things appear much worse than they really are. The first type of this feedback focuses on what physicians are not doing well and where they are falling behind. Physicians also receive negative feedback through quantitative data. This focuses on the numbers, how many patients were seen, how much was billed, and other transactional aspects of practicing medicine. And finally the third is patient complaints. You can have dozens or hundreds of positive interactions with a patient and never hear a word, but as soon as that patient has a bad experience, that is the comment that gets heard. A few bad comments can soon become the focus of a physician who in reality is greatly appreciated by 99 percent of their patients.
Start listening now
Some ways to start listening include:
- Creating a formal listening forum — Schedule regular sessions where physicians and staff can come and just talk
- Adding a seat at the executive table — If you don’t already have physician representation on the executive team, add someone that can represent the thoughts and feelings of the physicians on staff
- Holding regular one-on-ones — Sitting down and meeting one-on-one with a physician is a great way to learn about what is going on in their life and ways you can help make their experiences with your facility better
Physicians that feel like their thoughts and opinions are being heard and acted on are far less likely to get burned out or leave a facility. The key is acting on the issues being brought up. Not only does this show listening, it also builds trust.