Pensacola, FL (September 2015)—Survey after survey proves it: Physicians are feeling exhausted, dissatisfied, discouraged, helpless, and hopeless. Burned out, in other words. Statistics indicate that one out of every two physicians is, has been, or soon will be suffering from burnout. And in some specialties, this estimate is too low.
“As a nation and as individual health systems, we can work with physicians to solve the burnout crisis,” says Quint Studer, who wrote
Healing Physician Burnout: Diagnosing, Preventing, and Treating (Fire Starter Publishing, 2015, ISBN: 978-1-622-18020-2, $28.00) in collaboration with George Ford, MD. “In fact, it’s even better than
can—we
will solve it. I believe the recent changes in healthcare have created the sense of urgency we need to finally put the needed energy behind the issue.”
Studer says the key is getting physicians aligned and engaged with the organizations they work with and for—but first we need to understand what’s causing them to burn out in the first place.
Healing Physician Burnout provides a solution to health system leaders and for physicians themselves. A good portion of the book is devoted to explaining the pressures that squeeze physicians from all sides.
Studer writes: “Yes, there are many complicated and intertwined factors that are plunging too many physicians into a state of depression and burnout: uncertainty created by the ever-changing landscape of healthcare, a lack of control over their future, highly stressful jobs, time constraints that keep them from forming meaningful patient relationships, salary concerns, and the feeling of being stuck in a career they no longer enjoy.”
Here are just a few of the burnout factors covered in the book:
Coping with “big picture changes” is incredibly stressful. The Affordable Care Act (ACA) has forever altered America’s healthcare industry. And no one has seen more change than physicians. Many physicians have moved from solo practices or small groupings to joining ever-larger practices and systems. Employment has moved from solo to a group LLC to often a large organization.
What’s more, value-based purchasing increasingly ties reimbursement to clinical quality and patient experience outcomes. This is a major paradigm shift from “services delivered” to “outcomes performed,” and it includes both public and private payers. Not only does this new reality ramp up the pressures physicians feel to perform, it’s counter to their “rugged individualist” roots.
And if that’s not enough, a looming physician shortage is hitting at the same time that our aging population needs more and more care.
“All of these changes have caused physicians to experience what they perceive as a severe loss of control,” says Studer. “It’s taking a huge psychological toll. Studies show physicians feel greater professional satisfaction when they have more control over their work. In my view, physicians’ current frustration is not because they crave authority. It’s more that they crave respect for their ability to make decisions.”
Physicians are experiencing too much change too fast. Besides the aforementioned paradigm shifts around how physicians get paid (and by whom) and the big demographic changes, there is also the need to learn new practical skills, which pulls physicians away from patient care. For example, the industry-wide move to electronic medical records (EMRs) is forcing physicians to learn time-consuming new systems—and while most agree this change will be beneficial in the long run, getting accustomed to the “new way” is far from easy.
Studer says the sense of feeling overwhelmed comes from having to move backward on a spectrum that describes the four phases of competency and change that all individuals go through when learning new things. (This model is usually attributed to Abraham Maslow as well as Noel Burch of Gordon Training International.) Essentially, people move from being Unconsciously Unskilled (where they don’t yet know what they don’t know) all the way up to Unconsciously Skilled (where tasks have become second nature and can be completed almost on autopilot).
“Physicians are high performers,” notes Studer. “Imagine what it feels like when more and more change and responsibility are piled on them and they have to move backward to Consciously Unskilled, which means they know what they don’t know. This state doesn’t feel good to them at all, and they may express their discomfort by pushing back. Health systems need to be patient and have empathy for what physicians are going through as they strive to move themselves back up to Unconsciously Skilled.”
Physicians are overworked and sleep deprived. The Physicians Foundation’s 2014 Survey of American Physicians found that more than 80 percent of doctors say they are “overextended or at full capacity.” Another study—“Burnout and Satisfaction with Work-Life Balance Among U.S. Physicians Relative to the General U.S. Population,” by TD Shanafelt, et al, published in the
Archives of Internal Medicine, 2012—reports that nearly 40 percent of physicians work more than 60 hours per week compared with only 10.8 percent of U.S. workers.
Ironically, very few physicians would recommend such an unhealthy, unsustainable lifestyle for their patients. Physicians are only human, and all humans need a certain amount of down time for their mental and emotional health. Like everyone else, physicians need and deserve time for a life outside of work.
“It’s not surprising these overworked physicians are also sleep deprived,” adds Studer. “This has always been the case for residents, but all the change we’ve experienced in recent years has made it true for physicians at all stages of their careers. Besides making mistakes more likely to occur, prolonged sleep deprivation almost inevitably results in burnout.”
Physicians face downward pressure in compensation, coupled with heavy debt. Not only are physicians being asked to relinquish control over their own lives and to change many things about the way they’re used to working, they’re now hearing, “Oh, yes, now we want you to do this for less money, or at least the same money.” There is definitely a downward pressure on physician incomes, which represents a massive shift in the “social contract” physicians have always operated under.
“This creates a feeling that the rules have been changed in the middle of the game,” says Studer. “When rules are changed during a game, most likely people will feel ‘this is not fair.’
“Also, it’s not unusual for new physicians to graduate with hundreds of thousands of dollars in education debt,” he adds. “The emotional weight of owing this much money on top of ever-rising living expenses cannot be underestimated. Once physicians take on a mortgage and possibly marry and have children, the burden can feel crushing. It can create the feeling of being a financial hostage.”
Many physicians need additional skills beyond great clinical expertise. A recent
Wall Street Journal article by Melinda Beck explains: “‘The fund of medical knowledge is now growing and changing too fast for humans to keep up with, and the facts you memorize today might not be relevant five years from now,’ says NYU’s Dr. Triola. Instead, what’s important is teaching ‘information-seeking behavior,’ he says, such as what sources to trust and how to avoid information overload.”
The additional skills needed today include: the ability to navigate electronic medical records, to consult a patient’s economic “big picture” when ordering tests, to work in teams with other professionals who aren’t doctors (and to be okay with not always knowing the answer), to communicate clearly, to engage patients as partners, and to know LEAN (process improvement) and cost-reduction strategies. Oh, and all of these new requirements are hitting at the same time.
“What’s happening in healthcare is that we’ve moved from an
episodic change culture to a
continuous change culture,” says Studer. “As John Kotter states, there is nothing more difficult for an industry, and it can implode a culture. It is like going from knowing you’re going to make Thanksgiving dinner one day a year to being prepared to make Thanksgiving dinner every day of the year.
“We will eventually get there and adjust, but it means a huge overhaul of the processes and systems currently in place,” he adds. “Physicians and everyone else in healthcare are living and experiencing these changes now. Yet a physician can sometimes see the transition as more difficult because the decisions they make may save lives. This is a lot of pressure.”
Patient needs and expectations are changing. As patients live longer, they often develop more and more health challenges. It’s not uncommon for a patient to have three or four or even five chronic conditions at the same time—say, obesity, congestive heart failure, hypertension, diabetes, and asthma. These patients tend to be on many different medications and are “prescribed” a certain type of diet and exercise plan. In other words, their care plan is extremely complex and demanding—and not surprisingly, they are often noncompliant.
Plus, because we now have so many treatment options that didn’t exist at all in the not-too-distant past, patients expect miracles. They believe doctors can solve any medical issue and save any patient—and obviously this is not true. Factor in the rise of the Internet, which means patients have more and more information at their fingertips (some correct and some not) and you have an incredibly tough and stressful doctor/patient dynamic.
“Imagine having to deal with non-compliant patients, critically ill patients who have unreasonable expectations for recovery, patients who are deeply skeptical of your diagnosis or treatment because ‘That’s not what I read on the Internet,’” says Studer. “It’s so tough. If physicians don’t know how to communicate with respect and empathy—and many are not trained to—they can alienate patients and negatively affect outcomes.”
Consistently high quality operations are now a must. Above all else, physicians care about patient outcomes. They need to know their patients are well taken care of, and if they don’t feel this is happening, they’re going to be anxious and stressed. Providing consistent and exceptional quality care—meaning quality care that occurs with every patient, every department, every time—remains elusive for many.
“The move to continuous change, transparency, and the need to cut costs while improving consistency can be difficult for health systems,” says Studer. “All health systems can provide excellent operations from time to time, but too often cannot be sustained 24/7, 365 days a year. This is incredibly frustrating to physicians and may become a barrier to getting feedback from them. Physicians think,
Well, I’ve told them before what they need to fix and they still can’t fix it, or they do but it doesn’t stay fixed. Why bother?”
Physicians want to receive consistent performance feedback. According to an article written by S. Schoenbaum, et al, in
The Commonwealth Fund, between 30 and 50 percent of physicians report they do not receive adequate or meaningful feedback on performance. This shortfall creates many problems. When physicians don’t know where they need to improve, it stands to reason that they can’t, and won’t, do so. This can negatively impact patient care, but it can also impact physician compensation.
Physicians benefit (as does the organization) from clearly defined and very specific goals that are aligned with the organization’s larger goals. Physicians also need relevant, objective metrics built into their feedback. Physicians like facts and figures, and it will be a struggle to engage them in collaborative dialogue if one can’t cite “the numbers.”
“Ultimately, physicians are just like everyone else in that they a) appreciate clarity around whether or not they are meeting expectations, and b) know exactly what needs to happen in order for them to meet expectations,” says Studer. “Vagueness in either area results in uncertainty, which results in stress. Clarity and directness dissolve stress.”
Many feel they spend too little time with patients…and too much time doing everything else. Physicians want to spend most of their time with patients. That’s why they went into medicine in the first place. Yet for a variety of reasons, physicians find themselves forced into frustratingly short appointments. A satisfied physician is a physician who feels confident their patients are getting the best possible care. A physician who feels rushed may not have that confidence.
Much of the problem, of course, is all the other tasks that have sprung up demanding physicians’ time and attention. The AMA-sponsored Rand Corporation report “Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy” notes that: “…many physicians—especially those without large numbers of dedicated allied health professionals and support staff—described spending a significant amount of time performing tasks that did not truly require a physician’s training and that ‘crowd out’ those that did. For example, such activities as filling out forms, typing and correcting automated transcriptions, dealing with multiple EHR order entry screens, and other ‘secretarial’ duties were reported as occupying a significant share of physicians’ time.”
None of this is to imply that we can’t overcome or at least mitigate many of these factors. Health systems and physicians, working together, can accomplish great things. (NOTE: See attached tipsheet.)
And, as Studer writes in his conclusion, the key is to win over physicians’ minds and hearts. When that happens, the rest will take care of itself.
“Over the past several decades, I’ve learned a lot about human beings in general and about healthcare professionals in particular, and one of the things I’ve learned is this: When people believe strongly in something and are fully invested in it, they can do amazing things,” he writes. “That’s why I am so certain that engagement and alignment are the keys to solving the physician burnout epidemic. Why? Because when physicians really buy into and get excited about an organization’s mission, they will put the full force of their passion, intelligence, and caring behind that mission. When that happens, miracles can occur.”
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About the Author:
Quint Studer is the founder of Studer Group
®, a recipient of the 2010 Malcolm Baldrige National Quality Award.
Inc. Magazine named Quint its Master of Business, making him the only healthcare leader to ever have won this award. Twice
Modern Healthcare has chosen him as one of the 100 Most Powerful People in Healthcare. He is the author of numerous books. There are currently 700,000 copies of his
BusinessWeek bestseller,
Hardwiring Excellence, in circulation.
About the Book:
Healing Physician Burnout: Diagnosing, Preventing, and Treating (Fire Starter Publishing, 2015, ISBN: 978-1-622-18020-2, $28.00) is available at bookstores nationwide and from major online booksellers.