Is Single Payer the solution to burnout?
I received an email from a good friend this week, Dr. Patty Gabow, who is CEO-emerita of Denver Health. As CEO, Patty led a Lean transformation of Denver Health that achieved great physician and staff engagement while saving the State of Colorado over 200 million dollars. She is also a passionate advocate for equity in health care. I feel fortunate to know her.
She shared with me a recent blog post from the Right Care Alliance by Dr. Surafel Tsega, recommending single-payer as a solution to physician burnout. Dr. Tsega makes some good points. Single payer would reduce some of the drivers of burnout physicians deal with daily:
- Different coding/reimbursement requirements by different payers
- Different prior auth requirements for medications, referrals, and DME
- Patients prioritizing treatment options (or choosing between food, shelter, and healthcare) based on inability to pay
- Worrying about patient compliance due to the financial challenges
Dr. Tsega, who originally posted this on his own website The Medical Minimalist, acknowledges that single payer is not a panacea. He notes that physician burnout is increasing in most countries, including those with single payer insurance. I agree. The work I have done internationally has connected me with physicians from Australia, to Lebanon, to The Netherlands, to the United Kingdom, and to Scandinavia. Physician burnout is everywhere, in countries with all payment schemes.
So if Single Payer is not the solution to burnout, what is?
Single Payer helps with one factor that drives burnout, but brings its own unintended consequences. It relieves some administrative burden, a good thing. It concentrates power over physicians’ workloads and daily workflow control in other ways. Without enlightened leadership, this is a bad thing. If leaders:
- mishandle their power,
- do not lead with respect for frontline caregivers,
- do not prioritize improving operations,and
- do not build collaborative relationships with their physicians
they add to the drivers of burnout.
If they are serious about reducing burnout, leaders must work with physicians and nurses to:
- reduce the barriers and frustrations that lead to work overload,
- give front line clinicians control over patient care workflows,
- foster the intrinsic rewards of patient care,
- support steps to rebuild community and camaraderie,
- communicate openly to rebuild trust and fairness, and
- partner with physicians for mutual alignment on core values.
Healthcare Is Complex
The challenges of providing quality patient care are significant. Healthcare is complex, and getting more complex every day. That complexity comes from an array of external factors – financial incentives, regulations, technology, cultural diversity, new treatment options, etc. The pace of change is accelerating.
Physicians on the front lines know the problems they face within their sphere of influence. They can fix these if given support. In most cases, they don’t think the leaders care enough to provide that support.
It’s the leader’s job to change this. Dr. Diane Shannon and I devoted an entire chapter to leadership in our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine.
Leading change is hard. It takes courage. It means taking risks. Having been a CEO, I know from experience that those leading real change deserve empathy and support. I’m here to help.
In the next few weeks I will focus on the leader’s role in preventing burnout. Stay tuned.
And please share your thoughts on what works for you, or what you would like to see your leaders doing. Click here to add your comments.