The Last Straw

Category Archives: Physician Burnout

The Last Straw

We are all familiar with the saying, The Last Straw. It refers to the fable of the camel who could carry heavy loads.  The camel is a beast of burden. Its owner, in an effort to transport as much straw as possible, keeps piling more and more on the camel’s back. Camels are strong and can handle a lot.  But as some point, even the strongest camel will buckle if enough weight is piled on.

How Much Is Too Much?

As more and more gets piled on, there is a point at which the camel reaches its limit. This is the point at which any more weight, even the weight of one Last Straw, becomes too much for the camel to handle, and it collapses. And when that happens, the camel’s value is gone. That’s The Last Straw.

I’m passionate about PREVENTING PHYSICIAN BURNOUT.  What does a fable about a camel have to do with burnout? Stick with me, the parallels are striking.

The Root Cause of Physician Burnout

The root cause of physician burnout is putting highly motivated and caring professionals in a work environment in which they are unable to succeed.  A work environment full of barriers and frustrations that prevent physicians from providing quality care to their patients.  Frustrated physicians burn out as they go to heroic lengths to maintain quality and service to their patients.  They:

  • Try to make varied patient clinical presentations fit within the constraints of the EHR
  • Learn workarounds to maneuver through unfriendly EHR user interfaces
  • Hunch over keyboards performing data entry that could be done by others or by cognitive support
  • Click boxes to prove to CMS their Meaningful Use of the EHR
  • Hassle with payers over prior auth issues
  • Pick the right diagnostic code from the 10-fold increase in choices following ICD-10
  • Answer questions coming in through the EHR’s patient portal
  • Check state opiod databases prior to prescribing narcotic pain meds
  • Ensure they are conforming with multiple quality measures to ensure maximal reimbursement in 2019 through MACRA
  • Explain to patients that the testing and treatment that Google recommended for their symptoms is not in their best interests
  • Get translators or language lines into the exam room for increasingly diverse patient populations
  • Learn virtual visits and figure out how to get paid for them
  • Spend thousands of dollars and hundreds of hours on Maintenance of Certification, performing tasks and taking tests to prove they are current and competent

The Last Straw for Physicians

The items above are new, or more demanding, due to changes in external demands in the last 10 years. Many seem reasonable, or did as they were introduced.  Each was added incrementally, and each on its own would not be that big of a deal. Physicians can cope with each one, one at a time.

But consider the cumulative effect. Each represents another straw on the camel’s back. And the camel is now overloaded. They can’t hold up under the burden. The camels are breaking.

Just look at the impact.  Physicians have high rates of depression, substance abuse, family dysfunction, and suicide.  We lose 400 physicians a year to suicide – the equivalent of two medical school graduating classes each year.

Are Leaders’ Reducing the Burden?

Leaders are beginning to take notice. A group of 11 CEOs of major health systems recently posted a blog in Health Affairs declaring physician burnout a public health emergency. The AMA has dedicated significant resources and appointed a VP to focus on provider well-being and practice resiliency. The National Academy of Medicine is launching its initiative.

It’s great to see this long overdue attention to physician burnout and the increased focus on wellness.  My question is, “Are we responding the right way?” My answer is, “Not really.” There is a lot of emphasis on wellness programs. Wellness and resiliency programs help to make the camel stronger.  That’s good. Your hospital or group should have one.  But they don’t address the root cause.

We’ve got to stop piling straws on the camel’s back.

Are you investing more in making the camel stronger, or in decreasing the burden?

Do you know of a place that is decreasing the burden?  If so, please use the comments to share.

Physicians, what do you think we should do ensure we don’t all buckle under The Last Straw? Share your comments here, and share this post with your leaders.

The Physician Suicide Pandemic

In case you had any doubt that there is a physician suicide pandemic, read Dr. Eric Levi’s latest blog post, The Dark Side of Doctoring. Eric is an ENT surgeon in Australia.  This post starts with a letter from the wife of a gastroenterologist in Brisbane who took his life last week. This eloquent letter… Continue Reading

Physician Leaders Need to Get Angry

I’m on my way home from the Annual Meeting of the American Association for Physician Leadership in New York.  Three hundred physician leaders came together from across the nation to share their challenges and learn from great keynote speakers and from each other. Among the 35 breakout sessions were five on physician burnout, including a… Continue Reading

The Hamster Wheel – Shorthand for Physician Burnout

Using the burnout model of Maslach and Leiter, and relating it to a hamster wheel, and a busy physician, the impact of this analogy becomes clear. Lean Done Right is an effective way to address the problem. Continue Reading

Conflicting Values – Physician Burnout Driver Number Six

Today’s Posting on Conflicting Values is the sixth and final in my series on the drivers of physician burnout as described in The Truth About Burnout by Maslach and Leiter.  Physicians place great value in their ability to provide compassionate quality care to their patients.  Health system leaders similarly proclaim a dedication to compassion and… Continue Reading

Absence of Fairness – Burnout Driver #5

Today marks the fifth entry in my weekly series reviewing the six key drivers of burnout described in Maslach and Leiter’s classic book The Truth about Burnout – Absence of Fairness.  They state “A workplace is perceived to be fair when three key elements are present: trust, openness, and respect.”  This makes intuitive sense.  When… Continue Reading

Fixing Frustrations at the Front Lines

Here is another in my series of vignettes about health care organizations that are reducing physician burnout, taken from our book Preventing Physician Burnout: Curing the Chaos and Returning Joy to Patient Care. Following my post on Sunday about burnout driver #3 – Insufficient Reward – I’m happy to share this example of Lean providing… Continue Reading

Physician Burnout Driver #3 – Insufficient Reward

Today’s posting takes a deep dive into the third driver of physician burnout – Insufficient Reward.  When most of us think about the reward we receive from work, we first think about compensation.  Most doctors are paid relatively well.  Pay is an extrinsic reward.  Many will argue that what they are paid is not worth… Continue Reading

Lack of Control

Today in my ongoing series on the six drivers of physician burnout we discuss burnout driver number two as identified by Maslach and Leiter in The Truth about Burnout – Lack of Control. In last Sunday’s post we discussed the first driver – Work Overload – which for physicians is exacerbated by a chaotic work environment… Continue Reading

Work Overload – First Driver of Burnout

Over the next six weeks I will be posting about each of the six primary drivers of burnout, starting today with the first of the six – Work Overload.  Work Overload is the first thing people think of as a root cause of burnout.  When there is too much to do, people become overwhelmed and… Continue Reading