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 presentation by yours truly. The breakouts are like Ted Talks, with each speaker getting 15 minutes to present and 5 minutes for questions. That’s not a lot of time to cover the multiple facets of burnout we discuss in our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine. I realized that there was one message that this audience of physician leaders needed to hear most of all.
Physician Leaders Must Take the Lead on Burnout
If we, as physician leaders, do not take action to prevent physician burnout, things will continue to get worse. Why should non-physician leaders invest their time and money in preventing burnout if physicians themselves are not leading the charge?
The reason I’m concerned about this is that every time I talk to audiences, large and small, with many physicians in attendance, it’s hard to get physician leaders emotionally engaged. I present a graphic that explains one of the reasons burnout is getting worse. It shows the array of changes that have impacted health care in the last 10 years. These have made our clinical workplaces truly toxic.
I don’t use the word “toxic” lightly. Burnout results from placing a highly motivated person into a workplace in which it is nearly impossible to succeed. As someone burns out, they develop emotional exhaustion, cynicism, and/or a sense that they are not longer effective. This impacts physicians personally, resulting in depression, substance abuse, family dysfunction, and suicide. We lose on average a physician a day to suicide. We are making our doctors sick with a potentially terminal illness.
What Has Changed to Drive Burnout?
I make it a point in my presentation to run through the litany of these changes:
- The EHR impact of spending hours on data entry and distracting us from our patients
- Meaningful use requiring meaningless extra clicks
- CMS regulations spurred by the ACA
- The payers denying billings or putting up the barriers like prior auths
- ICD-10 increasing the number of diagnostic codes by a factor of 10
- Patient satisfaction ratings in a world of changing patient demographics
- Patients consulting “Dr. Google” and undermining our professionalism
- Yelp ratings
- Maintenance of Certification requirements, and
- Reducing Reimbursements
I get increasingly passionate as I add each issue, filling out the circle. I then ask the audience how this makes them feel. I’m hoping they are outraged, but consistently I get a resigned, half-hearted response. I’ve thought a lot about why this is. Why don’t we get mad, really mad, like “I’M MAD AS HELL AND I’M NOT GOING TO TAKE THIS ANYMORE” mad?
I think it’s because as each of these changes got introduced to the clinical environment, we adapted to them, one at a time. As physicians, we are passionate about taking care of patients. We will do almost anything in order to pursue our calling. We made it through organic chemistry, MCATs, 5:00am rounds with abusive attendings, and long hours away from friends and loved ones just so we could take care of patients. As each of these new impediments entered our world, we just sucked it up and figured out how to get by.
But now, the cumulative effect has us at the end of our rope, sometimes literally. Physicians are breaking as more straws get loaded on our backs. We have to take the lead in dealing with this. To get activated to change, just like activating a patient to change a bad health habit, we need to get emotionally engaged. We have to feel this deeply. As physician leaders, we need to let the physicians we lead know how we feel. If we remain restrained and professionally distant, they assume we don’t care. A recent Vital Worklife study showed that 82% of physicians thought their organization was not offering help. EIGHTY-TWO PERCENT!
I don’t know any physician leaders who don’t care about this. The physician leaders at the meeting all cared deeply. It was a major topic of discussion. But your doctors don’t know how much you care.
So I want you to get angry.
We don’t have time to take a complacent approach to physician burnout. It is getting worse with each passing day. If you are not sure what to do, read our book, or take a look at some of my blog posts from January and February this year. I addressed each of the drivers of burnout and posted vignettes from our book describing what a number of health care organizations have done to make a difference.
This is a call to action.
If not now, then when?
If not us, then who?
Go for it. And let me know how it goes. I’m excited to hear about what happens.