Redesigning Clinical Workflows to Return Joy to Patient Care
Why Is Physician Burnout Getting Worse?

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Why Is Physician Burnout Getting Worse?

When I graduated from my family medicine residency 35 years ago, nobody talked about physician burnout, let alone physician burnout getting worse. Nowadays such talk is commonplace. Everyone from physicians who spend all their time deep in patient care, to senior level leaders are aware of physician burnout getting worse. Some understand why this is happening. Fewer know what to do to reverse the trend. A very few are doing something meaningful to reverse the trend.

(Heads up: Each year in early January Medscape releases their physician Lifestyle Report, which lists burnout rates by specialty. The 2018 update should be due any day. I am looking forward to it, hoping this year may show a change in the trend. Realistically I expect to see physician burnout getting worse once again. I’ll be happy to be proven wrong.)

What’s Changed Over 35 Years?

A lot has changed. I’d like to share the changes that have affected the six drivers of burnout as described by Christina Maslach and Michael Leiter in their landmark book originally published in 1997, The Truth About Burnout. The six drivers are:

  • Work Overload
  • Lack of Control
  • Insufficient Reward
  • Breakdown of Community
  • Absence of Fairness
  • Conflicting Values

The changes that healthcare delivery has experienced over the past three and a half decades have had a significant impact on all of these. As a service to my readers, I’m going to devote a blog post each week over the next six weeks, one to each driver, to provide some insight into the root causes of why we see physician burnout getting worse. Hopefully these insights will help you in your work to reduce burnout in your organization. For today, I’ll share what I recall about how things were back then. You can start to form your own opinions regarding what’s changed and how those changes have impacted the drivers of burnout.

What Was Medicine Like in 1983?

While it seemed complex to us then, it was a much simpler time.

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  • The EHR did not exist in any meaningful way, despite my residency director’s efforts to develop one for us on his homegrown Heath-Kit desktop computer. Steve Jobs was just getting Apple off the ground. There was little need to chart after work, because we hand-wrote or dictated every note. Rx’s were refilled by my nurse asking me if it was OK while she was on the phone with the pharmacist.
  • Patients were younger on average, with far fewer chronic conditions.
  • Diagnostic testing was simpler, with fewer options for imaging or lab testing.
  • Treatment options were fewer. We had one class of beta-blockers, but no ACE-Is, ARBs, or calcium channel blockers.
  • Outpatient surgery was rare. Someone getting their gall bladder removed got admitted the night before to prep for an open procedure.
  • Immunization schedules were simple and rarely changed.
  • Medicare and Medicaid existed, but in a simpler fee for service form. DRGs were introduced in 1983, and I heard older colleagues predict the end of the “golden age of medicine.”
  • Capitation existed in very few places, and at the time systems like Kaiser Permanente were considered less expensive but with inferior quality of care. Of course, no one could objectively assess quality because quality comparison data did not exist.
  • There was no such thing as prior authorization.
  • And of course, Google, Yelp, and WebMD were unimaginable in the days before the internet.

I could go on, but you get the picture. While we worked hard, talk of burnout was rare.

Stay Tuned!

For the next six weeks, we’ll take a deeper dive into how changes from the “good old days” up to now have led to physician burnout getting worse. I suspect you’ll find the discussions of each of the burnout drivers will provide both verification and new challenges to your thoughts on the subject. I welcome you to join the discussion by contributing a comment.

See you next Sunday…

Preventing Physician Burnout – We Must Do More

One year ago tomorrow, yes on Christmas Day 2016, our book “Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine” was published on Amazon. A few weeks later the Kindle edition became available. In the past year about 2000 people have purchased copies. That’s a start, and we’d like to… Continue Reading

Toxic Workplaces

Why do we tolerate toxic workplaces? Would patients be admitted, or people be allowed to come to work, in a hospital that had Legionnaire’s disease spreading through it’s HVAC system, or cryptosporidium in its water supply? When there is a unusual smell associated with headaches and nausea in a surgical unit or emergency department, do… Continue Reading

Attention CFOs – Do You Know the Financial Impact of Burnout?

As the CFO, are you aware of the financial impact of burnout? Can health care leaders afford to take actions preventing burnout in physicians?  Perhaps the better question to ask is, can they afford not to? The Mayo Clinic Experience of the Financial Impact of Burnout In a recent letter published in the Mayo Clinic… Continue Reading

Fail to Plan = Plan to Fail

“If you fail to plan, you are planning to fail.” Most everyone who has been in management has heard this quote. It is variously attributed to Benjamin Franklin and Winston Churchill, both great leaders whose advice is worth following. Yet it’s far to common for leaders to fail to plan. I’ve done it myself. Continue Reading

Executives – The Missing Stakeholders in Preventing Burnout

The National Academy of Medicine has launched an Action Collaborative on Clinician Well-Being and Resilience, but there is one missing stakeholder.  Last Friday, July 14th, NAM hosted it’s its first public meeting on establishing clinician well-being as a national priority. The inaugural sponsors include nearly many medical specialty societies, the major insurance companies, the American Associations… 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

Denver Health: Engaging Physicians through Engaged Leadership

Last Sunday I discussed the sixth driver of burnout – Conflicting Values.  Today’s posting is a vignette from our book, Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, and discusses Denver Health’s Lean journey.  As CEO of Denver Health, Dr. Patty Gabow engaged Simpler Consulting to coach her and her… 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

A New Year with a Primer on Physician Burnout

Welcome to 2017! I’m taking a new approach this year, starting off with a series on all things Physician Burnout. I’ll start off with a weekly update on Sundays explaining each of the six drivers of physician burnout in successive posts. Midweek I will share vignettes about health care organizations are reducing the risk of… Continue Reading

Preventing Physician Burnout Now Available on Amazon

Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, is now available on Amazon. You can order the paperback version here. In addition, the Kindle edition will be available in about two weeks. My co-author, Diane Shannon, and I spent over a year researching this work, interviewing over 50 experts… Continue Reading