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 spread our message further.
Diane Shannon and I spent months interviewing 60 experts on healthcare, burnout, and Lean in researching the book. (We were fortunate to have Christina Maslach write the forward.) We came to realize that for physicians, burnout’s root cause is the workplace. In particular, the disorganized, chaotic, and time-pressured clinical workplace that requires a physician to be constantly vigilant to care for patients effectively.
And even with their best efforts, things go wrong:
- Patients wait too long – both to get an appointment and get seen once they are in the doctor’s office
- Doctors can’t focus properly on their patients when they are trying to enter data into the EHR
- Supplies aren’t in the right place, delaying or disrupting procedures
- EHR workflows and interfaces are clunky at best, and increase the risk of error
- Physicians get frustrated with “running on this hamster wheel”
- As a result, doctor depression, substance abuse, and suicide worsen
- This list could go on…
In addition, until recently little was done to truly address the root cause of the problem. Most work on preventing physician burnout had been to help physicians cope with the dysfunction. Health systems offered yoga, burnout coaches, and mindfulness classes. While appreciated, most physicians saw these for what they were, band-aids on a hemorrhaging arterial bleeder.
The vast majority of physicians felt that their organizations, in particular the leadership, either did not care or did not know what to do. There are two unfortunate things about this. First, most of the leaders do care but don’t know how to show they care. Second, the doctors know what’s wrong and have great ideas about how to fix it. They simply aren’t given the opportunity.
In the past year, I’ve seen things begin to change. Tait Shanafelt, MD, a leader in physician burnout from Mayo and now at Stanford, is promoting a three pronged model to address burnout including:
- Personal Resilience,
- Organizational Culture of Wellness, and
- Efficiency of Practice
Christine Sinsky, MD, and the AMA have made their STEPSforward website more robust, with many good ideas that help.
The thing we don’t know yet is if any of this is helping. Medscape publishes their annual physician burnout report in early January each year. Every year up to now physicians burnout rates have increased. I’m looking forward to the 2018 report release in a few weeks, but don’t hold out high hopes for a reversal in that trend.
In 2017 I visited 16 health systems and gave presentations at 12 conferences. Many systems are getting started with programs aimed at organizational culture and practice efficiency, but these are almost all small local programs that don’t impact the broader organization. And financial support from the C-suite is meager. Leaders are doubtful that the investments will produce an ROI.
The longer we go without health system leadership making significant investments in preventing physician burnout, the worse this threat to our public health will get. If you are a physician feeling the pain, or a health care leader who wants to learn what to do and why, read the book. The first step is to understand what is going on and why. But that is NOT enough.
What will you do to get truly engaged in preventing physician burnout?
What actions will you take in 2018?