• Paul DeChant MD, MBA

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 BurnoutLack of Control. In last Sunday’s post we discussed the first driver – Work Overload – which for physicians is exacerbated by a chaotic work environment and time pressure.


Lack of Control results in part from work overload. You can’t feel in control when faced with too much to do in a chaotic environment. It’s worse when you’re running behind on your schedule.

When I speak on Preventing Physician Burnout to groups of physicians and health care leaders I show a video of a hamster running on a wheel. The poor rodent goes faster and faster, then starts spinning around and around, and eventually falls off. The physicians in the audience relate to this all too well.


Autonomy and Lack of Control


Physicians strongly value autonomy, and we should. Much of what we do requires making decisions and taking independent actions that have a profound impact on our patients’ lives. We go through intensive training to earn the right to do so.

And yet our autonomy is being restricted in many ways:

  • We are expected to follow a growing number of best practice guidelines.

  • We join hospital-owned groups, reducing the challenge of running a small business but sacrificing a lot of freedom in the process.

  • The requirements to maintain board certification have become more onerous, yet certification is required for most insurance contracts and hospital privileges.

  • Insurers are paying us less, improving their bottom lines while reducing our income.

  • Even the routine task of writing a progress note is unnecessarily complicated by poorly designed EHRs, ICD-10 coding, and requirements to check the right boxes for Meaningful Use.



  • To add insult to injury, as progress notes become more labor intensive, physicians lose control over their personal and family time, returning to their keyboards after working hours in order to keep up.

Taking Back Control


There are a number of actions you can take to regain control. Although we have historically been trained to be autonomous, many of us recognize the value of working collaboratively.


Lean Done Right


If your organization is engaged in Lean, get involved. Lean Done Right starts with deep respect for people - particularly those doing the work on the front lines of clinical care. If Lean is not grounded in this principle, it can worsen burnout.

Key components of Lean as a management system that reduces burnout include:

  • Strategy Deployment which provides a venue for you to share your ideas.

  • Value Stream Improvement, including Rapid Improvement Events, enables you and your team members to redesign the way you work.

  • A Daily Management System enables your team to solve most problems in your own clinical setting, and to get help from elsewhere when needed.

If you are not working in a Lean organization, there are other options.


Team Care

There is a growing movement of team care in which physicians, nurses, and medical assistants intentionally redesign their workflows so everyone works at the top of their license. Done well, this can reduce the time a physician spends keyboarding by 70 – 90%, enabling us to focus on our patients, and improving quality and productivity while eliminating the hours spent working at home late into the night.


Tech Solutions


In the past few years we've seen a wave of AI-enabled innovation that pends progress notes and orders using voice-to-text and even conversation-to-text that significantly reduces keyboarding while allowing physicians to re-engage with their patients, looking them in the eye like to good old days.


Co-locating with Your Team


A core concept of team care is co-locating doctors and support staff. While most physicians are reluctant to give up their private offices, once they spend a day side-by-side with their team, they find that much of the burden of the in-basket goes away.


Patient calls that used to take multiple emails back and forth are resolved quickly when the doctor and medical assistant can talk to each other right then and there. This simple change is easy to experiment with. You could try it tomorrow!


Get Involved

Most of us hate being on committees. We’d rather be with our patients. When we don’t participate on committees that make decisions about how we practice, we end up dealing with decisions we don’t like. Committee work is not easy. It takes a different mindset.


As Stephen Covey said in The Seven Habits of Highly Effective People, we should “seek first to understand, then to be understood.” This does not come naturally to doctors. Yet when we listen carefully, we gain the trust of those we work with. And they are more likely to listen to and accept our ideas.


Don’t Accept Lack of Control


Lack of control leads to victimization. I love Dr. Steve Beeson‘s quote, “I’ve never met a happy victim.” Who wants to be miserable? Go ahead. Give some of the recommendations above a try.


You probably have better ideas than what I’ve offered here. If you do, please help.

Click on the “Comments” link and share your great ideas.


Let’s regain control together!

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