• Paul DeChant MD, MBA

Physician Burnout Driver #3 – Insufficient Reward


Today’s post takes a deep dive into the third driver of physician burnout – Insufficient Reward. When we think about the rewards we receive from work, we first think about compensation. Most doctors are paid relatively well. Pay is an extrinsic reward. Burned out physicians will argue that what they are paid is not worth it for the effort and hassles they put up with. Every day physicians confront barriers and frustrations to providing quality care. Over time, these contribute to burnout.


That’s why insufficient reward is directly connected to the second driver of burnout – Lack of Control. Doctors are mission-driven professionals. We have sacrificed a lot to earn the trust of their patients. Because we have earned their trust, patients tell us things they tell no one else. They even let us examine parts of their bodies that no one else gets to see.


Our patients’ trust in an intrinsic reward. While patients trust us most of the time, it is all too common these days for physicians to be treated by some leaders as though we are not worthy of trust or respect, limiting opportunities for collaboration and improving care delivery.


Respect is Like Air


Intrinsic rewards are deeply tied to respect. “Respect is like air. If you take it away, it’s all people can think about.” Dr. Monica Broome is an international expert in the neuroscience of communication. She shares this quote from Crucial Conversations in her presentations, making the point that lack of respect in healthcare drives the epidemic of physician burnout.


Lack of Respect Drives Insufficient Reward


Physicians thrive on the respect embedded in intrinsic rewards. These include:

  • The trust our patients give us,

  • The professional status we have earned through decades of hard work, and

  • The joy we experience when patient care flows smoothly.

Having already discussed patient trust, let’s consider professional status and joy in patient care. Professional status for physicians had deteriorated significantly over the last few decades. There are a variety of reasons for this as societal norms and the way medicine is practiced have both changed significantly. Whatever the reasons, we feel that loss of status as insufficient reward.

Perhaps the most compelling intrinsic reward is experiencing joy in caring for patients. We experience the joy of patient care, like athletes in peak performance, when we are in “the zone.” This is a time when everything comes together. We move effortlessly through the day able to use our professional knowledge and skills in a setting that facilitates our best work, in sync with our colleagues and support staff, and connecting fully with our patients.


Those days, or moments, when we are in “the zone”, are fewer and farther between. Our workplaces are full of barriers and frustrations that limit our effectiveness. We burn out when we can’t work effectively.


Removing Barriers and Frustrations


Lean offers us a chance to deal directly with insufficient reward. When Lean is done right, based deeply in the Lean principle of Respect for People, physicians are empowered to fix what’s wrong in our workplaces. We know the workflow barriers that cause our frustrations. We have good ideas about how to remove many of those barriers.


Given the chance to partner with our clinical colleagues and enlightened leaders, we can fix a lot. That takes trust from leadership. That trust exemplifies respect.


An Insufficient Reward Action Plan


So how do we reduce insufficient reward?


If you are a leader, listen to your physicians. Listen deeply with respect. Shadow them while they work to better understand their challenges. Engage with them in process improvement activities.


If you are a physician, find a member of your organization’s leadership that you can trust. Reach out to them with respect for their challenges. Offer to partner with them on process improvement.

The Lean approach of a week-long Rapid Improvement Event is a great way put these recommendations into action.

  • RIE teammates learn from and about each other.

  • They realize that working together they find solutions that remove barriers and frustrations to quality care.

  • They come away both empowered and with deep respect for each other.

Have you found an effective way to reduce insufficient reward?

Does it follow the action plan above?

Or do you have another approach that we could all learn about? If so, please share it.


Check back here on Wednesday, when I’ll share a vignette from our book on how the University of Michigan has engaged their teams to improve the workplace and reduce insufficient reward.

© Copyright 2019 Paul DeChant, MD | All Rights Reserved

If you share my passion for returning joy to patient care I hope that you will find value in visiting this website. Feel free to reach out to me with your thoughts.