Healthcare leaders have attributed physician burnout and frustration to increased paperwork burden, prior authorization, work-life balance, loss of autonomy, lack of community support and a lack of trust. While many physicians are leaving the profession, leaders are working to bring joy back to medicine.
Researchers found 43 percent of physicians said they would not choose to become a physician again, and professional fulfillment scores dropped from 40 percent in 2020 to 22.4 percent in 2021.
Here are ways some systems and leaders are addressing physician frustrations:
Note: Responses have been lightly edited for length and clarity.
Linda Brubaker, MD. Interim Director of Physician Wellness at the University of California San Diego: Our institution has developed an administrative infrastructure that amplifies physician voices, connects them with colleagues and provides feedback on plans and priorities. All clinical departments have at least one department wellness director who receives a stipend to enhance bidirectional physician wellness communication. The institution's Physician Wellness Steering Committee reviews physician investigator-initiated wellness research proposals and provides recommendations for funding to generate evidence to inform our wellness work.
For example, the importance of sustenance and hydration (simply having coffee machines that work!) cannot be underestimated. Physicians commonly experience dehydration and/or skip meals during clinical work. Our institution has implemented several strategies to improve the ability to hydrate, access healthy snacks/meals and get coffee/tea when needed. Another example is that, after learning that approximately 30 percent of the surveyed physicians do not have their own primary care physician, our institution created a dedicated phone line so that physicians could schedule themselves with one of our primary care physicians.
In addition, all physicians have access to a full spectrum of mental health support that helps individuals thrive and supports those in need. Since May 2023, all clinically active physicians (along with spouses and qualifying dependents over 18) have free access to Ginger, a program that provides 24/7 behavioral health coaching, and, when needed, therapy and/or psychiatric care. The Healer Education Assessment and Referral program is a unique, nationally renowned program that administers a suicide screening questionnaire to all physicians annually.
Thomas Corkery, DO. Chief Medical Officer at Canonsburg (Pa.) Hospital/Allegheny Health Network: Reducing authorization referrals is difficult, but we have one insurer here that does a gold card process for certain primary care practices and physicians based on their utilization of tests. These gold card holders do not have to get authorization for certain diagnostic tests like MRI, CT or stress tests. I think that's a step in the right direction. It reduces the inordinate amount of authorization referrals for different tests and medications and reduces the time consuming work physicians have to go through in that process, which allows them to provide better care to patients.
Michael Ivy, MD. Deputy Chief Medical Officer at Yale New Haven (Conn.) Health: We have noticed that the physicians at our smaller hospitals are less burned out overall. While there are probably many reasons for that, some of the difference arises because the collegiality and social support is better at our smaller hospitals. There is evidence that social connection is very good at decreasing burnout.
Consequently, we are working to restore the social fabric that has been torn over the past couple of decades, particularly since the start of the pandemic. Which means trying different ways to re-establish the communication and support that physicians have traditionally offered to each other. One of our hospitals recently started hosting CME dinners for physicians, with talks given by one or two of their colleagues. That seems to create the right climate for connection.
A few more things that can help improve physician job satisfaction are: Invest time, money and personnel in making the EMR easier to use; hire more ancillary staff to decrease the burden on clinicians; changing documentation requirements to be less onerous; and malpractice reform. Most mistakes are due in large part to system failures, we could recognize that and reshape the malpractice landscape.
Eric Katz, MD. Chief Medical Officer at Banner Estrella Medical Center (Phoenix): Today, as we try to clinically recover our ability to deliver consistently excellent care, we are realizing that Banner Estrella cannot be a suitable place to receive care without also being a great place to work. Being a great place to work involves focusing on our people through recruitment, culture work, and sensible processes that make things easier. A competitive salary is also a key part of that equation and staying competitive is necessary to retain strong physicians.
Other ways we work on physician engagement is through shared experience and opening opportunities to be together. Banner's Cultivating Happiness in Medicine funds group activities that can be created by the physicians. Estrella's medical staff recently started lunchtime education that has been well received by physicians and nurses. Meanwhile, our communication focuses on wellness and articulating the "why" behind each action. Our overarching goal is to show the respect we feel for our physicians. That is how we will continue to build trust and resilience in our physicians and teams.
Oliver Mayorga, MD. Chief Medical Officer at the Lawrence + Memorial and The Westerly Hospital (New London, Conn.): We spend a significant amount of time trying to decrease excessive clicks in the EMRs. We put together work groups of front line clinicians who care for the patients so that we can streamline their interaction with the EMR. Some examples of success include: optimizing note writing through dot phrases, simplified ordering processes through clinical pathways and the utilization of virtual scribes to improve the ease and accuracy of notes.
We have also purposefully moved back to in-person gatherings and social events. Supporting and cultivating the human connection is critical to promoting a positive medical staff culture.
Ryan O'Connell, MD. Regional Director of Quality at Hartford Healthcare Fairfield (Conn.) Region: Specifically, for ambulatory medicine, there exists a role of a nonclinical person (often one per practice site) whose role is to better ensure patients follow up for appointments and screening tests, which shifts this burden away from clinicians. In addition, "pools" have been created for "in-basket" messages, so that questions not requiring clinician time can be answered by clerical staff.
Most compensation models for employed physicians are based on how health systems are compensated. Organizations bill for encounters and then physicians are generally paid based on relative value unit productivity. As a result, physicians are driven to do "piece work" in order to make their income and they feel their compensation is based on quantity, not quality. A more holistic mechanism, such as extending value-based payments for physicians, could permit them to focus more on qualitative aspects of care.
Karan Singh, MD. Chief Medical Officer at San Gorgonio Memorial Hospital (Banning, Calif.): We are trying to help physicians find joy in medicine and part of that is getting more physicians to take the burden off ones currently working here. That's a huge thing. I think also giving autonomy back to physicians is important. We're seeing the change in culture, change in the environment of healthcare and more and more progression towards centralization, which is good in the sense of there's not that much variability. But what that also breeds with it is a lack of autonomous decisions for physicians, or lack of engagement for the physician. When we bring on a physician, we get them working on a passion project. Some physicians might want to be a patient experience advocate, or they might want to be involved in some of the quality projects within the hospital, or they might want to do ultrasound, or they might want to work with the residents, or so on. I think everybody has that extra thing that gets them up in the morning besides providing patient care and that's where we need to tap into the human side of the physician.
Nancy Sudak, MD. Chief Well-being Officer and Director of Integrative Health at Essentia Health (Duluth, Minn.): The career of a physician is typically fascinating and offers a meaningful and rewarding opportunity to serve others. However, it is difficult to sustain joy in the practice of medicine with even just some of the pressures physicians face. Younger clinicians are particularly vulnerable to burnout as they navigate young families, work burdens, factors they hadn't anticipated and financial pressures. Furthermore, it is increasingly common for physicians to feel more like laborers and less like artful clinicians in today's corporatized model of healthcare — a profound loss that is at the heart of increasing dissatisfaction and regret.
In 2021, Essentia Health appointed its chief well-being officer and launched its office of well-being that serves clinicians and the organization as a whole. The office has launched programs that help reduce burnout and influence a culture of compassion and authenticity. Some programs include a yearly assessment for burnout, safety nets for clinicians in distress, leadership training and strategies to reduce the patient message burden.
It is clear that clinicians have widely available choices in today's competitive healthcare market. Healthcare systems that can tangibly demonstrate a commitment to the well-being of their healthcare workers will be among the more appealing choices for prospective candidates.
Donald Yealy, MD. Chief Medical Officer and Senior Vice President of Health Services Division at UPMC (Pittsburgh): Helping physicians — and all on the healthcare team — manage the changing demands of patients is needed, and finding new ways to extract the gratitude that makes service fulfilling are the key needs, but these are not easily addressed by one lever. We address these over and over, in many formats, trying to find those combinations of solutions to aid the most, led by a group called Physician Thrive.