As a performance expert and the mind behind Evidence-Based Leadership, Quint Studer has spent years advising hospital leadership on how to lead through change. Only in recent years did he fully realize how poorly physicians are faring — and it was then that he started thinking about what was to become his newest book, Healing Physician Burnout.
"Major shifts in the external environment have changed the game for everyone in healthcare," he says. "But I think nobody has gone through more change than physicians."
Mr. Studer says physician engagement and alignment is not a new priority in healthcare. He remembers reading a book about it in the late 1980s or early 1990s. In the past, though, results were inconsistent. Now, with many health systems being more fully integrated, with more physician employment, with accountable care organizations, with population health, with shared risk formulas, everyone is on the same page — or soon will be. Motivation to heal burnout is at an all-time high.
Studer Group conducted a series of panel discussions with physicians and leaders across the country to determine the root causes of burnout. Insights from these interviews combined with Studer Group's proven tactics yielded the book's innovative and powerful approaches for recognizing, diagnosing and treating physician burnout.
One thing's for sure: Burnout is a symptom of many big, complex issues unfolding in healthcare. And many physicians are suffering from it — whether they're fully aware of this or not.
Recognizing burnout
People with medical degrees can't always diagnose themselves. Last week, a physician walked up to Mr. Studer to tell him he was experiencing symptoms of burnout — something he didn't recognize until reading the book.
"Burnout" is a common term in our language. You may hear someone say they are burned out on watching a TV show, following a diet or hearing a Top 40 song. Burnout has the connotation of disinterest or boredom — a plight with an easy fix. That's why if you casually mention you felt burned out from work, someone might recommend that you take a vacation, for instance.
But burnout is not casual nor easily solved with five days on the beach. This condition was codified by psychologist Christina Maslach, PhD, as having three dimensions: emotional exhaustion, cynicism and ineffectiveness. It leaves you physically, spiritually and emotionally drained. Your personality changes. You progressively lose your ideals, your energy and sense of purpose. It becomes difficult to function on a professional level.
Those experiencing burnout have range of symptoms, including insomnia, irritability, headaches, inability to concentrate, depression or anxiety, and the sense that they are "just going through the motions." They may self medicate with drug or alcohol abuse. They may even exhibit suicidal thoughts or behaviors.
In 2015, 46 percent of physicians claimed they were burnt out — an uptick from the 40 percent who reported as much in 2013, according to the Medscape Physician Lifestyle Report. The specialties most affected are critical care (53 percent) and emergency medicine (52 percent), but the lowest rate of burnout reported (among dermatologists) was still 37 percent.
In the past five years, several physicians have put pen to paper to describe burnout in their own words. Mr. Studer's book features personal stories from five physicians, who shared their struggles with burnout and what they did to overcome it. These anecdotes add to a growing volume of notes from the field.
"When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I'd be: impatient, occasionally indifferent, at times dismissive or paternalistic," Sandeep Jauhar, MD, wrote for the Wall Street Journal. The 2014 column was titled "Why Doctors are Sick of Their Profession."
"I am emotionally exhausted and suffering from burnout. I realize how scared and vulnerable my patients must be feeling. Unfortunately, I am unable to spend the time I'd like with each patient because I have so many other patients whose needs must also be met," a four-year medical student said in a 2013 column for the New York Times.
"For a two-year period, I would use the weekend to gear up for the week, then be depleted by the end of the week. I felt like a grape on Mondays, and by Fridays my vitality was drained and I felt like a raisin," George Ford, MD, wrote in Healing Physician Burnout.
What is triggering the burnout epidemic?
"Today, physicians are expected to have much more knowledge of teamwork than ever before. An organization suddenly decides to implement Lean, and physicians need to be experts on patient flow. They need to have technology skills for the new EMR. They're asked to use problem-solving skills in ways they never have before," Mr. Studer writes.
Burnout is one result of many complex changes unfolding in healthcare. In his book, Mr. Studer outlines a few overarching trends contributing to the chronic fatigue many physicians experience, including:
- The shifting payment model from fee-for-service to pay-for-performance
- The imminent physician shortage
- An aging population in need of more care
- Changing patient expectations
- Increased transparency
- Changing technology
These forces are coupled with physicians' direct experience, which often involves a shortage of sleep and long hours — 40 percent of physicians reported working more than 60 hours per week in 2014. Physicians also feel they spend too little time with patients — A Geneia survey of more than 400 full-time physicians found 78 percent felt rushed during their time with patients — and too much time on administrative tasks. The explosion of technology and EMRs has exacerbated their time constraints.
"While many physicians agree that EMR will be a good thing in the long run, getting accustomed to them is far from easy," Mr. Studer wrote.
What can executives do about it?
There is no one factor to blame for physician burnout, insists Mr. Studer. The fact is, when a person's external environment changes so drastically, he or she cannot avoid feeling overwhelmed and stressed out. The good news: There's a lot healthcare executives can do to help physicians cope.
For example, they can help by recognizing that physicians are their industry's top performers and by doing everything possible to provide feedback and support — in the same way that other fields such as athletics, the arts and military do.
"Every other elite profession gives a lot of feedback to their highest performers," says Mr. Studer. "Top athletes watch videos of the games to learn from mistakes, for example, and ensuring that they get enough sleep, nutritious meals and exercise are top priorities. There is no reason why we can't do the same in healthcare."
Mr. Studer remembers the young physician who operated on his sister in 2014, Dr. Pamela Hodul, MD. The procedure took 13.5 hours and ultimately was not successful, as Mr. Studer's sister died shortly after. When Dr. Hodul emerged from the OR, she was emotionally and physically exhausted. She later broke down and cried, another physician told Mr. Studer.
Mr. Studer pointed out that this ordeal was treated as just another day of this young physician's six-day workweek.
"What type of nutrition do you think she'll get?" he writes. "What type of conditioning training has she had to prepare her to handle this type of situation? What type of rub-down will she get from a trainer? Most likely what she'll get is a hard bagel and a cold cup of coffee before she goes home so she can grab a few hours of sleep before she has to do rounds the next day."
Not only is the physician's job incredibly physically demanding, it often puts them through an emotional wringer. When a patient dies, many physicians internalize their grief or feel as though they have failed. Opportunities for collegiality and honest, safe peer-to-peer dialogue can be few and far between.
Mr. Studer urges hospitals and health systems to invest in wellness programs, support groups and feedback systems for physicians, and to think of these resources not as expenses but as investments that will pay off — many times over. He also recommends CEOs, CMOs and other high-level executives make time for feedback.
"It would be really exciting if time was taken with physicians on a regular basis to create a professional development plan to track their progress and performance — much like other industries do for their top performers," he writes.
Expense is obviously an issue, but Mr. Studer broke down some numbers. If a physician makes $200,000 a year with benefits, that totals $1 million over a five-year period. How does the hospital treat pieces of equipment that cost $1 million? "A machine would not just be bought and installed only to have the organization just move on," he writes. "Instead, it would receive regular check-ups and enforcement to ensure it was operating at an optimal level.
"Organizations that offer these types of services are going to win," he writes. "Even physicians who don't take advantage of support groups are going to feel good about those that are offered."
Learn more about Quint Studer's book, Healing Physician Burnout.