In the never-ending list of issues in healthcare, one major concern isn't often discussed. It can't be communicated in spreadsheets or Power Points, and it's not likely to come up in board room discussions. Nonetheless, it can hurt hospitals, patients and the healthcare industry as a whole if left unaddressed.
Physicians may have prestigious education or training, top-tier credentials and high rates of productivity. They are often respected in their communities and live comfortably. Still, one question can make all the difference: Are they happy?
It sounds simple, particularly when posed in the plain language of satisfaction surveys. But struggles with morale, self-esteem and energy go much deeper than most physicians are willing to discuss. Bob Uslander, MD, is the founder of Doctors on Purpose, an organization dedicated to helping health providers create more joyful and meaningful lives. Dr. Uslander has been in practice as an emergency physician for 20 years, though he has been branching out into other areas of health care and business for the past 10 years after recognizing that unhappiness and stress did not have to be part of his career.
Dr. Uslander shared insight on why physicians may suffer from low morale, barriers they face in communicating this and how hospitals can help.
Grin and bear it
Part of the problem goes back to medical school and residency training, where medical students are conditioned to persevere and complete task after task without complaint. They work long hours and become accustomed to pushing themselves, which is admirable but can also harm their mental health. "They end up not doing anything for themselves," says Dr. Uslander. "They get in a pattern where it's normal to push themselves and they lose insight as to what they're missing. Then one day they wake up and say, 'Wow, this was not the life I wanted. I'm not really happy.'"
Paired with pressure to avoid complaint, physicians often feel a sense of obligation to the career path that has cost them hefty amounts of time and money. They may also fear that even though they're not satisfied, this is what they must do for the rest of their lives — an overwhelming thought for any individual. "I would venture to say that for most physicians who aren't truly satisfied with their career, their unwillingness to change is not that they feel an obligation [to medicine], but they fear that they can't do anything else. They don't have the skills or training to do something that would replace their income, and they've sort of lost their sense of adventure," says Dr. Uslander. "They're not comfortable taking risks."
Gaps in public perception
The assumption that physicians have it good is widely held. They have decent salaries and ample employment opportunities. They are valued in their communities and hold positions commonly associated with high intelligence and prestige. But Dr. Uslander says there is a discrepancy between the outer world of physicians, or what the public perceives, and their inner world. This leaves many feeling hesitant to discuss personal problems.
"This is where there's a lack of true, authentic happiness," says Dr. Uslander. "They think they should be successful, but they don't feel successful. There’s an incongruence. That creates a lack of self-respect and self-esteem." Physicians tend to internalize these feelings and limit complaints to external factors of healthcare, such as reduced reimbursement, uncooperative patients or other workplace stressors.
Dr. Uslander says physicians don't talk to one another about their personal satisfaction because they consider it a sign of weakness. They don't discuss it with spouses because they don't want to bring their families down. Dr. Uslander formed Doctors on Purpose to meet that conversational need for physicians and provide an outlet for them to share any feelings of stress. He also coaches individual physicians and groups on how to live with more authentic happiness and success.
The spillover effects
Career dissatisfaction has its obvious side effects, such as strained personal relationships, depression and even substance abuse. However, some effects are unique to physicians. "I think physicians are generally intelligent, hardworking and have demonstrated that they are able to make big commitments, but when they're dissatisfied and unfulfilled, they often lose their initiative and passion. They have so much to offer, but they often end up being wasted resources in their communities," says Dr. Uslander. Unhappy physicians may not be as engaged or involved in philanthropy, community service, their hospitals or their personal career advancement.
Also, career dissatisfaction affects more than the husband, wife and kids. "It has a negative impact on all the other people they're around," says Dr. Uslander. "Staff who work with them see that negative energy in the practice and work space. It has an impact on their patients — they feel it, they know it and they don't get [the kind of care] they need. Ultimately, patients' health suffers from it."
The "mid-life crisis"
Though there has been controversy over the validity of mid-life crises, the middle ages of adulthood do present opportunities for people to reflect on their lives and may also bring on self-doubt or regrets. Not surprisingly, Dr. Uslander says this is also the time many physicians come to realize they're unhappy in their work.
"I think it's more common to start happening between the ages of 40-55. It's not an uncommon time for people, in general, to have a period when they want to find more meaning in their life," says Dr. Uslander. By the age of 40, most physicians have already been practicing for 7-10 years and may wonder what else is out there for them.
The unhappiness isn't reserved for the middle-aged, however. Physicians are beginning to feel downtrodden at younger ages as well — even when they're still in medical school. And the broken spirit and low morale of physicians training these residents and students is partly to blame, says Dr. Uslander.
"I'm hearing from people who work in residencies and medical schools that there is a fair amount of dissatisfaction happening at that level," says Dr. Uslander. "People in their residency are thinking, 'Oh my gosh, how will I do this for 40 years? I can't imagine!'"
How hospitals can help
More than 65 percent of physicians say their stress and burnout has increased in the past three years, but only 15 percent of them say their organizations provide resources or assistance in overcoming these anxieties, according to a recent survey. One respondent even noted that administrations often don't listen to physicians about stress, which hurts physician retention. https://www.beckershospitalreview.com/hospital-management-adminstration/survey-physicians-say-hospitals-dont-offer-enough-help-in-stress-management.html
Here are three steps hospitals can utilize to help physicians avoid burnout, stress and dissatisfaction.
1. Help with leadership development. It can be a double-edged sword when physicians are placed into positions of leadership. It's a significant accomplishment, both personally and professionally, but it can wreak havoc on their well-being if physicians aren't properly trained to lead. "A lot of times, physicians move into leadership positions in hospitals. We have credibility and respect but no real training, coaching and mentorship in leadership," says Dr. Uslander. This can cause a great amount of stress for physicians, as they feel externally qualified but internally inadequate for the role.
2. Allow hospital-acquired practices to develop their own unique culture. When hospitals acquire physician practices, it may be helpful to allow each group to develop their own culture. A uniform approach to cultural development isn't likely to work the same for hospitals and practices given the differences in size. Core elements of this culture should include shared vision and values and the understanding that every member of the team is valuable. "Patients will feel it, there will be much more loyal staff with lower turnover and physicians will feel like they don't have to force the positive qualities out of one another," says Dr. Uslander.
3. Ensure that physicians understand the line of communication in the hospital. Physicians undergo a number of transitions when their practice is acquired by a hospital, and a significant amount of stress can be alleviated if hospitals help them understand the line of command and communication. More specifically, physicians will fare better in their workplace if they know who is their advocate or champion and who is likely to present obstacles for them. For example, the physician advocate may be based on formal title — such as the CMO — or it may be an individual in hospital management whose personality is more attuned to physicians' wants and needs. This can help physicians avoid the anxiety that may result from the change to hospital employment, or feelings of being lost in a large health system.
"I think one of the biggest problems is understanding the chain of command for physicians and knowing who is in charge. Unless there is a clear organizational flow chart for addressing the medical and non-medical needs of the medical practices, there are problems," says Dr. Uslander.
Learn more about Dr. Bob Uslander and Doctors on Purpose.
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Physicians may have prestigious education or training, top-tier credentials and high rates of productivity. They are often respected in their communities and live comfortably. Still, one question can make all the difference: Are they happy?
It sounds simple, particularly when posed in the plain language of satisfaction surveys. But struggles with morale, self-esteem and energy go much deeper than most physicians are willing to discuss. Bob Uslander, MD, is the founder of Doctors on Purpose, an organization dedicated to helping health providers create more joyful and meaningful lives. Dr. Uslander has been in practice as an emergency physician for 20 years, though he has been branching out into other areas of health care and business for the past 10 years after recognizing that unhappiness and stress did not have to be part of his career.
Dr. Uslander shared insight on why physicians may suffer from low morale, barriers they face in communicating this and how hospitals can help.
Grin and bear it
Part of the problem goes back to medical school and residency training, where medical students are conditioned to persevere and complete task after task without complaint. They work long hours and become accustomed to pushing themselves, which is admirable but can also harm their mental health. "They end up not doing anything for themselves," says Dr. Uslander. "They get in a pattern where it's normal to push themselves and they lose insight as to what they're missing. Then one day they wake up and say, 'Wow, this was not the life I wanted. I'm not really happy.'"
Paired with pressure to avoid complaint, physicians often feel a sense of obligation to the career path that has cost them hefty amounts of time and money. They may also fear that even though they're not satisfied, this is what they must do for the rest of their lives — an overwhelming thought for any individual. "I would venture to say that for most physicians who aren't truly satisfied with their career, their unwillingness to change is not that they feel an obligation [to medicine], but they fear that they can't do anything else. They don't have the skills or training to do something that would replace their income, and they've sort of lost their sense of adventure," says Dr. Uslander. "They're not comfortable taking risks."
Gaps in public perception
The assumption that physicians have it good is widely held. They have decent salaries and ample employment opportunities. They are valued in their communities and hold positions commonly associated with high intelligence and prestige. But Dr. Uslander says there is a discrepancy between the outer world of physicians, or what the public perceives, and their inner world. This leaves many feeling hesitant to discuss personal problems.
"This is where there's a lack of true, authentic happiness," says Dr. Uslander. "They think they should be successful, but they don't feel successful. There’s an incongruence. That creates a lack of self-respect and self-esteem." Physicians tend to internalize these feelings and limit complaints to external factors of healthcare, such as reduced reimbursement, uncooperative patients or other workplace stressors.
Dr. Uslander says physicians don't talk to one another about their personal satisfaction because they consider it a sign of weakness. They don't discuss it with spouses because they don't want to bring their families down. Dr. Uslander formed Doctors on Purpose to meet that conversational need for physicians and provide an outlet for them to share any feelings of stress. He also coaches individual physicians and groups on how to live with more authentic happiness and success.
The spillover effects
Career dissatisfaction has its obvious side effects, such as strained personal relationships, depression and even substance abuse. However, some effects are unique to physicians. "I think physicians are generally intelligent, hardworking and have demonstrated that they are able to make big commitments, but when they're dissatisfied and unfulfilled, they often lose their initiative and passion. They have so much to offer, but they often end up being wasted resources in their communities," says Dr. Uslander. Unhappy physicians may not be as engaged or involved in philanthropy, community service, their hospitals or their personal career advancement.
Also, career dissatisfaction affects more than the husband, wife and kids. "It has a negative impact on all the other people they're around," says Dr. Uslander. "Staff who work with them see that negative energy in the practice and work space. It has an impact on their patients — they feel it, they know it and they don't get [the kind of care] they need. Ultimately, patients' health suffers from it."
The "mid-life crisis"
Though there has been controversy over the validity of mid-life crises, the middle ages of adulthood do present opportunities for people to reflect on their lives and may also bring on self-doubt or regrets. Not surprisingly, Dr. Uslander says this is also the time many physicians come to realize they're unhappy in their work.
"I think it's more common to start happening between the ages of 40-55. It's not an uncommon time for people, in general, to have a period when they want to find more meaning in their life," says Dr. Uslander. By the age of 40, most physicians have already been practicing for 7-10 years and may wonder what else is out there for them.
The unhappiness isn't reserved for the middle-aged, however. Physicians are beginning to feel downtrodden at younger ages as well — even when they're still in medical school. And the broken spirit and low morale of physicians training these residents and students is partly to blame, says Dr. Uslander.
"I'm hearing from people who work in residencies and medical schools that there is a fair amount of dissatisfaction happening at that level," says Dr. Uslander. "People in their residency are thinking, 'Oh my gosh, how will I do this for 40 years? I can't imagine!'"
How hospitals can help
More than 65 percent of physicians say their stress and burnout has increased in the past three years, but only 15 percent of them say their organizations provide resources or assistance in overcoming these anxieties, according to a recent survey. One respondent even noted that administrations often don't listen to physicians about stress, which hurts physician retention. https://www.beckershospitalreview.com/hospital-management-adminstration/survey-physicians-say-hospitals-dont-offer-enough-help-in-stress-management.html
Here are three steps hospitals can utilize to help physicians avoid burnout, stress and dissatisfaction.
1. Help with leadership development. It can be a double-edged sword when physicians are placed into positions of leadership. It's a significant accomplishment, both personally and professionally, but it can wreak havoc on their well-being if physicians aren't properly trained to lead. "A lot of times, physicians move into leadership positions in hospitals. We have credibility and respect but no real training, coaching and mentorship in leadership," says Dr. Uslander. This can cause a great amount of stress for physicians, as they feel externally qualified but internally inadequate for the role.
2. Allow hospital-acquired practices to develop their own unique culture. When hospitals acquire physician practices, it may be helpful to allow each group to develop their own culture. A uniform approach to cultural development isn't likely to work the same for hospitals and practices given the differences in size. Core elements of this culture should include shared vision and values and the understanding that every member of the team is valuable. "Patients will feel it, there will be much more loyal staff with lower turnover and physicians will feel like they don't have to force the positive qualities out of one another," says Dr. Uslander.
3. Ensure that physicians understand the line of communication in the hospital. Physicians undergo a number of transitions when their practice is acquired by a hospital, and a significant amount of stress can be alleviated if hospitals help them understand the line of command and communication. More specifically, physicians will fare better in their workplace if they know who is their advocate or champion and who is likely to present obstacles for them. For example, the physician advocate may be based on formal title — such as the CMO — or it may be an individual in hospital management whose personality is more attuned to physicians' wants and needs. This can help physicians avoid the anxiety that may result from the change to hospital employment, or feelings of being lost in a large health system.
"I think one of the biggest problems is understanding the chain of command for physicians and knowing who is in charge. Unless there is a clear organizational flow chart for addressing the medical and non-medical needs of the medical practices, there are problems," says Dr. Uslander.
Learn more about Dr. Bob Uslander and Doctors on Purpose.
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