Stop Ignoring Physician Burnout

While new data confirms that the stability of the physician workforce is as precarious as ever, a multi-specialty group's CMO explains how reducing burnout is an achievable goal.

Physician burnout is threatening to engulf the provider workforce, a Mayo Clinic study published this month suggests.

By analyzing physician surveys in conjunction with payroll records, investigators found that for every point increase in the seven-point scale of emotional exhaustion, one of three domains measured by the Maslach Burnout Inventory, there was a 40% greater likelihood a physician would cut back his or her work hours over the next 24 months.

They found a similar relationship for every one-point decrease in the five-point scale measuring professional satisfaction.

And contrary to stereotypes, this trend was not linked to a greater proportion of women physicians or younger physicians reducing professional work effort, Tait Shanafelt, MD, professor of medicine at Mayo Clinic and lead author of the study, told me. "Rather, it was primarily due to an increased proportion of men, particularly male physicians over age 55, reducing professional work effort."

The Cost of Ignoring Alarms

Compounded with a predicted physician shortage and not counting the 89% of respondents to a 2015 Cejka Search survey wanting to change jobs, cut back, or leave medicine, these findings obviously aren't good news for healthcare leaders.

"These results have important repercussions for healthcare organizations seeking to maintain a productive and engaged physician workforce," says Shanafelt. "Burnout is, in large part, a system issue. Organizational efforts to address the problem must address the drivers of burnout, including problems with excessive workload, inefficiency in the practice environment, loss of flexibility and control over work, and barriers to healthy work-life integration."

It's not uncommon, however, for leaders to regard burnout as an emotional issue rather than a business one, according to Karen Weiner, MD, chief medical officer at Oregon Medical Group. This mindset is seemingly unique to healthcare.

Related: PCPs Outvalue Specialists as Hospital Revenue-Generators

"In any other industry, if we were to pull together the CEOs and say, 'you are burning out your primary revenue generators faster than you can replace them,' it would be an all-hands-on-deck emergency situation where every technology, every innovation is focused on sustainability models for that valuable and limited resource," says Weiner. "In medicine, that's where CEOs and leadership needs to be."

The Mayo study may help leaders get there. "If you want to quantify your risk for losing physicians in the coming year, run the Maslach Burnout Inventory on your physicians. You can translate that to an ROI if you want to, if you need to, to direct resources toward improving burnout."

The cost to replace a physician, Weiner notes, ranges from $250,000 to $500,000.

An Outdated Culture

As a physician and leader, Weiner knows first-hand how this exercise can impact an organization. In 2013, when she was on the board of directors and practicing full-time at Oregon Medical Group, morale was at an all-time low.

"We were at a crisis point where we had a lot of angry, frustrated physicians," Weiner says. Perhaps not surprisingly, the MBI revealed that 58% of the group's physicians were experiencing burnout.

"We had implemented our electronic medical record [system], and that really highlighted all of the dysfunction we had in our group. The culture that we had developed over the decades prior had worked well [until] then, but the environment was changing and our culture wasn't conducive to being able to meet the needs of the changing market."

With that impetus to change, the physician-owned group took several measures to update its culture, including articulating a new vision and generating the group's first physician compact, which stated "the new rules of engagement," Weiner says.

"In retrospect, the biggest deficit in our group was lack of community, that we did not have the collaboration that we needed to get anything done," she says.

But once the physicians jointly agreed on the group's new vision, which is to collaborate to provide the highest quality of patient-centered care, their unity became more powerful than the problem. "Once collaboration was in place, everything [else] was doable," Weiner says.

When the group conducted follow-up burnout surveys two years later, the incidence of burnout had dropped significantly, she notes, but there was more work to be done.

"In our progress, we've achieved collaboration and we're trying to remove barriers to providing care because that's always a frustration to physicians and it's not good for patient care. So removing the waste in the system makes everybody's work more rewarding," she says. "It's ongoing. It's small, incremental improvements."

Part-Time Is Better Than No-Time

It's important to note, though, that some of these adjustments involve the very consequence that the Mayo study illuminated: Giving depleted physicians the ability to work less. As of today, Oregon Medical Group has several physicians who work one day per week in the walk-in clinic or jobshare as part of a primary care team.

"An organization has to understand that it has to be flexible—not just flexible—but they have to develop models that work to salvage people," Weiner says. "That resource is so valuable that we have to make it work. And that's what we've done. We have quite a few physicians that would have been gone otherwise that are contributing to care in the community."

Shanafelt agrees that having a part-time physician is better than a physician leaving medicine altogether. "Organizations that provide physicians the flexibility to adjust work-effort to preserve meaning and satisfaction may have a competitive advantage in recruiting and retaining physicians," he adds. 

"There is a societal imperative, however, to provide physicians a better option than choosing between reducing clinical work or burning out. Large numbers of physicians reducing their professional effort due to burnout would exacerbate the already substantial projected U.S. physician workforce shortage as well as impact continuity of care for patients," Shanafelt says.

Standardization Needed

The elephant in the room is the idea of offloading non-physician work to others, specifically, APRNs.

In addition to the cultural changes required to implement team-based care, there are practical ones, especially regarding standardization. "You can't offload work from physicians unless that work is standardized," says Weiner, "because you have to be able to know what work you're giving away and making sure that work is getting done."

And you can't standardize work without physician engagement, Weiner adds. And you can't create physician engagement without collaboration.

And without leadership committed to understanding how physicians are balancing their work and life responsibilities, you can't get the fight against burnout even started.