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Leadership

Physician burnout: 5 steps CEOs can take to fix the problem 

Gabriel Perna | February 10, 2020

Key Takeaway:
*Burnout costs the U.S. health care industry an estimated $4.6 billion every year.

*Experts say there is an immediate ROI for CEOs when trying to solve this problem.

*Interventions that address the organizational drivers of burnout are more effective than simply offering goat yoga or Pilates classes.

*Burnout impacts nearly half of all physicians, especially those mid-career.

 Clinician burnout, in many ways, is a costly problem for CEOs.  

It takes a mental toll on your physicians, nurses and other practitioners. It is undoubtedly the reason some of the most talented people in your organization will leave the job. It is a culture killer. Studies have shown that burnout among clinicians has led to decreased productivity, lower quality of care, as well as reduced patient satisfaction and, perhaps most important, safety.  

For all these reasons and more there is an actual business cost to burnout. Yes, a cost that can be calculated. 

A survey in the Annals of Internal Medicine last June, in fact,  estimated that burnout costs the U.S. health care industry $4.6 billion every year — a conservative estimate, according to authors Christine Sinsky, MD, Vice President of Professional Satisfaction for the American Medical Association, Stanford University’s Tait Shanafelt, MD and Harvard Business School’s Joel Goh.  

While not every physician leaves a job because of burnout, research suggests that burned out physicians are twice as likely to turn over. Researchers have found there is significant cost savings for installing an intervention that helps reduce burnout.  

“As a CEO, you’re already investing considerable financial resources every year on physician burnout … you just may not recognize it. If your organization has 1000 physicians, experiencing average rates of turnover and factoring in very conservative rates of the cost to replace one physician, you’re already investing $10 million per year on burnout. You’re just investing it at the sharp end of the stick, on replacing physicians who leave because of burnout rather than on prevention,” says Sinsky.  

While there are obvious moral and ethical reasons to address burnout, it has also become a legitimate business imperative.  

Dan Shapiro,  Vice Dean for Faculty and Administrative Affairs at the Penn State College of Medicine, who has written books on physician burnout, says there is an immediate ROI in trying to solve this problem. He and colleagues developed a five-tier hierarchy to help CEOs and other administrators prioritize burnout interventions.  

Interventions and other solutions not named yoga 

The five-tier intervention, Shapiro says, is comparative to how pilots use a systematic approach when responding to a warning light in their cockpit. The intervention starts with 

  1. Physiological wellness. Are your employees hungry? Are they sleep deprived? The first tier also touches upon behavioral health and their mental wellbeing. Up from there, it goes to…
  2. Safety and security. Shapiro says one institution found that 58 percent of nurses had been struck, bitten, spit upon or kicked in the last year. “That makes it a more dangerous profession, in some ways, than law enforcement,” Shapiro says. This can also come in other forms (Is my job secure? Am I being threatened?)
  3. Respect.  Am I respected by the people and things I interact with every day? This could mean the obvious examples of respect (a culture of accountability and communication) and the less obvious (is the EHR optimized? Are their dead spots where pagers don’t work?).  
  4. Connected and appreciated by colleagues. Shapiro says that isolated health professionals burn out in higher numbers and leave in higher numbers. 
  5. Making an impact. The highest level of this five-tiered intervention is whether or not the clinician feels they are making an impact. “If you clear up a lot of details lower on the hierarchy, you get to a place where physicians and nurses feel they are making an impact,” Shapiro says.

Other advice to CEOs: Yoga isn’t going to fix burnout  

Both Sinsky and Danielle Ofri, MD, say that just offering yoga or Pilates to cure burnout won’t solve anything. The most successful approach, Sinsky adds, is by identifying and understanding the drivers of burnout within your organization and tackling them head on. 

“We’re not just sitting here recommending goat yoga,” Shapiro says. “The problem with not having a prioritized list and organized approach is you’re just throwing darts.”  

[Related: CEOs on leading through increased scrutiny 

Ofri, a Clinical Professor of Medicine at New York University School of Medicine, has written essays and books about physician burnout, including an op-ed in The New York Times. She says health care CEOs often miss the mark on clinician burnout because they don’t understand what their day-to-day is like.  

“Everyone in the hospital, and I mean everyone, should have to do patient care for a day. They should have to spend regular time with patients. If you have an MD or RN degree, then do patient care. If you don’t have one of those degrees, work at the front desk. See what it’s like. See how the system impedes your ability to do a good job,” Ofri suggests. 

 

Leadership is never neutral. You’re always making an impact, whether it’s intentional or unintended. Paying proactive attention to your organization’s problems is critical.

Robert Sundelius, COO of Ascension Medical Group in the Michigan Market.

While this direct approach to reducing burnout may not be for everyone, there is something to be said for having MDs on your leadership team, says Robert Sundelius, COO of Ascension Medical Group in the Michigan Market. Ascension Medical Group is a physician-led national provider network, which means clinician leadership is built in. This doesn’t just involve giving them paper titles, it means physician leadership is present at all levels and engages its members to keep burnout levels down.  

Sundelius’ Ascension has built in governance structures at the national and regional levels of the organization to monitor physician wellbeing. They examine the physician-Ascension relationship in recruiting, onboarding and through mentoring programs. The provider also looks at clinician resourcing, whether it’s regarding use of the EHR and other technology platforms or having the right people around them, Sundelius says.  

“Leadership is never neutral,” he says. “You’re always making an impact, whether it’s intentional or unintended. Paying proactive attention to your organization’s problems is critical.”  

One potential issue with installing physician leadership to curb burnout is that it adds more work onto a clinician’s already-busy plate, says Renee Lockey, MD, an ob-gyn in Austin, Texas, who is now employed with the Ob Hospitalist Group.

CEOs who go this route should ensure there are mid-level providers and other staff resources in place that will enable physicians to take on this work.  

It’s not just an individual problem 

Lockey left a multi-specialty medical group and became a hospitalist after feeling she could barely keep her head above water in a more traditional environment. The hospitalist/shift type work allows her to maintain a healthy work-life balance while still practicing medicine regularly.  

 “There is a lot of tolerance for exhaustion. There is an expectation you have to deal with stress by pushing harder and harder. There are a lot of people who are unhappy who are just putting their heads down and doing the work. Unless someone is speaking out about it, [CEOs] may not understand how pervasive the issue is [within their organization],” says Lockey.  

A recent study revealed burnout to be a problem that affects nearly half of all physicians, especially those in the middle of their careers (between the ages of 40 and 54). Furthermore, half of doctors say they would be willing to take a substantial pay cut to achieve a better work-life balance. 

Sinsky says the CEOs she talks with understand the problem, but there are multiple stakeholders within an organization that typically house certain misconceptions about burnout. Like Lockey, Sinsky says the most common misconception she has seen is the misconception that burnout is an individual problem, not an enterprise one. It’s up to the CEOs to educate their entire workforce that burnout is a systems issue and to prioritize it.  

[Related: CEOs talk top priorities for next 3-5 years.] 

Shapiro says that another issue is that CEOs have a lot of competing demands in this health care environment, so burnout often gets pushed aside. Experts agree that it’s something that cannot be ignored or given lip service.  

“Institutions that prioritize taking care of their [clinician] workforce are going to be the ones that thrive in the future. When we unleash the professionalism and energy that physicians and other health professionals have and are driven to apply, we’ll see so much power for good within the health care system,” Sinsky says.  

Sinsky, along with Stanford University’s Tait Shanafelt, MD and Harvard Business School’s Joel Goh, also authored a JAMA Internal Medicine study in December 2017 looking at the business costs of burnout relative to the average rates of turnover that comes with an attached worksheet to help calculate actual costs of burnout at your organization. The AMA has since updated the worksheet and turned an easy-to-use online calculator. 

“Anyone who has been in management knows that at any given time, your workforce is disgruntled. It’s natural for a health care executive to ask, ‘How is this any different than what’s normal? It’s work. It’s not always fun,’” Shapiro says. “It’s because of the downstream consequences. Those of us who are able to create a work environment that doesn’t induce burnout are going to win the battle for talent.”  

About the Author

Gabriel Perna, Senior Manager, Digital Content

Gabriel Perna is the Senior Manager of Digital Content at Health Evolution. He brings 10+ years of experience in covering the intersection of health care and business. Previously, he was at Chief Executive, Physicians Practice and Healthcare Informatics. You can reach him via email or on Twitter at @GabrielSPerna