Physician Burnout Backlash – is it Warranted? (Yes, but…)

Is Burnout the New Disruptive Behavior?

Not too long ago, health systems were focused on physician disruptive behavior.  As they built employed physician networks, disruptive behaviors became a hospital problem and we saw a lot of literature discussing, and programs to address, disruptive behavior.  My own observation was that often, physicians were deemed to be “disruptive” when they expressed legitimate frustration.  Certainly, some physicians have behavioral issues and intervention, or discipline, is warranted.  It was, however, too easy for administration to dismiss the complaints and frustrations of a physician by labeling him as disruptive.

Burnout – Good intentions?

Now, we are all talking about burnout.  When this focus started a few years ago, it was well-intended, I think.  We had a growing physician shortage and increasing demand for services.  At the same time, we began adding a long list of non-patient care tasks to the physician’s workload.  Some physicians (and nurses and other providers) struggled under the burden to the point where their coping mechanisms could not keep up.

Recognizing the threat to individuals and to organizational effectiveness, well-intentioned people pointed out the need for programs to prevent, or address, burnout.  Now, interestingly we are seeing a growing backlash against the idea of physician burnout, as a concept.  Mostly from physicians, themselves.  It usually sounds something like this:

“The problem is not the physician but the system.”

“Burn-out implies there is a defect in the individual’s ability to cope and we can “fix” them by building up their resilience, and by teaching them wellness techniques.”

“There is no organizational accountability for the problem!”

All of these statements, to some degree, are true.  Just like frustrated physicians were deemed to be “disruptive”, now any physician or other provider who is struggling to manage the workload and stressors, must be “burned-out”.  He needs to be fixed with a wellness program.

Two Things Can Be True

As I like to say, two things can be true at the same time.  Burnout is a real problem, but it’s not the core problem.

  1. Burnout is real and its prevalence in physicians and nurses threatens individual physical and emotional health, career success and satisfaction, organizational culture and the patient experience.  When the burdens of a role outpace the individual’s ability to cope– that person suffers burnout and some intervention or assistance is necessary.  It’s not an individual defect.  it’s the just the reality of the situation and someone needs to recognize it and address it.
  2. It’s also true, though, that often the problem is NOT the individual’s coping mechanism but a system that is broken.    We can help the individual to build up his resilience, teach time management skills, help him to connect to his passion for patient care, engage him in discussions about solving the problems, and teach better life management and mindfulness skills.  In some situations, it may be enough.  I’ve worked with providers who simply weren’t good at managing their emotions, their workload, or their lives outside of work. When they improved these areas, the stress of the workload was lessoned.

But – and this is a very important “but” – physicians, as a group, have not become somehow less resilient over the past few years – the SYSTEM has continually added workload and stressors.   We’ve not thought about how physicians practice, though, and built these new systems and demands around that – we just keep stacking tasks and responsibilities on their workload, without making any operational accommodations.

Frustration vs. Burnout

Not surprisingly, physicians are frustrated and express that frustration.  They are not all burned out.  They don’t all need mindfulness training.  It should be noted, though, that physicians, by their nature may be more prone to the problem.  From a recent article in Psychology Today:

“Burnout is one of those road hazards in life that high-achievers really should be keeping a close eye out for, but sadly—often because of their “I can do everything” personalities—they rarely see it coming. Because high-achievers are often so passionate about what they do, they tend to ignore the fact that they’re working exceptionally long hours, taking on exceedingly heavy workloads, and putting enormous pressure on themselves to excel—all of which make them ripe for burnout.’

Yes, physicians, early in their career, particularly, need guidance on their own wellness.  It will serve them well.  Some physicians later in their career need this help, too.  But – back to the “but” – the system needs to take accountability.  We need to re-think the physician’s role and responsibilities and how we organize that work, what we are asking of them, and how to help them to succeed and maximize performance.

Organizational psychologists and process engineers are constantly designing and re-designing role function and responsibilities.  We engineer them so these people can be more efficient and productive.  The practice of medicine has evolved without much organized thought about “how” to best do the job. Hospital services have developed, largely, without consideration of how to maximize physician efficiency or to help them accomplish individual goals.

So – there is a difference between reasonable frustration, and burn out.  From the same Psychology Today article, burnout is described as a state of chronic stress that leads to:

  • physical and emotional exhaustion
  • cynicism and detachment
  • feelings of ineffectiveness and lack of accomplishment

When in the throes of full-fledged burnout, you are no longer able to function effectively on a personal or professional level.

The Solution(s)?

  1. Recognize that burnout is a real phenomenon.  When someone reaches that state, recognize it and address it.  Don’t demonize the concept.
  2. Wellness programs are a valuable idea.  Any professional can benefit from all that goes into individual wellness.
  3. At the same time, though, recognize that no intervention will fix the problem if the workload is simply too great.  Commit resources to understanding and lessoning physician burdens.  Sometimes, having administration recognize and acknowledge this issue and taking sincere steps to address is, lessons the stress on the physician and gives them a sense of hope.
  4. Design care delivery systems and administrative tasks so that we can keep physicians focused, primarily on taking care of patients.