Culture, Leadership Can Help Alleviate Physician Burnout

In just four years, the rate of physicians who experience more than one factor of burnout has gone up from 46 percent to 54 percent, according to a study from the Mayo Clinic.

To that point, William Jessee, MD, senior medical advisor at Integrated Healthcare Strategies and former president of the Medical Group Management Association (MGMA), just has one question: "Will it reach 100 percent?"

Jessee may only be half kidding when he asks that question. The truth is healthcare is experiencing a major problem with physician burnout, Jessee said, while noting the rates of disenfranchised physicians is higher than any other educated profession.

"Lawyers [and] accountants … don’t seem to have high burnout rates that less highly educated individuals do, so in general, if you have more education, you're less likely to burnout. But that does not apply to MDs and DOs," he said.

In general, only 28 percent of the U.S. workforce said it's burned out. This, Jessee said, puts the physician burnout problem into perspective. Jessee shared insight on how organizations can combat the burnout problem with culture and leadership during a session at the MGMA’s annual conference, held in Anaheim, Calif.

To start, Jessee identified the causes of burnout among physicians. More often than not, the work environment - not age, specialty, or another personal characteristic - is the core problem. Physicians, he said, are frustrated by lack of control over processes that affect them and a lack of alignment with leadership. Other factors contributing to burnout include poor relationships with the care team and the dreaded EHR.

"I'm a fan of the EHR … [but] how they've been deployed and the support we've offered to clinicians have created an additional burden," Jessee said. He noted that because of documentation requirements, the EHR is interfering with physicians' work-life balance and ruining their relationship with patients. He recommended the use of scribes to thwart this problem, saying they can increase productivity and revenue. "You can actually see more patients using a scribe, far in excess of what you are paying them." They also allow the physician to work directly with the patient, rather than staring at a computer.

The importance of culture and leadership

The consequences of burnout can be devastating. Not only is the physician not engaged in their work and more likely to make mistakes, Jessee said, but studies have shown that patients are less likely to adhere to treatment plans. There is also increased physician turnover at the practice, more part-time physician work, and more diagnostic testing and specialist referrals. The latter two will be problematic in a value-based care model, he said.

During his presentation, Jessee also focused on solutions to the burnout problem, in particular how to strengthen culture in the practice and engage physician leaders. Jessee said culture drives alignment and engagement, but can be problematic when multiple practices and physicians merge into a new entity. Everyone has their own culture and getting them all to subscribe to the same goal isn't easy.

"If you want people to buy into an organizational goal, you have to keep hammering, 'Why are we here? What are we trying to accomplish? What is our goal?' If people don't agree with that, you have to get rid of them. Get people to buy into the common goal," Jessee said.

Creating a coherent culture, he noted, is one with a widespread agreement around core values and beliefs. The first step to improving culture in the practice is measuring it. There are a wide variety of instruments to measure culture that can be found online.

In particular, Jessee recommended recruiting a potential employee as a cultural fit, actively managing cultural conflicts, and not be afraid to cut the cord on someone who doesn't fit. "It was Lou Holtz who said, 'Hire slowly and fire quickly.' Spend a lot of time hiring someone on the front end, but if they are a bad fit for the future, terminate the relationship. They'll be better off for it, the organization will be better off for it."

Organizational leadership is another element in improving physician engagement and reducing burnout, Jessee said. He noted that leadership isn't taught in medical school and that not every physician has to be a leader. "Someone has to be a follower… some should be inspired to follow," he said.

A few qualities of an effective leader, according to Jessee, are having a strong vision and sense of mission, the ability to frequently communicate with staff and get buy in, and overall trustworthiness. "Trust is a critical factor and it's easy to blow and hard to gain," he warned.