What Causes Physician Burnout?
I recently had the chance to join forces with HealthSystemCIO and Janae Sharp (Founder of the Sharp Index) on a Tweetchat centered around Physician Burnout.
If you happened to miss the discussion, I wanted to take the chance to recap some of the thoughts and highlights.
Healthcare is a complex field.
It makes sense, then, that physician burnout is a complex problem. There are many factors that impact burnout, but the key is to understand that burnout is a system-level issue; in need of operational resources to address. Rather than simply dealing with specifics doc who might be, well, “crispy”.
What causes burnout?
Part of the burnout problem is that clinicians don’t understand digital tools when the tools they’re presented with don’t always function as they should.
Simply telling doctors that they should “toughen up” is like nails on a chalkboard. These clinicians survived their undergraduate education, medical school, internships, residencies, and unending sleepless nights, and they frequently prioritized their body and well-being last. Do they really need to be more resilient?
It could be argued that clinicians in general are more resilient than the average person by virtue of their self-selection for such a demanding career. To me, that says that if clinicians of all people are burning out, the problem doesn’t lie with clinicians themselves.
It has been my personal observation that those clinicians who started out with the best, most altruistic intentions seem to be at the highest risk for burnout. While I’m speaking anecdotally, I think that perhaps the healthcare system doesn’t always align with the values of healthcare. This leads to dissonance and dissatisfaction.
When your organization talks a big “patient care” game but walks a big “defensive charting and good billing practices” game, it makes sense that the most altruistic among us would succumb to burnout first.
How does burnout impact healthcare?
Consider the clinical scenario of minor head trauma: do you order the head CT scan, or not? An engaged provider will understand that the risk of brain bleed is low and will counsel and discuss the issue with the patient.
The burnt-to-a-crisp doctor may instead shift all the risk onto the patient and just order the CT scan.
Patients, unfortunately, bear the brunt of physician burnout.
Disaffected clinicians frequently fail to truly listen, ordering unnecessary tests and setting a poor tone for those around himself or herself (nursing staff, technicians, etc.). This leads to patients walking away, shaking their heads, and writing one-star Google reviews.
Is the EHR to blame?
There’s some merit to the claim that EHRs influence burnout. The average EHR looks like the cockpit of an airplane, but many of the buttons don't do what you think they say they do.
In many ways (due to regulations or otherwise), EHRs weren’t designed with that famous Steve Jobs quote in mind: “Start with the customer experience and work backward to the technology.”
A critical and complex system like an EHR needs to make a good first impression beyond just the design. Taylor tweeted it best:
What can we do about burnout?
Want my advice for ongoing EHR success? Develop a provider-experience team. Give that team teeth and align it with the current governance structure in place. Allow the team to be the voice of your providers and empower it to make needed changes. It also helps to survey and listen to the voice of your end users.
My organization found great success when we switched from thinking that risk and legal issues were provider specific and understood that burnout is frequently a system-level issue. This switch needs to happen in every organization.
Although I’m all for stress-relieving disciplines like yoga, tai chi, and resiliency training, there needs to be more recognition that a health system remains at risk when the root cause of burnout isn't identified and addressed.
Accepting burnout as an ongoing operational and strategic risk forces leadership to look at it from a different angle.
We must understand that the issue goes beyond the accountability of a single provider; the EHR may be poorly designed for everyone, the education for the EHR may have been executed poorly, or other issues may be to blame.
At the end of the day, the battle against burnt-out clinicians is one we can win—not by fighting the clinicians, but by listening to their feedback, identifying the systemic root causes, and empowering providers to make the changes they need to feel and be successful.
Photo Cred: Shutterstock, Syda Productions