Thursday, May 28, 2020 | Ginger Biesbrock
Many of us heard of the suicide death in late April of an ED physician from New York who was a leader in her organization and on the frontline of the COVID fight. In this Becker’s Hospital Review article it states she had no previous history of mental illness. My heart broke for her, for her family and for our industry as her story is not unique. COVID has certainly magnified the issues with burnout and their consequences. A recent article from Harvard outlines the impact on healthcare workers due to COVID that includes both an increased workload and health risk to themselves and loved ones. Unfortunately, the impact of clinician burnout was high even before COVID hit. Then when you add a significant economic impact to the list, stress levels climb.
For quick review, burnout is a syndrome of emotional exhaustion, cynicism and decreased efficacy at work1 and has been noted within the physician profession for more than a decade. The most recent Medscape Physician Lifestyle, Happiness, and Burnout report described that an average of 44% of physicians experienced symptoms of burnout (cited by Kane, 2019). A review in 2014 noted burnout for physicians was twice as prevalent compared with workers in other fields even after adjusting for age, sex, relationship status, level of education and hours worked per week1. For healthcare leaders, recognizing clinician burnout and providing a solution for both prevention and intervention is critical in maintaining an effective, healthy physician workforce which is one of the most valuable assets in today’s healthcare organizations. Given the COVID pandemic, now is not the time to push clinician burnout concern to the bottom of the list for priorities.
Clinician burnout has been proven to affect productivity, quality and patient outcomes. It can also have a significant personal impact and has been associated with depression, broken relationships, alcoholism and physician suicide2. The impact is real and cost to our industry is enormous with estimations in the billions of dollars.
Causes of Burnout
My first question to you is when was the last time you evaluated your clinician workforce for satisfaction and possible burnout? If we don’t ask, we won’t know. We may see the symptoms that include cynicism, exhaustion and detachment but understanding the degree and spread of burnout is important. The Maslach Burnout Inventory is a well-validated assessment tool that is inexpensive and easy to implement. Your organization may have access to other tools, but a routine measurement is imperative in effectively managing clinician burnout.
The causes of clinician burnout have been studied with the most common causes including high workload, lack of work efficiency, poor organization support structure, ineffective leadership and lack of physician resiliency. Physician resiliency is the area that is most commonly targeted for intervention. With self-help programs, counseling, coping mechanisms and more being promoted to physicians to improve their state of burnout. However, research shows that they really do not have much of an impact3. Unfortunately, although the other factors have been shown to have a strong link with physician burnout, they tend to be the last place organizations look to for solutions. Even the Harvard article noted above is directing physicians to resiliency solutions.
It’s not wrong to provide resiliency skills training. However, I want to provide you another way to think about clinician burnout. You could expand this concept beyond physicians to think about the rest of the members of your team as well. A physician researcher from California described the suffering that physicians experience can be divided into two categories: avoidable and unavoidable4. The unavoidable suffering is a result of the work that physicians do, caring for patients. The COVID pandemic has magnified unavoidable suffering for sure. The avoidable suffering is a result of organization dysfunction. He outlines that resiliency training may be very helpful in providing coping skills for unavoidable suffering but the only way to improve avoidable suffering is to improve the organizational issues that lead to the suffering such as workload, inefficient workflows, hostile work environment and lack of resources.
What Can We Do?
Solving these issues when present will have a much stronger impact on improving clinician burnout than personal interventions. As you think about your organization, do you have the leadership structure in place to promote physician engagement, physician-led decision making and direction? Do you have enough resources and the right workflows to allow all members of your team to do their best work each day? Interestingly, the studies in literature that seemed to have the largest positive impact on clinician burnout were related to workload and work efficiency. Several studies that focused on the care team model showed great results. COVID is changing our world in ways that no other disruption could and creating an environment where care delivery and workforce decisions are being made daily. These decisions need to be made due to circumstances that we have no control over. This is the prime environment to create or magnify clinician burnout as detailed in The New England Journal of Medicine. We have heard countless stories of physician contract changes, compensation struggles, staffing changes, etc. Are your clinicians involved in these decisions? We need their expertise and knowledge like never before. A recent article in Becker’s, highlighted Novant and their development of a clinician burnout task force to address these issues.
When we get to the other side of COVID, we will not have done ourselves any favors if we survive financially and operationally but lose a high percentage of our clinicians due to burnout.
Ask yourself these questions
Assessing, understanding, and developing solutions now will pay dividends in the future. In addition, creating a strong clinician culture to include them in developing the new future will not only decrease rates of clinician burnout but also provide a stronger future model which is invaluable. We are in this together with many pressures that are uncontrollable, but empowering the clinicians through strong leadership, engagement and shared decision making will allow us to survive and maybe even thrive through this crisis.
Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle issues such as effective leadership, staffing/operational efficiencies, APP utilization and more.
You can also visit our COVID-19 page where we have compiled and developed resources for navigating this pandemic and the complex challenges practices and hospitals are facing.
Illustration: Lee Sauer
Ginger Biesbrock, PA-C, MPH, MPAS, AACC, is Executive Vice President, Care Transformation. She is a respected executive, provider and teacher with 20+ years of experience in the health care industry with a concentration in clinical care and operations. Before joining MedAxiom Consulting, Ginger was Director of Operations at West Michigan Heart, a 39 Physician practice with 24 mid-level provider. At West Michigan Heart, Ginger oversaw all operations for ambulatory services, tertiary care and rural health practices. Prior to that Ginger was the COO of the Cardiovascular Group at Centra-Health.
Her areas of consulting expertise include APP Utilization, Care Team Optimization and Transitions of Care.
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