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 the need for clinicians to understand digital tools, when the tools they’re presented with don’t always function as they should.

More than that, simply telling docs that they should simply “toughen up” is like hearing nails on a chalkboard. These clinicians survived their undergrad, medical school, internships, residencies, unending sleepless nights, and frequently prioritized their body and well-being last. Really? They need to be more resilient?

Clinicians in general could be argued to be more resilient than the average population, by virtue of their self-selection into such a demanding career. To me, that says if clinicians of all people are becoming burnt-out, the problem doesn’t lie with clinicians themselves.

It has been my personal observation that those who started out the most altruistic and best-intentioned seem to be at highest risk for burnout. While I’m speaking anecdotally, I think it could be that perhaps the system of healthcare doesn’t always align with the values of healthcare, leading 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 why 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 or not? An engaged provider will understand that the risk of brain bleed is low and will counsel and discuss with the patient.

The burnt-crisp doc may instead shift all risk onto the patient, and just order the CT. Patients, unfortunately, bear the brunt of physician burnout.

Frequently, disaffected clinicians don’t truly listen, he/she orders unnecessary tests and sets a poor tone for those around him (nursing staff, techs, etc.). Leaving patients to walk 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–only 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.”

Beyond just the design of an EHR, such a critical and complex system needs to make a good first impression. Taylor tweeted it best:

What can we do about burnout?

My advice for on-going EHR success? Develop a provider experience team. Give that team teeth and align it with the current governance structure in place. Allow them to be the voice of your providers and empower them 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 risk and legal issues were provider specific and came to understand that frequently burnout is a system-level issue. This switch needs to happen in every organization.

Although I’m all for stress-relieving disciplines of yoga, tai-chi and resiliency training, more recognition is needed that the 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 the issue is beyond the accountability of a single provider (i.e., the EHR is poorly designed for everyone, the education of the EHR was executed poorly, etc.).

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-cause, and empowering providers to make the changes they need to feel and be successful.

This piece was written by Lee Milligan, MD, CMIO at Asante, who co-hosted healthsystemCIO.com’s inaugural Tweetchat on Oct. 24 with Janae Sharp. The discussion focused on the risk factors of physician burnout, how patients are affected, and what can be done to prevent it.