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Today’s WCI Network post is from The Physician Philosopher and discusses problems with medical culture and how it is causing the incredibly high rates of burnout we see among physicians.]
In March of 1977, two 747 passenger planes collided on a runway. 583 people lost their lives on Tenerife Island that day. After the Tenerife investigation, it was determined that there existed a culture problem in the aviation industry. In an industry where the pilot was viewed as “God,” co-pilots were often so afraid of speaking up to the pilot, that they would sit silently to avoid being reprimanded – even if it meant that their silence would kill 583 people, including the silent co-pilot.
Can you imagine being so afraid of the system that you wouldn’t speak up, even if it led to your death – and the death of 582 other people?
The investigation into this tragic accident led to a realization that has forever changed the aviation industry – fixing culture problems involves fixing the system that causes the problem. It does not involve pointing fingers and expecting individuals, such as pilots, to change.
This way of viewing things is called Crew Resource Management.
The physician burnout epidemic has a lot to learn from the Tenerife tragedy and crew resource management.
Almost 50% of physicians are burned out. It is anticipated that 400 physicians end their own life each year. These are haunting statistics that point to a culture problem that exists in medicine. It’s time that we performed our own investigation in our industry.
Let’s start by answering these three questions:
- Why are doctors burning out?
- How can we fix the burnout epidemic?
- I am burned out – now what?
Why Are Doctors Burning Out?
The first time I realized I was starting to burn out, it had very little to do with my workplace. In fact, I love my job. Are there things I’d like to change about it? Yes. But they were not the cause.
For me, it was caused by my lack of work-life balance (and, what I would learn later – A Grave’s Disease diagnosis leading to some mental health struggles).
My wife started a full-time job in July, and that threw my world off-kilter. In my view, being a good husband and father trumps work every time.
So, when the current responsibilities at work began to encroach on my life (because of my increased responsibilities at home), the embers of burnout began to kindle.
That is my story, though. Many others have a story that is very different.
From electronic medical record requirements, pre-authorizations, and administrative requirements that take us away from practicing medicine, to work-life imbalance and financial stress, the initial causes of burnout are almost too numerous to count.
Most of us went into medicine to help people. When red tape, insurance companies, and unnecessary paperwork stands in our way, it can be frustrating. In fact, it often produces unproductive bitterness and resentment towards our workplace.
Burnout is Systematic, but Current Solutions are Individual
All of these causes of burnout are just the tip of the iceberg. They are initial sparks, but they do not explain the forest fire of burnout that is consuming the profession of medicine.
The real reason is that, when these initial problems are expressed by physicians, hospitals and their administrators often turn a blind eye.
Physicians feel helpless to change a system that results in depersonalization, feelings of inadequacy at work, and emotional exhaustion that were well described by Maslach almost 40 years ago.
In medical school, I was taught that “treating the symptoms and not the disease” is considered bad medicine. Tenerife taught the aviation industry the same lesson.
In medicine, we enjoy learning lessons the hard way. Many hospitals expect the physician to solve burnout by themselves. This includes recommendations to “fix burnout” through prayer/meditation, practicing gratitude, being in the moment, and other individual acts.
Such individual solutions miss the systemic and systematic causes of burnout.
We can see, then, why little progress has been made with physician burnout. The problem remains systematic/systemic, yet the solutions are all individual.
How to Fix the Burnout Epidemic
Many hospitals in the health care system have adopted crew resource management when it comes to safety in the operating rooms, including the one where I work. We keep patients safe by depending on a system with fail-safes and checklists to help catch individual errors or red flags.
The exact same process needs to occur in the realm of burnout.
A systematic solution needs to be proposed to help fix all of these systemic problems. Of course, this will cost hospitals money, but the return on investment stands to be massive.
Hospital administrators and board members need to get together and realize that a happy physician is more productive and that when physicians decide to leave a hospital, the cost is exorbitant (ranging from $250,000 to $1,000,000 to replace that physician).
If ten physicians leave a hospital because of being burned out and unhappy, this will cost the hospital $2.5 million to $10 million. If even a fraction of that money is spent reducing burnout by hiring scribes, improving resources, and allowing for more support and time with patients, well, that would be money well spent.
Additionally, any hospital that does this can expect to recruit the most talented physicians to their workforce as word spreads about the over-arching desire to work on physician burnout. This would lead to the most important improvement of all, an improvement in patient care.
I Am Burned Out – Now What?
Despite the flowery language above, I realize that many hospitals simply can’t or won’t help fix this problem. It turns out that our hospitals don’t always love us back. They will continue to pin the problem on the physician and their inability to deal with the job that they signed up for.
If you feel like you are in this boat, there are some possible solutions. And, no, I don’t intend to tell you to pray or meditate more often (even if that has been shown to be effective for some).
Solution Number 1: Change your focus
If you are burned out, I encourage you to do the same thing with burnout as I encourage you to do with your money. Be intentional.
Sit down. Write down a list with three columns. On the left, write down the parts of your job that you love. In the middle, write down the things about your job that you cannot stand. In the third column on the right, write down the goals that your employer has laid out for you.
For each part of your job that you would like to diminish, focus on something that matches your “love” column and your “employer’s goals” column. Then, go meet with your chair/boss/whoever.
Explain to them that you would like to do less of that thing you hate, focus more on what you love, and that this will help you meet your employer’s goals as outlined in the third column.
This may mean focusing more on research, education, administrative work, or something else entirely.
If you don’t feel like you have any bargaining chips, remember how much it will cost your employer to replace you. Your administration likely knows this information. You are not powerless here.
If all else fails, institute a Hell Yes Policy where you say “no” to everything that doesn’t make you say “Hell Yes!”
Solution Number 2: Financial Independence
If number 1 won’t work, then it may be time to focus on the tenets that are taught on this site: achieving financial independence as quickly as possible so that you can choose to practice medicine because you want to, and not because you have to.
When you reach this goal, you can do whatever you want – and no one else will have a say in that.
Even if you are not currently burning out, setting yourself on a path to FI is important. Who knows what you will think of your job in 5, 10, or 20 years.
Solution Number 3: Part-time work
“I can’t afford part-time work, what is he thinking!?!?”
I hear you. This is a possible solution, though.
Going part-time may involve earning some side income that is unrelated to your main gig. After all, side hustles are the best way to protect against job loss!
You may need to decrease your cost of living (which will likely result in an equal amount of happiness if we learn the art of contentment) or delay your time to financial independence.
Crispy Doc has a series of posts on doctors who have cut back. The truth is that many physicians find that they still love their job when they just do less of it. It’s often a balance issue, and part-time work can be a great fix.
If you have made wise financial decisions, then this should be an option. Who cares if it delays your road to financial independence from 50 to 55, if it prolongs a career that you might love?
It’s certainly worth consideration.
Solution Number 4: Change Jobs
When the rubber meets the road, your mental health is more important than your job. If your employer isn’t willing to change, and you have tried the three options listed above – it might be time to consider changing jobs.
This may mean going to work for another employer that has (supposedly) better balance than your current workplace. Locum tenens on your own terms is another option.
It may also mean leaving clinical medicine entirely. Some physicians opt to go and work for industry, pharmacy, or insurance companies. It may mean getting more involved in medical school education or some other non-clinical endeavor.
Never forget that your skillset is highly valuable. Working in the traditional “doctor gig” is not the only option.
Physician burnout is a problem that is consuming the field. It has impacts on patient care and – some may argue – is even a life and death problem for some physicians.
Like the aviation industry after Tenerife, our culture needs to change, and, if it won’t change, our doctors need to be empowered with solutions that allow them to take matters into their own hands.
What do you think is the predominant cause and solution of physician burnout? How can we fix physician burnout? What solutions have helped you in your journey? Leave a comment below.