Saturday, April 22, 2017
Ask your Physician How he is feeling?
The government insurance programs, health insurers do not care. Their goal is to extract the most from health providers for the least cost. Change is constant and never ending. A literal explosion of programs, MACRA, MIPS, SGR, ACO, and APMs, using HEDIS and STAR ratings to determine if your physician will be penalized for non-compliance.
Some physicians are now actively aware of the burnout issues, and have formed pro-active groups to reduce physician burnout.
Despite reduced reimbursements to physicians health insurance companies continue to make a profit. If their profits decrease, they eliminate programs that are not profitable.
Many physicians will not accept medicare or any insurance plan preferring to develop their own primary care direct payment business model.
A few weeks ago, I had the opportunity to interview a faculty physician at a large academic medical center. We spoke about burnout in students and faculty in general terms. He was aware of the problem yet did not seem affected himself.
Hallmark Signs and Symptoms of Burnout
I asked him how he managed to avoid burnout. He talked about remembering his purpose in entering medicine — that the profession is a calling, not just the daily tasks involved — by re-reading thank you cards from patients, residents, and students. He talked about taking time to chat with the staff in the clinics where he works, getting to know the schedulers by name, for example, to create connection in a world where he sees fewer and fewer opportunities to connect than in the past. Then he mentioned his “boss,” the chair of the department, a practicing internist herself.
He told me that her leadership helped him in small ways and large to avoid burnout. He mentioned her habit of asking, “How are you?” and meaning, “How are you doing as a person?” He said he had the sense that she cared about his well-being as well as the advancement of his career. His mention of his supervisor as a source of “burnout protection” caught my attention. The physicians I’ve interviewed rarely speak about their leader’s role in preventing burnout.
Although I haven’t heard physicians point to the importance of leadership, research corroborates this faculty member’s observation. The Mayo Clinic surveys its employees annually about the degree to which certain leadership behaviors are displayed by their immediate supervisors: appreciation, interest in the ideas and careers of those they supervise, transparent communication, and inclusiveness. Their data show significantly lower levels of burnout among physicians whose supervisors achieve higher scores on these behaviors.
Examples in other industries abound of the impact of leaders’ focusing on the well-being of their workforce. Paul O’Neill, former CEO of the manufacturing giant, Alcoa, steered that company to record high profits within a year by making worker safety the number one priority at every level of the organization. New United Motor Manufacturing, Inc., or NUMMI, a joint venture between General Motors and Toyota, became one of the most productive automobile plants in the world in the 1980s, with consistently high-quality scores. How? In large part by respecting the inherent knowledge of its frontline employees and making a commitment to their welfare.
Organizational leaders may be hesitant to attempt to address the systemic issues that drive physician burnout, thinking that all interventions are complex and costly. Adopting new leadership behaviors is neither — and has proven beneficial effects on physicians’ well-being.
Burnout directly threatens the health of the clinical workforce, the health care organization as a whole, and the ultimate client, the patient. Isn’t it time for leaders of hospitals and medical practices to take a self-assessment and consider the role they play in perpetuating an unsustainable workplace — and their power to build something better? Isn’t it time for leaders to take the longer view and prioritize meaningful systemic improvement — guided by the input of frontline clinicians — to really address this problem?
Given the increasing prevalence of burnout among physicians and the evidence of its wide-ranging negative effects, the time is most definitely now.Diane W. Shannon is an internal medicine physician who blogs at Shannon Healthcare Communications.