Physician Burnout VUCA and the Trump Effect

HINT: none of this is good for physician well being 

One of the core factors driving physician stress levels and physician burnout in the USA is the CHAOS in the healthcare marketplace.

What used to be a simple world of seeing patients and billing insurance has morphed into EMR's, Meaningful Use, Volume to Value, MACRA, the Affordable Care Act and a blizzard of mergers and acquisitions that have turned even the average 50 bed hospital into a major physician employer. Independence and autonomy are out the window and who knows what Big Brother will demand of us next.

This chaos is stressful and adds to the risk of physician burnout

It is hard to feel certain about the future when your crystal ball has gone dark. It is hard to feel confident about your practice and your career when you are getting a paycheck from the third different organization in the last 6 years -- as the big fish gobble the little fish in many market places.

A very similar perfect storm of accelerated change happened in the US military in the 1990's when guerrilla tactics and crazy things like IED's and body bombs displaced orderly tank battles on the modern battlefield. After all, how do you feel confident as a commander in the field when you never know what is coming around the next corner. 

Physician Burnout – British NHS Announces World’s First Government "Burnout Service"

The British National Health Service (NHS) has been having a very rough time lately. Despite always being mentioned as one of the top healthcare systems for cost effectiveness, they are fighting a running battle with rampant physician burnout and a near mutiny by providers. Here are just a few of the low points.

• Burnout rates are sky high
• The providers will strike the government every month for the rest of this year over an attempt to force a standard 7-day work week
• There is even an effort to get doctors to turn in their colleagues for burnout

Now the government is attempting a turnaround

Last week the NHS announced that beginning in 2017 it will spend £19.5 million ($24M USD) in 2017 to treat burnout in General Practitioners (GP’s) nationwide.

The NHS announcement said:

“The service is the world’s first nationally-funded health service of its kind for general practice, a clear signal of NHS England’s commitment to help retain a healthy and resilient workforce and in supporting GPs and GP trainees who wish to remain in or return to clinical practice after a period of ill health.”

The service is described as follows:

Physician Burnout Cartoon - and a good one

You don't see many cartoons that capture the essence of burnout ... at least not ones that are funny at the same time. Check this one out ... and feel free to share.  

Here is the cartoonist's website ... great stuff. http://robrogers.com/tag/second-opinion/

Mayo Clinic CEO says fire your doctor if you suspect physician burnout - during PBS interview

By Dike Drummond MD, CEO TheHappyMD.com

Dr. John Noseworthy MD, CEO of the Mayo Clinic, said patients should actually fire their doctor if they suspect physician burnout during a recent TV interview on WTTW in Chicago.

This is a first on two levels

This is the first time I have ever heard a major American healthcare executive asked this obvious question ...
AND
... the first time I have ever heard a CEO answer it.

Not only that, Dr. Noseworthy is a physician and the boss of the massive and well respected Mayo Clinic no less. (full disclosure; I graduated from Mayo Medical School in 1984)

Here's the bind

Mayo measured its internal physician burnout rate two years ago and it is 40%. Here is the article link. The physician burnout rate is the first statistic quoted in the body of this research report even though they fail to mention it in the abstract. Grab the full PDF and you will see that 3896 Mayo Clinic doctors were surveyed and 40% admitted to at least one symptom of physician burnout.

Hmmm ... Is Dr. Noseworthy saying ... that patients should be able to diagnose physician burnout and then figure out a way to dismiss their doctor ... an act that could result in up to 40% of the Mayo Clinic physician workforce being sidelined on any given office day? 

This is a can of worms indeed!

The full interview exchange is in the video at the base of this blog post. Here is my transcript of the interchange:

Physician Leadership - the fundamental currency of leadership 

Physicians are at a distinct disadvantage when they assume leadership roles. The top-down leadership style we absorb in our training - where the doctor gives orders, the team is expected to obey and the patients to comply - doesn't work when you are leading a work team. Giving orders is a style that falls on its face when the people you are leading happen to be other physicians.

And here is what I mean by "work". You choose a retreat - rather than a straight vacation - because you are longing for something to change about your practice.

But three months after your retreat experience, you look around and notice nothing is any different. Nothing has changed. It is the same old grind and the same feelings of "I don't know how much longer I can keep going like this".

You eventually admit you are still stuck in Einstein's Insanity definition. ARRRGGGHHH

Here's why that happens.

Have you ever tried to get CME authorization for a non-clinical physician training?

It is the most frustrating example of a Catch 22 you will find in modern healthcare.

Succinctly put - if a training directly benefits the attendee and their quality of life, it is ineligible for CME credits

Sometimes, when you are feeling down about the stresses of modern medicine, it can be a small comfort to remember how far we have come as a profession

From the four humors and leeches to the "magic" we are sometimes able to perform on behalf of our patients. Here is a blast from the past for sure. 

Watch the short video below for a tour of one of the first anatomy dissection teaching theaters, build in 1637 - the TEATRO ANATOMICO

The carved, wooden ampitheater is on the campus of the oldest continously operating university in the world - the University of Bologna, in Bologna, Italy.

The "Spilatti", wooden statues of skinless men, adorn the "pulpit" where the instructor lectured as the dissection progressed. Galen and Hippocrates watch over the students from the walls and Apollo hangs from the ceiling. And you won't believe the walls of the lecture halls or the size of the stacks of literally ANCIENT texts. 

One of the most overlooked components of your strategy to prevent physician burnout is to make sure you take regular long vacations - two weeks every other year at a minimum. A previous blog post shows you a foolproof method to get your vacations scheduled and implemented. 

We also recommend you shoot for your bucket list whenever you can, to get the most of your time away from your practice.

Here is one of Sherri and my bucket list items for sure. Come along with us on a sunset ride down the Grand Canal in Venice on the #1 vaporetto from Piazza Roma to St. Marks Square. 

--- make sure to grab your favorite beverage and display this full screen ---

Sit back, relax and enjoy ... then get busy planning YOUR next vacation.