Physician Burnout Vs. the Bottom Line - the Epic Battle

Posted by Dike Drummond MD

physician burnout vs the bottom line employed physicians dike drummondPhysician Burnout Vs. The Bottom Line: The Epic Battle

The wave of consolidation sweeping healthcare in the US is causing wholesale collapse of private practice in many markets. Physicians are trading in their practices for employee status in rapidly growing provider networks usually based on a local hospital system.

Let me show you how this move sets up an invisible Battle that will determine your quality of life … and how to restore Balance as an employee physician.

As the ink dries on your new contract with MegaHealthCorp, realize you have just entered into a ceaseless battle with forces you don’t recognize until you are firmly in place as an employee. The week to week skirmishes in this battle will determine a number of things:

- Your quality of life
- The quality of your practice
- Your level of stress and burnout
- And how much of you is left when you get home after a day in the office or hospital

I am talking about the hidden Battle Between Physician Burnout and the Bottom Line

You might not see these two as intimately connected at the moment ... I assure you they are. And there is a third factor in play ... the new Referees. These Referees are the ones who set the rules under which the clash occurs ... rules they make up and you must obey.

Now the referees are your CEO and your immediate supervisor but it didn’t used to be that way.

In Private Practice:

You or a committee of your peers would set policies, call schedules, reimbursement formulas ... all the rules under which you would see patients and (hopefully) turn a profit in your business.

With physicians as referees in the battle ... you had an intimate understanding of the stress and burnout these systems caused. You made sure things did not get too out of whack ... that you did not ask too much of the people in the system.  

And in private practice, your ability to change things was in your hands ... you could move quickly when things did not go as planned or the systems began to take a toll on you and your people.

describe the imageAs an Employee:

You are no longer a referee in this battle. You traded in your ability to set the rules of the game and now you are simply a Pawn inside a bureaucracy. 

In many cases, the ultimate referees are not even doctors and have never taken care of a single patient.

Policies and procedure decisions are now made with a single consideration ... Profit / The Bottom Line ... often with complete ignorance or disregard of the workplace stress and burnout these decisions cause.

The Battle is On

And I can say from working with hundreds of overstressed physicians this year alone ... that the ultimate winner of this battle is unclear at this moment.

It does not matter whether your CEO or immediate supervisor are simply unaware of the working conditions in the front line or actively do not care about the health of the providers ... the results are the same; overstressed and burned out doctors and other providers reduced to simply complaining about the way things have changed and their apparent inability to control their work day.

This does not have to be a Battle at all

What is needed is Balance

physician burnout prevention with balance between patients providers and profits

The only way to create a healthy organization in healthcare is to trade in the current BATTLE for a consciously crafted BALANCE between these three interests.

1) Profit
2) Quality Patient Care
3) The Health and Happiness of the Providers in the system

The Laws of Physician Energy are clear. You can't give what you aint got.

If your energy levels - physically, emotionally, spiritually - are below zero, you cannot be available for your patients, your care quality and patient satisfaction will suffer, your quality of life will be poor and your family will bear the brunt. 

The health of the providers must be taken into consideration when making decisions on work flow issues in the front lines.

This is the source of the Balance we are all seeking.

When I use the work "providers" here I mean everyone in the organization, from the front line docs, nurses, PA's, NP's, MA's, receptionists, NA's all the way through your administrative staff and the leadership team.

If your organization is not focused on the health of your people ... how in the world can you promote and support health in your patients.

Who Will Power this Shift ? 

It has to be the Physicians

We are the only ones who can see the whole system in play on a day to day basis. The organizations where the Battle between Burnout and the Bottom Line is hurting the providers ... are the ones with the largest physician leadership vacuum.

If ethical, responsible physicians with clinical experience are not well represented at the Board Table in your organization ... you are in trouble.


I have seen organizations of over 350 physicians ... formed in just the last five years ... with a single physician representing them to the Board. Many of the doctors in this group have never had a one on one conversation with this CMO. That is the definition of a physician leadership vacuum.

If the physicians cannot organize, install a functional leadership structure independent of the administration org chart ... and take their rightful place at the Board Table to exercise meaningful influence over the key decisions going forward

... you will be stuck fighting the Battle instead of creating the Balance that is required.

The Conundrum

All is not lost.

In my experience, most non-physician administrators would much rather deal with a strong physician leadership team. One that

- represents the doctors and speaks for them
- comes to the board table with solid positions and requests for support
- speaks frankly about the conditions in the front lines and the clinical implications of policies being discussed

This kind of solid leadership is much preferable to their current experience of trying to get the "herd of cats" that is their physician employee pool to quit whining and come to the leadership meetings.

The Bandwidth Issue:

I want to be completely honest with you here. In order to move from Battle to Balance, you will have to participate in leadership activities that are in addition to your patient care responsibilities. In most cases you will not be compensated either … until you have a seat at the board table and can make sure leadership is valued and fairly compensated in your organization.

This is an investment in a better future for you and your colleagues in the front lines. If you are feeling called to action by this article, I hope you have the bandwidth to take it on.

First Steps to Balance

a) If you have a meaningful physician leadership structure ...
participate in the committees, give your opinion, offer to represent your department up the chain of command, stay in touch with your colleagues.

b) If you do not have an existing structure ...
it is time to organize your physicians. It all starts with you and your department. Do you have a monthly staff meeting? If not, start one now. Get your people to take on the issues you are seeing in your work day. When you need support from above ... ask for it clearly and as a representative of your wing or department. Get the physicians in your group in other departments to do the same. Create a wing/department meeting structure and grow your physician leadership team from the inside out. When you are ready, ask for a seat at the decision making committee table in your organization.

It is up to the doctors to lead Healthcare to the Balance that will assure the survival of your organization and the health of the doctors and everyone else inside the system.

The time to act is now or this Battle will just keep raging - and you know which side will ultimately Win.

[please contact me for specific recommendations on how to get started]


Please Leave a Comment

  • What role do you play in the leadership of your organization?

  • Is your workplace one where you are in Battle with the Bottom Line – and, if so, how are things going?

  • If your workplace has some healthy balance, how were you able to achieve it?



Tags: physician burnout prevention, Dike Drummond MD, Physician Burnout, Physician Leadership