Physician Leadership can cause Physician Burnout

Posted by Dike Drummond MD


physician-leadership-physician-burnout-cause.jpgPoor Physician Leadership is a cause of Physician Burnout

A new study provides evidence for a direct link between the physician leadership skills of your boss and your level of physician burnout and satisfaction.

In this article we will dissect the study and look at an even worse scenario than a bad boss - yes it can get even worse.

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There is a widely accepted saying in business,

"People don't quit the company, they quit their boss."

It hints at the importance of your immediate supervisor - and their leadership skills - in your job satisfaction and burnout. There is no difference when your job is that of a practicing physician. Here is the truth ...

A bad physician leader can burn out the doctors they supervise

If your boss' leadership "skills" are abusive, inadequate or completely absent, it will cause you pain. Sometimes these same leadership skills can drive you right out of your practice. It would appear that even doctors don't quit the company, they quit their boss.

When you read this, it may strike you as the "DUH of the week" - a no brainer that is obvious in hindsight. Up until now though, we had no evidence this connection was also true for front line physicians in a healthcare organization.

physician-leadership-quadruple-aim-dirty-little-secrets-the-happy-md_opt400W


Now we have solid evidence of the leadership - burnout connection via a recent study from the Mayo Clinic

mayo-clinic-proceedings-physician-leadership-and-physician-burnout

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Impact of Organizational Leadership on Physician Burnout and Satisfaction
Shanafelt, T, et. al.
Mayo Clinic Proceedings April 2015, 90:4;432–440

Full PDF download is here:
http://www.mayoclinicproceedings.org/article/S0025-6196(15)00071-3/pdf 

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Summary and Comment:

3896 practicing physicians in the Mayo Clinic system were surveyed regarding ...

a) Burnout

b) The leadership skills of their immediate supervisor
Physicians were asked to rank their boss' skills in 12 specific leadership dimensions on a 5 point scale. The top score a boss could obtain was 60 points. 

RESULTS:

  • 70% responded to the survey
  • 40% had at least one symptom of burnout
  • 79% were satisfied or very satisfied with their job

Quadruple-aim-physician-leadership-retreat-physician-burnout-the-happy-md_opt400W


Then the other shoe dropped

Here are quotes from Tait Shanafelt MD, the lead author and a well known researcher in the area of burnout prevalence.

 

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“The leadership qualities of physician supervisors have a direct impact on the personal well-being of the physicians they lead. 

We found that at the work-group level, 11 percent of the variation in burnout and 50 percent of the variation in satisfaction among physicians was attributable to the leadership qualities of their supervisor.

After adjusting for age, gender, length of employment, and specialty area, for every one-point improvement in the 60-point leadership score there was a 3.3 percent decrease in likelihood of burnout and a 9 percent increase in satisfaction."
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Half the variation in physician satisfaction was due to the leadership skills of their boss

Physician leadership was also directly related to burnout

So the leadership skills of your boss now becomes the 5th cause of burnout, joining ...

  • The practice of medicine
  • Your specific job and its unique stress profile
  • Having a life (or not!)
  • The conditioning of our medical education


But wait, there's more ...

This study looked at physicians in a mature delivery system. When it comes to leadership structure and the arboreal branching of the org chart, the Mayo Clinic is probably the top of the heap in the healthcare industry. 

Most physicians are not so lucky. Most of us are not practicing within a mature, sophisticated leadership structure. What this means is ...

This study is looking at a best case scenario. Things can be MUCH WORSE

The BIG Three

In my experience coaching hundreds of burned out physicians, there are three situations where physician leadership is a major source of stress and cause of burnout. Hopefully none of the descriptions below feel familiar to you.

In these situations you are in trouble even if you learn how to manage your boss

physician-leadership-causes-physician-burnout_opt-300W1) The Poor Leader

There are multiple "flavors" of poor leadership skills here.

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The communication vacuum:

The leader who goes to the leadership meetings and that's it. You supposedly are being represented at the Executive Committee or equivalent body, but your representative never asks for your input or tells you what is going on. You spend your days on your gerbil wheel while you are completely in the dark about anything going on outside your three exam rooms.

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The "what did I do now" leader:

This leader only shows up when there is a problem or you are in trouble. As soon as you see her/him your shoulders slump because you know its bad news. Never a thank you or "good job". The less you see of this one the better.

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The General Patton:

They take their "doctors give orders" programming to the extreme. They treat you like they do a nurse or orderly, barking orders and expecting rapid obedience. At the worst, these are classic bullies, intimidating all who get within earshot.

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Quadruple-aim-physician-leadership-retreat-physician-burnout-the-happy-md_opt400W


physician-leadership-dike-drummond-cause-of-physician-burnout_opt-300W.jpg2) The burned out leader

In my experience, approximately 60% of physicians in leadership positions get there because they burned out of their clinical practice.

This is the classic 55 year old male medical director who jumped at the position when it opened up simply because it gives him a break from seeing more patients.

This physician is completely unqualified for a leadership position for one simple reason - being a clinician and an administrative leader are two completely different skill sets!

This doctor's rise to a leadership position is the classic "Peter Principle". Simply stated, "Managers rise to the level of their incompetence".

Here's that dark little secret: Physician burnout is a tried and true path to a physician leadership position. 

This does not mean that same physician won't ever become a high quality leader, however, to become a good leader, they would need to actively engage in leadership development training for a sustained period of time.

 

physician-leadership-vacuum_opt-260w3) The missing leader

This is often the worst case scenario and a classic sign of the immaturity of your organization. This situation often arises in quickly growing employee physician groups. The story often goes like this.

8 years ago you were in a 15 physician practice where you knew all your partners, had strong leadership and you were an owner of the group.

4 years ago your group sold out to one of the local hospitals. When that happened and you became an employee of the hospital ... you counted on that hospital "mother ship" to take care of you.

Your group relaxed its leadership structure believing that your employer would supply all the leadership you need. You were assigned a new office manager. 

  • Your employed physician group is now 140 physicians and 30 APP's.
  • You still work in the same office. The administration offices for your employer are across town.
  • You have a new CMO, who was recruited from outside the community.
  • You have never met this person.
  • You don't have a medical director or a designated leader in your office or your service line.
  • You are having a major issue with your Office Manager that is directly effecting quality patient care, but no one is listening to you.
  • You suddenly realize you have no boss.There is no one to go to bat for you now that you really need them.
  • You are referred to HR.  
  • HR says you are being disruptive and puts you on probation

THAT is the worst case scenario

I have seen this play out multiple times. It is the worst case scenario. This always occurs in groups of employed physicians that have formed rapidly in the last several years.

[ Click Here for the "Disruptive Physician's Toolkit" ]

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The answer to all these problems is high quality physician leaders

Here are the keys to building a skilled physician leadership team.

  • Pick them with a skills based selection process
  • Train them by providing the people skills training they need to do their job well. NOTE: this is not an MBA. 
  • Mentor them / Coach them / Groom them
  • Measure them using a system that gives them real time feedback on the performance and morale of their direct reports. The leadership skills inventory in the referenced study above is a fine place to start.
  • Provide them with burnout prevention education and support. Physician leaders are at high risk for burnout and it is critical they be able to recognize and prevent burnout in their direct reports.
  • Place them in a strong physician leadership structure on equal footing with the lead administrators. Ideally you have qualified physician/administrator dyads in all geographic locations, departments or service lines.

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Your Last Resort

Learn how to manage your boss and hope for the best. You CAN learn to manage your boss more effectively. Even then you will eventually run up against the limits of their physician leadership skill set.

We sincerely hope you have a good boss - one who acknowledges your hard work, helps inject some clinical sense into the systems of care in your group and has your back when you need their help.

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PLEASE LEAVE A COMMENT:

What are your top recommendations for high quality physician leadership skills?

 

Tags: Physician leadership and physician burnout


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