American medicine is facing an epidemic of physician burnout that threatens the overall quality of healthcare. Unhappy clinicians are bad for patients and for business, leading to an estimated $5 billion in losses annually due to turnover, reduced clinical hours and inefficient care, according to an analysis by investigators at Mayo Clinic, Stanford University School of Medicine, the American Medical Association and other institutions. This predicament takes on great urgency as the nation confronts a shortage of primary care physicians and specialists that is expected to worsen in the coming decades.
Some healthcare scholars argue that modern physicians aren’t burned out but are experiencing “moral injury” from the difficulties of providing care under unyielding demands for greater productivity and burdensome administrative tasks driven in part by tightened scrutiny from insurers and government agencies that regulate the treatment of patients.
This distinction is important: A diagnosis of “burnout,” like that of “shell shock,” may imply a personal failure. The stigma can lead to baseless assumptions about individual physicians lacking the necessary tenacity, resilience or grit to succeed in a challenging profession. This hypothesis is shaky, especially when considering the rigor required to get through years of medical school, residencies and other training. Most doctors are high achievers who go into medicine because they want to help and serve. The system they enter often interferes with their good intentions by underinvesting in the physician workplace and opportunities to cultivate social connections that support a healthy and invigorating professional community.
Based on decades of combined clinical and leadership experience, we argue that the key to greater professional satisfaction rests not in individual assistance but in targeted social interventions that promote a rewarding personal experience in the places we provide care. This is even more imperative as the practice of medicine becomes increasingly technical and intense, requiring physicians to juggle patient care with onerous paperwork and red tape. As a thought exercise, consider the major resources world-class sports organizations devote to equipment, training and other activities that reinforce the communal fabric of the team. It is the rare hospital or outpatient practice that prioritizes similar environmental investments to build a sense of belonging. Contemporary medical practice is a team sport if there ever was one.
Understandably, financial stressors often lead hospitals to concentrate funding and resources on those things that contribute directly to the bottom line. While it would be wrong to argue against thoughtful budgetary management, it is well-recognized that hospitals too often reduce costs in ways that pull clinicians from the purpose-driven work that drew them to medicine. When support staff are cut, physicians are required to spend more time doing relatively unskilled tasks, such as anesthesiologists transporting a patient into the OR or surgeons spending excessive time on a computer performing clerical and non-patient facing tasks.
In fiscally challenging circumstances, the “soft” social fabric of the workplace is always an attractive target for budget reductions. First to go is money for educational courses to gain individual expertise or service time off to allow attendance at professional conferences. Next are the investments for off-site activities where colleagues can spend time with each other in a social and pressure-free setting. The overall effect of these cuts is subtle but powerful: The collaborative culture of the institution is undermined incrementally over time, depriving physicians of important opportunities to connect and re-energize.
We see many opportunities to reduce physician unhappiness. Modest investments can strengthen the work environment, optimize social integration and enhance a sense of shared purpose. The cost of a yearly retreat is a small price to pay to ensure that individuals work productively and efficiently in teams to prioritize the organization’s mission. Less formal interdisciplinary meetings can encourage stakeholders to collectively examine problems specific to their daily work and consider not just technical challenges but also the social context in which they occur. These activities break down tribal silos between caregivers, such as those between physician groups (e.g. surgeons versus anesthesiologists) or other caregivers (e.g. physicians versus nurses). Such opportunities also help reduce the potential blame game with one group of clinicians suggesting that another group could perform their work better, smarter or faster.
Creating forums for more social interaction does require time and effort but little if any money. Such investments not only improve morale, engagement, retention, efficiency and collaboration, but signal to physicians that institutions value their opinions while encouraging innovative solutions to healthcare challenges. By participating, physicians become empowered stewards of their wellbeing and their institution’s future—and not commodities “managed” by bottom-line oriented bureaucracies.
A resilient, motivated and robust physician workforce is essential to sustaining excellence in healthcare. Investments in the social environment should be prioritized to improve productivity amid budgetary constraints. The costs are modest and are outweighed greatly by the benefits in morale and performance of physicians and staff. The quality of healthcare depends on a commitment to physician wellbeing. Our patients deserve no less.
Michael Nurok, MD, PhD, and Bruce L. Gewertz, MD, are academic physicians at Cedars-Sinai in Los Angeles
