Beating Burnout Through Engagement

Neil J. Farber, MD, FACP
SullivanLuallin Group

Recent surveys show that at least 50% of physicians currently exhibit symptoms of burnout.The stressors contributing to their burnout include EHR and patient portal work, governmental pressures (such as CURES, i.e., reporting the use of opioids and benzodiazepines by patients in California), payor required prior authorizations for routine therapeutic and diagnostic procedures, medications, etc., and ever more demanding patients.  It is no wonder that many physicians are either leaving medicine or reducing their hours. The result is increased difficulty recruiting and retaining physicians, particularly in primary care and emergency medicine.

More Respect, Less Burnout

However, while these factors are among the major causes of physician dissatisfaction, more striking is the loss of the value and respect doctors once had as a matter of course.  Physicians are expected to work longer hours, see more patients, and complete additional tasks with less recognition and input into their work environment, all the while receiving less or at least no more pay.  These conditions would cause a decrease in worker engagement in any work environment.

Unfortunately, when a physician retires or leaves a practice, it negatively impacts patient care as well as the group’s revenue:   it is estimated that for every physician who leaves, the organization pays two to three times the departing doctor’s salary for recruitment, ramping up, etc.2  the new hire.

Relationships with Leadership is Key

There is one aspect of this problem that often goes unrecognized.  The relationship between doctors and their immediate physician supervisors plays a major role in overall clinician satisfaction and burnout.  Shanafelt et al 4 found in a survey of 3,896 doctors that ratings of physician supervisors inversely correlated significantly with burnout and satisfaction rates.  For example, those respondents who reported their physician leader favorably in “treats me with dignity and respect,” showed a lower burnout rate, 38%.  Whereas those who rated the leader unfavorably in the same dimension, had a greater level of burnout, 56%. In another example, physician satisfaction was very high (85%) when leaders were rated favorably in the dimension, “is interested in my opinion.” By the same token, nearly half of the respondents (48%) were dissatisfied when the leader was rated unfavorably in the same dimension.

The study also showed that for only a 1-point increase in the physician leadership favorable ratings there was a 3.3% decrease in physician burnout and a 9% increase in physician satisfaction.  Notably, most of these factors in the scale related to communication between the physicians and administrators.

As a practicing general internal medicine physician in large heath care institutions for forty years, I can attest to the burnout, dissatisfaction, and discouragement my colleagues experienced when there were problems in communicating with administrators.

The SullivanLuallin Group Approach

At SullivanLuallin Group we believe that a program which helps align the values, expectations, and priorities of physicians and their administrative leaders is an effective strategy for improving physician satisfaction and reducing burnout. The approach uses a series of brief, focused round table discussions attended by both administrators and physicians.  The round table agenda is determined ahead of time from input provided by interested clinicians and their leaders.  Also considered are the issues of greatest importance to the organization.

To ensure that the agenda is followed and the round table meetings are productive, an outside, objective facilitator is usually brought in to help guide the dialogue and provide a report of issues discussed and resolved.

We believe that this type of program more fully aligns the values of administrators with those of the physicians.  It is particularly helpful in engaging physicians in problem-solving the challenges facing all members of the healthcare delivery team.  Decisions made in this fashion take into account the interests of both physicians and their leaders and help to address and reduce the problem of burnout affecting so many physicians today.

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  1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014.  Mayo Clin Proc. 2015; 90: 1600-1613.
  2. Atkinson W, Misra-Herbert A, Stoller JK.  The impact on revenue of physician turnover: an assessment model and experience in a large healthcare center.  Med Group Manage J.  2006; 21: 351-355.
  3. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being; nine organizational strategies to promote engagement and reduce burnout.  Mayo Clin Proc.  2017; 92: 129-146.
  4. Shanafelt Td, Gorringe G, Menaker R et al. Impact of organizational leadership on physician burnout and satisfaction.  Mayo Clin Proc.  2015; 90: 432-440.