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Jun 22 2018

Getting at the root causes of physician burnout

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Image for Getting at the root causes of physician burnout Recently, the Charlotte emergency medicine group of which I am president agreed to be the first medical practice in the state to try out a new program offered by the NC Physicians Health Program (NCPHP). Over the next several months we will open the practice up to NCPHP’s team, which will do a top-to-bottom analysis to assess how “burned out” our physicians are, and how “burnout inducing” our organization is. We’ll receive a report and recommendations for improvement, and a check-in after one year to see how things have changed (hopefully, for the better). With emergency medicine perennially at or near the top of the list of specialties most affected by burnout, it was an easy decision to debut NCPHP’s new service.

Discussions of physician resilience so often focus on self-care – taking vacations, getting regular rest and exercise, eating well, building healthy relationships. And while those things are critically important, they are not the only solution. To really make progress towards resilience, it’s time to start addressing the root causes of burnout, as well as dealing with the symptoms.

Think of it this way: If you keep stepping on tacks, you wouldn’t just pull them out and treat the wounds, you’d clean up the floor so you stop stepping on tacks. Identifying challenges and solutions at the practice and system levels is a similar preventive approach. When you consider that as much as 90 percent of burnout may be driven by factors outside of the physician’s control, this approach makes even more sense. The most common drivers include staffing levels, long shifts/work hours, mounting administrative duties, electronic health records and a general sense of loss of autonomy over patient care (due to system- or practice-level policies).

Now, I happen to think that my practice is already doing a lot of things right when it comes to confronting systemic drivers of burnout. Over the years we have been thoughtful and deliberate in building a professional environment that frequently results in long, productive and healthy careers. For example, we have maintained local control over staffing and compensation decisions so our physicians have direct input into their workload, shift length and pay formula (e.g. how much is based on productivity and how much is based on a set hourly rate). But no organization is perfect.

I’m looking forward to receiving an independent assessment of what we’re doing well, and where there may be opportunities to improve. As president of the practice, I’m hopeful working with NCPHP will identify blind spots, lead to strategies that set us up for even greater success, and improve our relationships with the hospitals we staff.

Over time, I believe the practice’s commitment to setting its clinicians up for success may even help us recruit and retain talent in one of the state’s most competitive physician labor markets.

I am glad to say that NCMB also recognizes the need to look beyond self-care to make headway in physician resilience. The Board is in the process of planning, with the NC Medical Society (NCMS), NCPHP and other partners, a wellness summit that will bringtogether hospitals, health systems, and other large physician employers to discuss ways to reduce systemic drivers of burnout. This meeting will take place immediately before NCMS’s LEAD Health Care Conference in Raleigh Oct. 18-19.

The Board can’t fix the root causes of burnout, or compel organizations and employers that have a more direct role in those causes to improve their processes. What we can do is acknowledge the problem and be a catalyst for discussion and change. NCMB is committed to filling this role whenever possible.

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