We know that burnout is a deeply-rooted problem within our healthcare system. Yet, the term ‘burnout’ has received some backlash from different healthcare professionals online. Burnout has been a well-defined construct for over 30 years- it consists of emotional exhaustion, cynicism, and decreased self-efficacy.
What has happened is that the term ‘burnout’ has been frequently misused to deflect the causes and responsibility of burnout from the organization/system to the individual. Burnout is a byproduct of working in a dysfunctional system with unrealistic expectations placed on individuals. This can look like many different things, including sky-high productivity numbers, or a mismatch between the employee’s values and the organization’s values, or insufficient rewards (i.e. everything can look great on paper, but you are not being appreciated or recognized for your work).
I chat with Dr. Robert Pearl MD (see his full bio here) about the deeply-rooted causes of burnout in healthcare on the Burnt Out to Lit Up Podcast. Here are the golden nuggets/takeaways from our conversation:
BURNOUT FROM A BROKEN SYSTEM
The American healthcare system has no CPT or ICD code for compassion. There is no way to bill to be with a family in their most difficult and trying moments. That lack of economic incentive is representative in many ways our healthcare system is broken today according to Dr. Pearl. The current US healthcare system is fragmented, and healthcare professionals are unconnected with each other.
The way the system is currently structured is as follows: the more you do, the more you get paid. Whether if it’s any good or not, it doesn’t matter. No one would call a contractor to come to fix their bathroom and tell the contractor: “Do whatever you want! I’ll pay you time and materials after.” Yet, that is how our system functions. Other problems in healthcare include technology that is outdated in healthcare and a lack of clinician-led leadership structure.
To sum up healthcare’s challenges:
- Care is not integrated between physicians
- Paid on a piecemeal basis
- Technology is outdated
- Leadership doesn’t exist in the way it should within a business context
According to Dr. Pearl, changing physicians will be the most difficult move. Physicians aren’t the only issue, but it’s the most problematic, and there is a big gap between what’s needed and what needs to be in place. Over 40% of physician report burnout compared to 26% of the rest of the job market place. Dr. Pearl breaks down the problem in three pieces:
- Systemic issues
Demands are going up all the time 80-hour work week for physicians is actually a reduction in hours (it used to be over 100 hours a week). The cumbersome electronic medical record (EMR) adds to the burden of clerical work. The world is advancing, but the healthcare system is slow to catch up.
- Suffering of patients
Half of people in the United States cannot afford medical care according to Dr. Pearl. Clinicians are struggling with the workload, and burnout AND moral injury can both be present. When patients can’t get the care they need
- Cultural clash
The culture in healthcare involves the stories it tells, the hierarchy it creates, and the medical cultures left over from the past. Medicine values individual experience and intuition. Patients are better off with an evidence-based approach, yet that conflicts with the way physicians want to see themselves.
We value the physician specialist that comes in that does a heroic measure more than a primary care physician. End of life care, opioid addiction, an evolving definition of sexuality, gun violence, climate change are issues that physicians are NOT trained in, but are evolving in our society.
CHANGING CULTURE THAT IMPACTS BURNOUT
Dr. Pearl describes the shift to isolation and fragmentation within healthcare. He points out that primary care physicians are hardly seen in hospitals anymore. There is a great sense of isolation and loss felt within the system, which impacts patient care due to that lack of a supportive culture.
Culture is passed down from generations, which is true in medicine. The problems that exist now culturally are ones that got passed down and is something physicians can’t overcome now to provide the care that’s there. Physicians have learned to deny and repress. End of life is often more torture than treatment, and physicians are trapped in a culture and don’t know how to get out.
This creates a sense of being a victim. Dr. Pearl believes that physicians and all clinicians need to take accountability and be innovators and changers of care. If it doesn’t happen, the problems will only continue to worsen.
People with a fixed mindset give up easily, whereas people with a growth mindset believe in a learning process and the opportunity for growth. This can apply to how we work as healthcare professionals. How can we work as a team vs. how can we work harder comes from a growth mindset. Context shapes perception and changes behavior.
Dr. Pearl advocates for integration between specialities so that physicians don’t just meet the minimum standards, but meet the highest standards of care so that patients can receive the proper care they deserve while decreasing medical errors. He advocates for paying physicians on a capitated basis to help them take accountability for prevention because the incentives are aligned. He stands for advances in technology that actually works that allows effective communication between healthcare professionals (i.e. NOT a fax machine) to allow for a more seamless, integrated care. Lastly, an ideal healthcare system enables strong clinician leadership and focuses on rebuilding a new and improved culture.
Connect with Dr. Pearl:
Take Dr. Pearl’s survey: https://robertpearlmd.com/
Listen to Dr. Pearl’s podcast: https://fixinghealthcarepodcast.com/dr-robert-pearl/
Dr. Pearl is the author of Mistreated: Why We Think We’re Getting Good Health Care-and Why We’re Usually Wrong. You can find it here.