Back to basics for bashing burnout

I recently created 2 documents outlining expectations for physicians: one addressed professionalism and the other productivity.  The intent was to articulate what is needed as a baseline from each physician, and point out the importance of discretionary (extra) effort for us to be successful.  Acknowledging and thanking those who go above and beyond on a regular basis was essential to this exercise.

The activity was undertaken because of complaints from a number of colleagues about low productivity and poor professionalism among a few; this small minority was threatening the joy and pride in work of those many who go above and beyond.  Although obvious but not always front of mind is the connection of professionalism and productivity to burnout – the more individuals in the workforce underperforming in either, or both, the higher turnover, the lower overall engagement, and the more likely burnout will occur.  The underperforming few can drag the hardworking majority down.

As leaders we know clarifying expectations is important.  It sets the bar, and it also provides the opportunity for us to remind those pushing themselves way beyond the bar to cut back and strike a healthier balance.

Expectations need to be clear before people can be held accountable, self-reflect and resolve to improve where appropriate, whether it be on one’s balance, commitment or focus.  The under performing who feel burned out despite doing the minimum need to improve efficiency and cut out activities that aren’t aligned with what is needed (i.e. essentialism).

The explanation of professionalism I drafted centered on the following principles:

Respect for the voice and value of others – listen to learn and understand; value others contributions.

Kindness – speak with humility and respect, not dogmatism or for the purpose of demoralizing another.

Focus on the mission and core functions of the team; avoid drama, avoid drawing attention to oneself unnecessarily.

Professionalism – balanced and non-judgmental communication; courage balanced with consideration

The explanation of productivity centered on the following:

Time– >50 hours a week on average outside of night call is almost always needed – professionals who need to work less than this may need to go part-time.

RVUs– a starting place for reflecting on efficiency and contribution – it’s not a 4-letter word, but it is an imperfect measure, and needs to be taken in context.  Yet its needed because it’s too easy (and very human) to be biased about how hard one works.

Discretionary effort for certain committees, projects (e.g. quality improvement) and activities (e.g. teaching) is a must for us to be successful.  Yet one must feel that this work is meaningful and making a difference.

Triaging– invariably individuals and teams need to prioritize their activities, schedules, patient care, phone calls, who and what they teach, etc.  We can’t do it all.

Still a work in progress, yet it does drive a good dialogue.


Is Servant as Physician and Leader a Dead Concept?

Servant leadership: I’m concerned it’s dead.  It’s been suffering a deep malignancy for years, and it seems to be reaching the terminal phase.  The profession of medicine is dying along with it, because of the indivisible link between the two.  What happened?  Greed? Arrogance? Apathy? A decline in responsibility and ownership?

One possibility is that it was never alive to begin with, but merely an illusion.  I can’t name one doctor or leader I’ve met or been mentored by over the past 25 years I would like to be like.  There are those who have attributes I admire, and those who have attributes that I share, but none who I aspire to be.  Thus, I can only conclude that servant as physician and leader has always been and remains a rare anomaly.

Another possibility is that there is no energy or time to acquire the knowledge and skills or for the reflective listening needed to expand the awareness required to be a servant as leader and physician.  The lack of time has many contributing factors: the increasing complexity of practicing medicine, the immense breadth and depth of knowledge required, and the increasing amount of time required for EHR documentation, insurance-related administrative tasks, and various regulatory and licensing requirements.  A more positive reason for the lack of time is the shift to valuing wellness and balance if not synergy in one’s life, as well as the importance of being present with one’s family if you’ve decided to raise children.  Thus, some things had to go and among them were taking the time to learn the skills and behaviors to be a servant physician leader, and executing them on a regular basis.

A common root cause of both possibilities may be the lack of value individuals and society as a whole give to the concept of servant leadership or servant as physician.  Today there are conflicting priorities. One is forced to choose, often choosing with a natural self-centered bias.

Physicians often complain about RVUs, work hours and compensation; many want to make more money then complain about the focus on RVUs, which is how physicians get reimbursed.  Almost universally money eventually wins in this generative tension. What happens is that the physicians drive (perhaps unknowingly in some cases) an increasingly more efficient system designed to optimize revenue.  The resulting culture is: if a physician isn’t going to get paid for doing it, they won’t do it as much, or as well, or even at all.  Servant leadership often takes time and energy that has no RVUs attached to it.

I don’t have a cure, and it may already be dead.  I fear this lonely dream of servant as physician and leader will forever be securely stuck in the corners of my imagination.