Oftentimes, physicians are healing others at risk to their own health.
Not only do 51% of US physicians face burnout, a rate which is 15 times higher than that of other professionals, but many physicians view an increase in their own resiliency levels as the only solution to this ongoing problem. By increasing their tolerance to burnout, many doctors believe that they can keep up their current pace while avoiding the issue of accessibility—which I argue is the underlying cause of physician burnout.
Outsider Expectations vs. Physicians’ Needs
The high expectations regarding accessibility by patients, healthcare leaders, and others is concerning in light of this physician burnout trend. In addition to managing bureaucratic paperwork, non-compliant behaviors, burdensome administrative duties, and decreasing reimbursement, physicians are also often expected to be available for patients 24/7.
In many ways, doctors are instructed to be “always on”—an expectation which is far from reasonable.
Rather than looking for solutions to the ensuing burnout, however, they tend to accept it as an unavoidable occupational hazard. Instead of eliminating the causes, many physicians strive to become more efficient or build mental robustness to avoid burnout. However, in my experience, I’ve found that a solution that depends solely on improved resiliency will likely be short lived and largely ineffective.
Finding a Cause-Based Solution
In order to address the high levels of physician burnout, the core causes must be evaluated, managed, and when possible, addressed. Unfortunately, removal of the main reasons for burnout requires physicians to step back from what they feel to be their primary obligation to patients: high levels of accessibility.
In other words, physicians can be effective for a few by limiting their accessibility and combatting burnout, or they may be ineffective for many if such burnout is left unchecked. Thus, the difficult question that physicians must answer is whether they will tolerate the core causes of burnout or, instead, proactively eliminate the stressors.
To effectively identify and manage the sources of physician burnout, the patient–physician relationship itself must be understood. It is natural that, during medical uncertainty, patients may become particularly self-involved. In such times of crisis, they may not be able to recognize the demands that they, along with the physician’s other patients and healthcare structures, are placing on their hardworking caregivers.
Individual patients are only aware of the demands they make on their physician personally, meaning that an extra half-hour or so may not seem like a big deal. However, they often fail to realize that such access occurs as part of the aggregate demands from a physician’s entire patient base. What they don’t appreciate is that even five minutes here and there can quickly add up to an unhealthy workload.
The Answer: Decreased Physician Accessibility
As patients become increasingly dependent on their physicians, unlimited access to one’s doctor contributes to a growing dependence. This pattern then develops into an unsustainable relationship whereby patients may expect 24/7 access to their physicians.
To break this cycle of overwork and burnout, physicians must restrict patient accessibility. Of course, this is far from an easy task: to do so is not only a difficult decision for physicians to make but an equally difficult one for them to manage. However, if left unresolved, this excessive availability may lead to increased physician burnout rates, cases of medical error, and instances of patient harm.
According to the self-determination theory of motivation, there exist three universal needs: autonomy, competence, and relatedness. However, physicians are notably more motivated by relatedness, the desire or obligation to have a positive and supportive relationship with others, than autonomy or competence.
Doctors’ need for relatedness includes an obligation to one’s community or group of patients. This sense of responsibility may explain the excessive physician availability afforded to patients by doctors themselves.
A Competence-Driven Approach to Healthcare
I believe that the corrective action of decreased accessibility on the part of physicians is a paradigm shift. I argue that doctors and healthcare structures should support competence as the primary source of physician motivation rather than relatedness and the way it is most often enacted, through accessibility.
When competence becomes physicians’ primary motivation, they will begin to limit the number of patients they can safely and effectively care for, as well as the amount of time and energy they allocate to each person. To avoid causing harm to their patients and themselves, physicians and healthcare structures should shift the paradigm to focus on higher efficacy levels for a few rather than ineffective care for the masses.
In short, I argue for a focus on quality-based rather than quantity-based care.
Rod Brace, Ph.D., is a healthcare executive, executive coach, speaker, and author on topics related to leadership and high-reliability organizational development.