Physician burnout is prevalent, spanning all medical specialties. A January 2024 Medscape report noted 83% of physicians surveyed said their burnout comes directly from the day-to-day stressors they encounter in their work at various healthcare organizations. Although healthcare leaders are certainly aware of the issue, they can be far removed from the realities of patient care and might have significant blind spots in understanding the extent of clinician burnout and its ramifications.
Blind Spots in Understanding Burnout
Despite their good intentions, leaders often lack a deep appreciation of physicians’ journeys, their workloads and their lack of time for vacation or paid time off. This potentially leads to more physician burnout and the further distancing of administrators from their clinical teams.
Fernando Triana, MD, medical director of cardiovascular services at Methodist Healthcare in San Antonio, observes:
“Very often I find that the physician journey and workload are not well understood by healthcare executives. Typically, a physician is expected to work in a hospital setting at least one weekend out of the month. Traditionally, we have referred to those hours to work during the weekend as being ‘on-call,’ implying that the physician is available if needed. This is very far from reality. The actual requirement is for the physician to leave their home and accomplish a series of tasks, such as rounding on patients in the hospital and evaluating patients that come to the emergency room. The reality is that physicians are committed to a certain workload during these ‘on-call weekends,’ and that workload may vary from as little as 10 hours to as many as 40 hours during a single weekend.”
In addition, administrators often are not aware of how little personal time off many physicians have. Recent research conducted by the American Medical Association, in collaboration with several universities and health systems, revealed that some physicians hesitate to use some or all their vacation days. Their reasons included financial concerns and the inability to find another physician to cover their patients while they are gone. The study, which appeared in the Jan. 12, 2024, issue of JAMA Network, showed that one in five physicians take five or fewer vacation days each year.
To their credit, most healthcare organizations have developed burnout reduction programs that aim to improve resilience. Unfortunately, many of these programs unintentionally make physicians feel that burnout is their fault. The programs tend to focus on overly simplistic solutions, such as deep breathing and meditation, while not realizing that physicians feel as if they are the proverbial canary in the toxic coal mine: If the environment around them doesn’t change, their burnout is not likely to change.
Physician burnout, however, can be lessened a great deal when we systematically take the time to understand what they go through day in and day out. This approach can build trust and make physicians feel appreciated and noticed, which can build and strengthen relationships between executives and the organization.
As an executive coach that has worked with dozens of physicians, I have found that most physicians just want better understanding and appreciation by administrators so that they can serve their patients more effectively.
Shadowing: An Effective Approach to Reduce Burnout
One important way to help better understand physician challenges is shadowing them. Paul DeChant, MD, a national expert on physician burnout and principal/co-founder, Organizational Wellbeing Solutions, believes shadowing physicians is the simplest and most effective strategy to better understand their burnout:
“There are few approaches that are more effective at eliminating information deficit between administrators and physicians than direct observation by shadowing physicians while they work. When done carefully, with preparation and a supportive intent, shadowing also builds the trusting relationships that are key to engaging physicians in transformational change.”
Immersive shadowing, where executives spend several days from the beginning of the shift to its end following a physician around, can help leaders develop empathy and change their perspective for the long term. With empathy and understanding in place, every physician interaction will have positive intentions that give physicians the benefit of the doubt. This mindset requires the humility to take the time to be on the front lines and to be open-minded to learn, and the ambition to want to improve physician engagement and help lower their burnout. It is a “humbitious” approach to leadership.
Experienced leaders who have never shadowed a physician can start planning to make shadowing a regular part of their weeks. Certainly, time limits are an obstacle for schedules that are already packed, but what could be more important for a healthcare executive than medical staff engagement and well-being? The main barriers, other than time limitations, include convincing superiors and corporate offices that shadowing is worth the investment in terms of time and effort. An effective approach is to coordinate with physicians and block times on their calendar months in advance, committing to the practice of shadowing while making the business case for it. The benefits will far outweigh the costs for them, their organizations, their patients and their communities.
In addition, it’s important for early careerists to intentionally shadow physicians as soon as possible in their career. This goes beyond watching a surgery being performed or spending their lunch hour in the physician lounge. It is about committing to following physicians from the time they start their day at their practice, to their commute to the hospital, to their rounding on patients or time in the OR, to their hours on-call, and all the way until the end of their shift.
Some higher learning institutions are even requiring postgraduate students to shadow physicians as part of their coursework. The Health Care Administration graduate program at Trinity University San Antonio, for instance, is piloting an initiative that requires students to spend at least one week of their administrative residencies fully immersed in shadowing several physicians. The program’s administrators strongly believe that nothing can be more formative for an early careerist than to start understanding physicians’ worlds and their daily struggles and challenges. Only then can young executives develop empathy and realize that physicians just want to provide their patients with high-quality care without being pushed beyond their human limits.
When organizations adopt shadowing practices consistently, physician engagement and resilience will drastically improve while burnout will significantly decrease. As a result, quality of care and patient safety will only benefit.
Amer Kaissi, PhD, is a professional speaker, executive coach and professor of healthcare leadership at Trinity University in San Antonio. An ACHE Member, he is also the author of the book Humbitious: The Power of Low-Ego, High-Drive Leadership (amer.kaissi@trinity.edu).