Physician burnout still a major factor even as unexpected turnover eases

The American Medical Association (AMA) made big headlines earlier this year when its latest survey found that physician burnout dipped below 50% for the first time in four years — a welcome change after the strain of the COVID-19 pandemic pushed it to a record-high level of 62.8% in 2021.

Despite positive signs such as the AMA findings, the long-term stresses that remain unchecked continue to drive physicians to leave their practices unexpectedly.

A Sept. 3, 2024, MGMA Stat poll found that 27% of medical groups report having a physician leave or retire early in 2024 due to burnout, compared to 68% that did not and 5% reporting “unsure.” The poll had 449 applicable responses.

This marks a slight improvement since an October 2023 MGMA poll that found that 29% of medical groups had a physician leave due to burnout that year, compared to about two-thirds (67%) that did not.

However, this physician turnover as a manifestation of underlying burnout is not always a reliable indicator of how well medical practices are addressing physician well-being and burnout:

• About four in 10 (41%) of the same respondents to this week’s poll said that burnout was worsening this year, while slightly more (45%) said it was about the same as last year.
• Only 14% of respondents said their organizations were improving on the burnout issue in 2024.

Complaints don’t always define the problem

The sources of physician burnout cited by practice leaders in this week’s poll frequently included specific challenges that many medical groups have endured in recent years:

• Increasing administrative burdens: As one practice leader told MGMA, “until we can get AI for documentation, the burden of documentation is too much.”
• Flat reimbursement rates and collection challenges amid higher expenses: “We have to see more patients to make the same profit due to increased costs,” another respondent said. As another practice leader added: “There’s a big squeeze on providers feeling the effects of inflation without increased revenue; that is causing lots of burnout.”
• Busier schedules: Workloads for physicians have taken a toll from support staff shortages or spending more time on a flurry of MyChart messages taking time away from patient visits. “Nearly all providers are looking for ways to decrease the number of patients on their daily schedules,” one practice leader told MGMA.
• Picking up the pieces: Many practice leaders noted the increased strain on their physicians from taking on more patients after other physicians left practice in recent years. “Recruitments can take a year or more sometimes, leaving a gap in service.”
• Tech troubles: The challenges of system outages caused by prolonged cyberattacks, as well as a generation of physicians nearing or at retirement age “tired of constant tech changes,” as one respondent noted.

While these challenges are factors in the day-to-day stress faced by physicians and practice administrators, they often are just part of a broader issues that, over time, cause the mental, physical and/or emotional exhaustion that typify burnout.

Restoring purpose

On a recent episode of the MGMA Insights podcast, Dr. Roger Gerard, management consultant and author of Lead with Purpose: Reignite Passion and Engagement for Professionals in Crisis, pointed to the growing commodification of healthcare professionals as a serious concern. He also shared strategies for leaders to restore purpose and autonomy in their teams.

“People go into their professions almost as a sacred calling, they have purpose. … They're intrinsically motivated to do well in that profession,” Gerard said, “and then we treat them like commodities when they get there,” echoing some of the sentiments that have led many to refer to burnout as more of a moral injury. “The leadership challenge is to respect those professionals — respect them for what they bring and treat them like the professionals they are.”

Gerard sees issues around stagnant reimbursement as a contributor to the loss of professional autonomy and goodwill. “When you treat a professional like a commodity, they start treating the job like a job instead of a calling,” he said. “If we understand that businesses are communities of practice, that means they're human — and if we aren't careful, we will take the humanity out of the business.”

To keep that humanity within the business of healthcare, Gerard recommends making commitments to the care team that affirm they are respected and valued, such as:

1. Listening with respect and taking input seriously.
2. Helping others learn and grow to be outstanding in their practice.
3. Competitively compensating them
4. Having their back when things go awry.

Following through on these promises will lead to a relationship that lasts over time and produces loyalty not just to the profession but also the organization. “That's the kind of relationship you want to cultivate,” Gerard said. “I'm not saying this is easy; try doing that with 5000 people — but this is what leadership should be doing.

“Instead of controlling, we should be causing people to be co-authors with us in their day-to-day realities,” Gerard said.

Acknowledge technology’s role in burnout

Author and public speaker Celeste Headlee joined another recent episode of MGMA Insights to discuss themes from her book, Do Nothing: How to Break Away from Overworking, Overdoing, and Underliving.

Headlee’s personal burnout journey

Headlee's journey to writing Do Nothing began out of a desire to understand and address her own struggles with burnout. "I started getting regularly sick, every two to three months, when I'd have to miss work," she recalls. "And the other thing I noticed is that I was really irritable, small things that people did wrong sent me over." This realization led Headlee to explore the underlying causes of her condition.

Technology’s role in burnout

Although modern technology is often designed for convenience, it can sometimes evolve into something that negatively impacts human behavior and cognition. While technology itself is not inherently problematic, the constant presence of devices and the blurring of boundaries between work and personal use can have detrimental effects.

"Our brain behaves differently in the presence of the phone, and we just don't evolve fast enough to handle healthily the changes that have happened so rapidly," she says. To combat these challenges, Headlee advocates for a more intentional and balanced approach to technology use, including:

• Establishing clear boundaries around technology use, such as setting "opening and closing" hours for email and social media.
• Experimenting with different strategies to find what works best for individual needs, whether it's a tech-free vacation or a daily time limit on device usage.
• Advocating for organizational cultures that prioritize work-life balance and well-being over excessive productivity.

Building physician collaboration through transparent leadership

On a recent episode of Adrienne Lloyd’s Women in Healthcare podcast, healthcare leader Kenyokee Crowell emphasized the roles of transparency and trust in leadership in fostering effective physician collaboration.

The power of strategic collaboration

Crowell has emphasized the importance of working closely with physicians to build trust and foster teamwork throughout her career.

“As a senior leader in healthcare, it’s critical to understand that a physician’s priority is delivering great care to their patients,” she explained. Crowell highlighted the need for transparency and clear communication when implementing initiatives, noting that despite potential initial resistance, establishing trust through open dialogue is key to successful collaboration.

This approach involves educating and creating awareness around new initiatives, as well as being mindful of not disrupting the physician’s core focus: “You have to navigate anything you're trying to implement in a way that doesn’t interrupt their ability to deliver great care,” Crowell advised.

Cultivating organizational culture

Crowell’s experience in large, complex organizations has taught her the value of understanding and adapting to organizational culture.

“You need to study and listen to how work gets done within the organization,” she said, emphasizing that success often depends on understanding the nuances of the workplace culture and how decisions are made.

In her leadership roles, Crowell has learned to identify key players who influence outcomes and ensure they are included in the decision-making process.

“It’s about knowing when to disrupt thoughtfully and bring the right people into the conversation to ensure sustainable solutions,” she remarked. This insight is crucial for leaders looking to drive meaningful change within their organizations.

Have a success story in addressing physician burnout in your organization? We’d like to hear it.

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