Physician burnout is not caused simply because physicians work too many hours or have too much to do. The “cynicism, depression, and lethargy that are characteristic of burnout most often occur when a person is not in control of how a job is carried out or [they are] asked to complete tasks that conflict with [their] sense of self.”[i]
Otolaryngologist William O. Collins uses math to help us understand the root causes of physician stress and burnout.[ii] His equation goes something like this: [(a + c = o) ≈ p] 10n = m.
Here is the colloquial translation of Collins’ equation: Provide physicians, especially resident physicians, with Autonomy and Continuity and you will create higher levels of patient-care Ownership. When physicians feel higher levels of ownership, they gain a greater sense of Purpose. Provide 10,000 hours of purpose-driven experience, and you will produce a crop of doctors who feel a sense of Mastery; the fulfillment of knowing that you’re good at what you do and are recognized and rewarded accordingly.
Let’s deconstruct Collins’ equation to understand it. First, Autonomy + Continuity = Ownership
Patient care ownership can be defined as “a commitment by physicians to approach each patient with a sense of personal responsibility for ensuring that [each patient’s] health care outcomes are the best possible…and fully accepting and embracing their role in the care of the patient.”[iii]
When hospital systems and residency programs provide physicians with greater autonomy and continuity, they encourage higher levels of patient ownership. Autonomy, to put it simply, is when physicians have greater say over what they do and how they do it. Continuity is when physicians “follow the patient’s clinical course to see the outcomes of [their] decisions” and “feel ownership of the clinical outcomes.”[iv]
Autonomy and continuity, then, lead to higher levels of patient ownership, which is not just good for patients. It is good for physicians, too.
But patient ownership provides more than accountability and quality of care, ownership plugs physicians into a greater sense of purpose, expressed in Collins’ equation as (Autonomy + Continuity = Ownership) ≈ Purpose.
Purpose is getting up each morning and doing a job that aligns with your core values. It is feeling connected to your patients and feeling that you’re dedicated to something beyond your own self-interest; the sense that you are contributing to the greater good. This is what most young people imagine when they answer the calling to become a provider. But finding purpose gets harder as physicians perceive the systems and processes they engage are more and more out of their control.
A key contributor to physician burnout, then, is feeling a lack of purpose. Conversely, if you give resident physicians 10,000 hours of purpose-driven clinical experience, you will produce passionate providers: [(Autonomy + Continuity = Ownership) ≈ Purpose] x 10,000 = Mastery.
Mastery, to be sure, involves proficiency, and it implies that physicians are recognized and compensated appropriately. But mastery, as used in Collins’ mathematical formula, implies far more. Mastery, autonomy, and purpose are the trifecta that feed the soul, generate passion, and lead to fulfillment—the antidote to burnout. Physicians sacrifice a lot to gain proficiency. The feeling of mastery inspires physicians with the assurance that the sacrifices they have made (and are making) are worth it.
Collins advises that “Some well-intended regulations may have the unintended consequence of contributing to resident burnout,” and he cautions that a “‘one-size-fits-all’ duty-hours-restriction definition may lead to some unnecessary transitions in care.” Residency programs would do well to customize reasonable restrictions and empower resident physicians to “observe patients for longer periods of time” so resident physicians can follow “the natural clinical course of some disease processes” and observe “the outcomes of their clinical decision making.”[v]
The issue of physician stress and burnout is complex. The thinking used to create solutions will need to be equally complex. To balance Collins’ equation, many of the necessary changes will need to occur on the organizational and structural level. The premises contained in Collins’ mathematical argument point us in the right direction.
Calls to Action:
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[i] Psychology Today, “Burnout,” https://www.psychologytoday.com/us/basics/burnout.
[ii] Collins, William, O., “A Paradoxical Fix to Physician Burnout: More Patients, Less Supervision,” Medpage Today’s KevinMD.com, June 3, 2020.
[iii] Masters, Philip, A., “In Our Health System, Who ‘Owns’ Patients?” Medpage Today’s KevinMD.com, June 7, 2019.
[iv] Ibid.
[v] Collins, William, O., “A Paradoxical Fix to Physician Burnout: More Patients, Less Supervision,” Medpage Today’s KevinMD.com, June 3, 2020.
Photo: Humberto Chavez