The Truth Behind Physician Burnout

New research finds feeling valued by leadership is critical to job satisfaction.

Posted May 17, 2019

We have a national crisis: Physician burnout in the U.S. has reached epidemic proportions. “Burnout is the disease of the 21st century and we don't truly understand what's driving it,” said Arabella L. Simpkin, M.D., MMSc, Instructor in Medicine at Harvard Medical School. “The actual understanding of the origins of burnout really remains an enigma.” But Simpkin set to find out—she is the lead author on the first study to ask what truly drives job satisfaction for physicians on faculty in an academic medical center. The findings are surprising—and it’s not about money.

The study, published in JAMA Internal Medicine, found that there was no association between feeling fairly compensated and job satisfaction for the 988 full-time members of the MGH Department of Medicine. This means that whether these doctors felt they were paid well or not was not a factor in how satisfied they were with their jobs.

Photo by Luis Melendez on Unsplash
Physicians want to feel their leaders care about them and don't take them for granted.
Source: Photo by Luis Melendez on Unsplash

So, what did determine their satisfaction? According to the survey, the drivers of job satisfaction were being treated with respect, feeling valued by leadership, and feeling that the work environment was social and supportive.

What led Dr. Simpkin to ask these questions? “Other industries that have suffered similar rises in employee discontent have found that demonstration of respect is the most important leadership behavior in improving satisfaction,” she shared. When her team looked for studies on this in medicine, they didn’t find any. So they set out to study it themselves.

Is low job satisfaction a known risk factor for burnout?

“What has been shown is that satisfaction is associated with quality of care that's delivered, particularly as measured by patient satisfaction. And it's been linked to faculty retention. We also know that dissatisfied physicians are more likely to leave the profession, and discourage others from entering,” said Dr. Simpkin. What she is describing sounds a lot like burnout.

When doctors burn out, they feel emotionally exhausted, ineffective, and feel like their work lacks meaning. Plagued by symptoms such as rigid thinking, irritability, difficulty sleeping, decreased attention and memory, they think about quitting medicine. It’s hardly surprising that when doctors feel this way, their work suffers. Physician burnout has been linked to increased medical errors, lower patient satisfaction scores, and increased malpractice risk. With recent statistics reporting that as many as 54 percent of doctors are experiencing burnout, this is something that matters to all of us.

Social capital matters more than we realized. 

The research team feels that their study shows that investment in social capital could make a difference for physician burnout. “People did say that feeling cared for by their leadership was very important,” said Dr. Simpkin. Specifically, faculty wanted to feel cared about as a person, and feel they were not being taken for granted. “They linked this to feeling that you could discuss work life balance and personal things with colleagues. And another significantly linked idea was that they were less likely to feel satisfied if they felt discriminated against by gender.”

Traditionally, one of the hallmarks of the medical profession has been collegiality. Doctors, as a rule, choose medicine because they care about people, and could expect to use their skills in meaningful work with a sense of purpose. They were trained to a very high level of expertise with the expectation of autonomy in the practice of medicine. Having bonded in the crucible of medical training, they could find a community with other doctors that provided built-in relationships. But now, doctors spend more time with the EHR (electronic health record) than they do with their patients or with each other. “I think that in this high stress, high responsibility profession, the ability to actually just be able to share concerns and vulnerabilities is essential. And that does not come just because you take home a bigger paycheck,” Dr. Simpkin explained.

What can we do to make a difference in medical organizations around these findings?

“I think there's no doubt that simply beginning to recognize how important promoting a sense of value and respect in the work environment is critical. And I think beginning to have these conversations begins to make you feel that the institution cares, and that they're trying,” Dr. Simpkin advised. “I think we need to intentionally promote collegiality, to try and work to break down silos, and to understand what it is that make faculty feel respected and valued.”

One key factor in job dissatisfaction was when faculty felt discriminated against. “There's no doubt that plays into creating a very toxic culture, and one that is the antithesis of truly supporting each other. We have to identify and eliminate sources of discrimination,” Dr. Simpkin went on. She believes this study provides real opportunity for growth in organizations. “There is so much that is amenable to change. We should be investing in social capital, which may not require large financial investments.”

Still, questions remain.

This was a study done at Harvard’s Massachusetts General Hospital, a large academic medical center with certain intangibles the study did not evaluate. When doctors choose academic medicine, they know that this will mean more prestige and lower compensation than other types of medical practice. Would we find compensation was more important to non-academic doctors, or even that it is for them a proxy for being valued by their organization?

The findings that academic faculty want to feel cared about and valued will likely carry over in other fields of medicine. Harvard Business Review has found that employees in other high performance fields want to be respected, and that feeling respected was a driver for job satisfaction. Over the past few years interest in preventing and treating physician burnout has been a hot topic for leadership in medical organizations, and this paper provides a new actionable suggestion: invest in social capital.

LinkedIn Image Credit: AshTproductions/Shutterstock

References

Simpkin, Arabella L., MD, MMSc.; Chang, Yuchiao, PhD; Yu, Liyang MS1; et al. Assessment of Job Satisfaction and Feeling Valued in Academic Medicine. JAMA Internal Medicine. May 6, 2019.