Yesterday marked the third annual Ending Clinician Burnout (ECB) Global Summit, a fantastic online event with a virtuous mission “to bring an end to burnout in healthcare.”
For hundreds of clinicians, the summit has become a must-attend event thanks in large part to the dedication and hard work of its co-founders Jonathan Fisher, MD, FACC, and Kelcey Trefethen.
This year, at their invitation, I presented a keynote address titled “Physicians Aren’t Powerless.”
A Touching Tribute
After I finished my remarks at the summit, I was surprised and honored to be named the first-ever recipient of the ECB Healthcare Leadership Award. Jonathan followed that announcement with a heartwarming gesture—donating $1,000 in my name to Doctors Without Borders, a wonderful nonprofit that provides emergency medical care around the globe.
“We look forward to recognizing other great physician leaders who make a difference in healthcare and make the lives of all clinicians better,” said Jonathan, who thanked all of the speakers for their excellent insights and leadership. Among them were Jack Resneck, Jr., MD, American Medical Association president, and Dr. Tina Shah, MD MPH, an ICU physician, burnout expert and recent senior advisor to the U.S. Surgeon General.
I encourage everyone who is concerned about burnout and moral injury to attend next year’s summit. In the meantime, please join the Ending Clinician Burnout Global Community, an online support system made up of over 6,000 clinicians, change-makers and leaders.
What We Know About Burnout
I began my talk at the ECB Global Summit by pointing out that “burnout” – a troubling constellation of symptoms that include fatigue, anxiety and despair – is getting worse.
According to Mayo Clinic study, as many as 70% of clinicians in the post-pandemic era have at least one of these painful symptoms. Physicians, in surveys, identify the causes of burnout as too many bureaucratic tasks (predominantly prior authorization), having to see too many patients each day (reflective of inadequate reimbursement. particularly in primary care), and the clunky electronic health record systems that literally come between them and their patients.
However, after a decade of telling the world about the problem and explaining how burnout negatively impacts patient care and shining a light on the 400 physician suicides that occur each year, the problems continue to get worse, not better.
It is my view that when something should happen, but doesn’t, there’s always an underlying and unrecognized problem. And that’s the case when it comes to burnout.
The Underlying Problem
Insurers, hospital administrators and purchasers understand the value in addressing burnout. They know the consequences can be severe for patients, physicians and the industry as a whole.
However, they are also caught in a broken and dysfunctional healthcare system. They struggle to keep costs affordable for patients. And the measures they put in place that create burnout—prior authorizations, cost containment efforts, etc.—are the result of our nation’s fundamentally flawed reimbursement model.
Dubbed “fee for service,” today’s payment model rewards the volume of services clinicians offer not the value of those services. This reimbursement system incentivized the delivery of more care, not better care. The only way doctors can earn more income is to see more people each day and spend less time with each patient. This raises cost and makes the practice of medicine less satisfying.
The solution is capitation. In this pay-for-value approach, doctors are rewarded when they prevent disease, avoid complications from chronic illness and eliminate medical errors. And, of course, that is what is best for patients. Physicians can’t force this transition in how care is reimbursed to happen, but they have a powerful voice in driving change. To do so, they need to become leaders. In medicine, leadership is a skill that can and must be learned.
The Leadership Antidote
Moving from FFS to capitation is the first step in the process of transforming American healthcare and eliminating burnout and moral injury.
The transition also serves as a catalyst to drive the other improvements needed to address healthcare’s dysfunctionality. When doctors look to increase quality while lowering costs, they are forced to come together to increase collaboration and cooperation.
They embrace 21st-century information technologies. And, rather than resisting strong physician leadership, they welcome it. And once these changes begin, physicians will find they have the power to implement change. Ultimately, success is dependent on the ability of leaders to use three anatomic structures: the brain, the heart and the spine.
The truth is that no one is going to come to our rescue, no matter how loud we yell. But we are not powerless to make a difference. If you want more details about how leaders can make these changes, sign up for my free (and ad-free) newsletter Monthly Musings on American Healthcare.
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Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a Forbes contributor, bestselling author, Stanford University professor, and host of two healthcare podcasts. Pearl’s newest book, “Uncaring: How the Culture of Medicine Kills Doctors & Patients,” is available now. All profits from the book go to Doctors Without Borders.
