Empowering Physicians or Change the Healthcare System?

Posted on April 24, 2024 by Brad Fern, One of Thousands of Executive Coaches on Noomii.

There are two general approaches to solving the problem of physician burnout. One side—typically administrators, managers, and wellness advocates—says healthcare organizations should provide resiliency training to physicians. Teach them mindfulness. Coach them to develop their sense of insight. Teach them to “reframe” their perceptions and objectify their thinking. Provide Employee Assistance Programs and offer counseling. Then you’ll have fewer physicians experiencing anxiety, discouragement, and depression. Then fewer doctors will want to abandon clinical practice or retire early.

On the other side of the issue, many physicians say that resiliency training, counseling, and coaching places the onus for the problem on their shoulders. There’s nothing wrong with us, they say. We’re tired of being psychoanalyzed. Change the system. Stop dumping endless record-keeping responsibilities on us. Give us the bandwidth to focus on our patients. Include us in on the decisions that affect how we provide care and give us the autonomy to do our jobs. Then we’ll reclaim our sense of autonomy, mastery, and purpose, and we’ll feel better.

Like all complex issues, this is not an either-or challenge. But it is urgent. More than half of all US physicians report some symptoms of burnout, and it’s getting worse. The rising tide of physician burnout “has the propensity to put patient care at risk and has a detrimental effect on medical workforce retainment.”[i] Experts predict a shortage of between 54,000 and 139,000 physicians by 2033.[ii] Which leaves us with a series of crucial questions. How do we address the physician burnout issue and avert the looming crisis? Do we reduce physician burnout through training, counseling, and coaching? Or, do we reduce physician burnout by “rehumanizing” healthcare organizations and the healthcare system?

My response is that that the current crisis is an opportunity for meaningful change. Instead of stopgap fixes, we can and should focus on the long game. Healthcare organizations must support physicians through wellness initiatives while simultaneously transforming the systemic dysfunctions that physicians experience as dehumanizing.

Wellness Programs Help

Dr. Francine Gaillour is a physician who has coached many of her colleagues and has trained many physician coaches through her organization the Physician Coaching Institute. “It’s not all about the doctors, and it’s not all about the system,” she says. “It’s both. When physicians enter the world of coaching, they step out of the world of either/or and into the world of and.” In other words, it’s true that healthcare systems and organizations are dysfunctional in ways. There are difficult and frustrating aspects to working in today’s complex healthcare environment. AND it is also true that physicians can empower themselves by “modulating and enhancing” the things they do have control over. Dr. Gaillour coaches physicians to articulate and align with their core values. She teaches them to get better at setting boundaries, to delegate better and to assert themselves.

Dr. Gaillour’s position is consistent with my experience. My physician clients do not present with healthcare-system or organizational problems. Typically, they use coaching to tackle the same types of work-relational issues as executive clients from any industry. The physician, for example, who perceives a surgeon colleague as rude, dismissive, and arrogant, and needs support to devise communication, assertiveness, and coping strategies. The physician experiencing chronic self-doubt, who repeatedly places herself on the losing end when comparing herself to her colleagues, and so on. The dysfunctions of the healthcare system and healthcare organizations act like a pressure cooker. They increase tensions that magnify and intensify the same types of challenges other high-skilled professionals experience. Without question, coaching and other wellbeing initiatives can help mitigate those issues.

Help by Changing the System

One question many of my coaching colleagues have been asking is this: Are we enabling systemic dysfunction by increasing physician capacity to endure? In other words, are we patching up the physician solders and sending them back to engage in an impracticable war?

Dr. Tait Shanafelt is the Director of the Stanford WellMD Center and Chief Wellness Officer for Stanford Medicine. In a NEJM e-book article about physician burnout, he says, “We tell physicians to get more sleep, eat more granola, do yoga, and take better care of yourself. These efforts are well intentioned. The message to physicians, however, is that you are the problem, and you need to toughen up.” For Shanafelt, this is the wrong message. “We need to stop blaming individuals,” he insists, “and treat physician burnout as a systems issue.”[iii]

Realizing effective change will require healthcare leaders to work in partnership with physicians. “Physicians and leaders working together constructively to identify, develop, and implement solutions for problems in the practice environment demonstrates to physicians that improvement is possible,” Shanafelt says. “[This] approach transforms physicians from victims in a broken system to partners working with leaders to create their own future.”[iv]

Bryan Ungard is a C-level leader at the Decurion Corporation. He is an internationally recognized authority in the field of organizational transformation. He warns that organizations regularly make the mistake of treating the symptom while ignoring the root cause. “Mindfulness turned into a movement and is now a mainstream tonic for people so they can endure the toxic ruthlessness of organizational life,” he says. “While this isn’t bad, it isn’t addressing the root cause.” If healthcare organizations are serious about reversing the trend toward higher levels of physician anxiety, depression, and burnout, they must change the way they perceive their employees. Ungard suggests tracing the toxic structures and practices to their source and transforming them so they are life giving instead. “It takes work—conscious work—but not only is it possible, it’s starting to happen in many organizations. Rather than treating symptoms, let’s use them as important clues to a deeper transformation whose time has come.”

Being a physician has always been a taxing, high-energy profession. The physician challenges of old, however, were counterbalanced by the rewards of mastery, purpose, and autonomy. These essential “elements of physician passion” are exactly what today’s corporatized healthcare systems erode. The wellness experts are telling us, loud and clear, that we must do something about the levels of anxiety, depression, and burnout experienced by our physicians and healthcare workers. Our actions must attend to the symptoms and address the root causes. So, when asked whether the solutions to physician burnout lie in supporting individual physicians or humanizing healthcare systems, our answer must be “Yes.”

Brad Fern is a Certified Physician Developmental Coach, Certified Immunity to Change coach, and licensed psychotherapist. He owns FernEPC, a consultancy that specializes in coaching executives, physicians, and physician leaders. You can reach him at bradfern@fernepc.com.

[i] The Lancet, Physician Burnout: The Need to Rehumanize Health Systems, Nov. 2019.

[ii] The Association of American Medical Colleges, New AAMC Report Confirms Growing Physician Shortage, June 2020.

[iii] NEJM Catalyst, Physician Burnout, The Root of the Problem and the Path to Solutions, June 20017.

[iv] Ibid.