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Physician Burnout Heavily Influenced by Leadership Behaviors

 |  By Alexandra Wilson Pecci  
   April 28, 2015

Researchers find a "very strong relationship between [physician] satisfaction and burnout and the leadership behaviors of physician supervisors" in large healthcare organizations.

Physician burnout is prevalent throughout the U.S. healthcare system—experienced by nearly half (46%) of physicians, according to data published in JAMA last year. But effective leadership appears to alleviate it, according to new research from Mayo Clinic and published in the April issue of Mayo Clinic Proceedings.  

In 2013, nearly 3,000 physicians and scientists across Mayo Clinic's three campuses in Arizona, Florida, and Minnesota responded to a survey about their wellbeing in the workplace. They were asked not only to rate themselves on burnout and satisfaction, but also to evaluate their immediate supervisors, who were physicians and scientists themselves, in 12 specific dimensions of leadership.  

Tait Shanafelt, MD

Not only did 40% of respondents report at least one symptom of burnout, but researchers were able to link burnout rates to how well the physicians rated their leaders.  

For every one-point improvement in the 60-point leadership score, there was a 3.3% decrease in likelihood of burnout and a 9% increase in satisfaction. Scores were adjusted for age, gender, length of employment, and specialty area.  

The leadership factor was also pronounced at the work group-level, with 11% of the variation in burnout and a whopping 50% of the variation in satisfaction among physicians explained by the supervisors' average leadership score.

"There was this very strong relationship between satisfaction and burnout and the leadership behaviors of physician supervisors," says Tait Shanafelt, MD, professor of medicine at Mayo Clinic and first author of the study. "At a high level, the most important point is that leadership behaviors matter."

Teachable Behaviors
Shanafelt says the specific leadership behaviors he and his team evaluated could be boiled down into how well the supervisors informed, engaged, and empowered those that they led. He points out that all of the leadership behaviors measured were actionable, ones that can be learned or developed.

"Part of what this tells us is that healthcare organizations probably need to invest more thought and energy both into how they select and also how they develop and train effective physician leaders," he says.

Traditionally, physician leaders have been selected based on being good doctors or experts in their field, rather than whether they necessarily have the have the skills and qualities of effective leaders, Shanafelt says.

"Those [clinical] qualities, while certainly admirable, may or may not set them up to succeed as a leader," he says. Rather, other qualities, such as being open to new ideas, consensus building, and bringing together diverse opinions, are ones that make good leaders who can bring about change.

Tim Gueramy, MD, a foot and ankle orthopedic surgeon who's experienced burnout, agrees, saying that physicians who rise to leadership roles because of the number of papers they published or how cutting-edge their practice is, don't always make good leaders.

"[Those are] not leaders, those are innovators," he says. "Physician leaders have to do what's best for everyone." They need to ask themselves, "How do I take a big group, and globally make patient care better?"

Ultimately, Gueramy left practice for three years to develop his startup, DocbookMD (he's the CEO), after years spent in the "rat race" of seeing huge volumes of patients and working long hours.  

Today physicians have less autonomy than ever before. Shanafelt says that 75% of physicians are now employed by large healthcare organizations, which is a profound change from the solo or small group practices of days gone by.

That remarkable change in practice structure has also brought a change in leadership needs. Shanafelt says effective leaders today, should ask their physicians for their ideas, let the individuals that they're leading identify and develop solutions to local problems, as well as given them the tools to put those solutions into effect.  

Physicians are 'Challenging' to Lead
"Physicians are inherently critical thinkers who want to solve problems," he says. "The good physician leaders recognize that and sort of engage and empower their physicians to develop their own solutions."

Shanafelt acknowledges that physicians are not always easy to lead.

"Physicians can be a challenging group of individuals to lead because they often bring this very deep understanding of medical practice, they often have developed a healthy degree of skepticism, which is part of the training process," he says. "They're very attentive to detail, want evidence for decision-making, [which] can make it hard to build consensus."

The rise in physicians working in large groups, combined with the perfect storm of burnout factors, makes it more important than ever for healthcare organizations to work on training and developing physicians who can lead in such a challenging environment.  

Moreover, improving leadership to reduce physician burnout will have a rippled effect across the organization, since burnout is linked to everything from physician satisfaction and turnover, to quality of care. Shanafelt says some organizations, like Mayo Clinic, have leadership development programs in place, but most don't.  

"I think there is an opportunity to expand those efforts," he says. "Good leadership matters and has a profound impact on the satisfaction and burnout rates among the physicians working within large healthcare organizations."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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