Minimizing Medical Burnout: Dr Joseph Stern On How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout
An Interview With Dan Rodrigues
Provide longer appointment times for physicians to work with patients.
The pandemic was hard on all of us. But statistics have shown that the pressures of the pandemic may have hit physicians and healthcare workers the hardest. While employment is starting to return to pre-pandemic levels generally, the healthcare sector is lagging behind with a significant percentage of healthcare workers not returning to work. This is one of the factors that is causing a shortage of doctors. Some experts say that the US may soon be short almost 124,000 physicians. (See here for example) What are hospitals and medical practices doing to help ease the extreme mental strain of doctors and healthcare workers? What are hospitals and medical practices doing to help solve the scourge of physician and healthcare worker burnout?
To address these questions, we are talking to hospital administrators, medical clinic executives, medical school experts, and experienced physicians who can share stories and insights from their experience about “How Hospitals and Medical Practices Are Helping To Reduce Physician and Healthcare Worker Burnout”. As a part of this series, I had the pleasure of interviewing Dr. Joseph Stern.
Dr. Joseph Stern is a nationally-recognized neurosurgical physician and author living in Greensboro, North Carolina. For nearly 30 years he has specialized in complex spine and brain surgery, working with a variety of medical provider teams. The death of two close family members brought a new perspective to his patient care experience, inspiring him to write a memoir called Grief Connects Us, in which he grapples with loss amidst his search for compassion and empathy in a field notorious for neutrality.
Thank you so much for joining us in this interview series! What or who inspired you to pursue your career? We’d love to hear the story.
I was inspired to become a neurosurgeon by my mentor, Dr. Julian (Buz) Hoff. He was a talented surgeon, a warm and compassionate doctor, a wonderful teacher and an inspiring leader. I wasn’t sure which specialty to pursue further training in until late in medical school. I was drawn to Neurosurgery by Dr. Hoff’s caring and curiosity as well as my awe for the brain and our nervous systems. He recognized and cared for the whole patient, not just a body part or an isolated system.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
I have become very active in “One World Surgery,” an organization which seeks to address healthcare disparities. Over 5 billion people in the world have no access to curative, life-changing surgical treatments, something we often take for granted in the US. We are providing free spinal surgeries to patients in Honduras and will soon be doing so in the Dominican Republic. Patients often have no access to care and suffer in extreme pain for an average of five or more years before receiving treatment. They often walk out of the Holy Family Surgery Center a few hours after major surgeries with smiles on their faces, expressing tremendous gratitude, with only acetaminophen and ibuprofen for pain control, as narcotics are not available in Honduras. Many of the volunteer practitioners (nurses, OR technicians, physicians, CRNA’s, general volunteers) arrive burned out, frustrated and disillusioned with care in the US, but return to the US rejuvenated. While we are helping to relieve the physical burdens of poverty in our patients, they, in turn, are helping to relieve our spiritual poverty, showing us repeatedly that we can make a difference, that we do matter, reminding us of the power of healing. Changing a person’s life for the better, restoring them to function and independence, is a gift–for patients and also the providers able to make a positive difference in the lives of patients and their families. We leave a world with an abundance of resources, but mired in protocols, red tape and adversarial relationships, for one with far fewer resources, but in which everyone is working together towards common goals as a team. This is where I go to reinvigorate my sense of purpose and commitment to the patients I care for. This has become a treatment for burnout for me and many other volunteers.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
The three personality characteristics that have been most instrumental in my success are: persistence, curiosity, and a willingness to question how things are and to envision how they might be changed for the better.
I did not start out as a writer, but after my sister Victoria died, I was determined to share her journey (and mine) with the world. I wrote, and rewrote, my book “Grief Connects Us” ten times before it was published. In that time, I kept improving the writing, honing the arguments, and learning as I went. This exemplifies persistence.
As a child, I used to take things apart. I took apart clocks and watches and other appliances. I couldn’t put them back together, so I ended up ruining things. This drove my parents crazy. Over time, I have learned better how to fix things and not just take them apart. This has paid off as a neurosurgeon and reflects my sense of curiosity.
Reflecting questioning current states and envisioning better future ones, I have nine issued device patents for neurosurgical devices, all of which seek to make surgeries easier, safer and more effective. I am fascinated by large organizations and how they transmit and stay true to their values. So much of the way we do things in healthcare could be done better, if only we had the courage and willingness to change. Entrenched interests would need to work towards greater common interests and be willing to sacrifice achieving their narrow goals, often centered on money, for larger greater goals requiring cooperation and empathy.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about minimizing medical burnout. Let’s begin with a basic definition of terms so that all of us are on the same page. How do you define “Physician and Healthcare Worker Burnout”? Does it just mean poor job satisfaction? Can you explain?
Physician burnout develops as a response to chronic occupational stressors. Symptoms of burnout may include emotional exhaustion or compassion fatigue, as well as feelings of depersonalization, frustration, overwhelm, inefficacy, and cynicism. Physicians are uniquely vulnerable to burnout because of the high level of responsibility they bear to their patients.
Burnout is different from poor job satisfaction: people in the medical field generally love helping others and want to do their utmost for patients, and thus it is dedication in the face of numerous difficulties, rather than dissatisfaction, that leads to physician burnout.
How would you define or describe the opposite of burnout?
The antithesis of burnout is mindfulness, presence, and engagement. When your work feels more like “play” there is a balance of passion, purpose and pleasure — an alignment of one’s unique natural talents and abilities, and work becomes a source of joy, fulfillment, and self expression. A positive and healthy job-related state of mind is characterized by energy, enthusiasm, pride, motivation, inspiration, and a willingness to invest effort in one’s work and persist in the face of challenges.
Maintaining this healthy kind of relationship with work in the medical field requires both external support and internal awareness.
A ready example comes from my work with One World Surgery in Honduras. I regard this as healing for patients as well as for myself. I arrive feeling burned out and leave feeling energized and rejuvenated, the opposite of burned out.
From your experience, perspective, or research, what are the main causes of Physician and Healthcare Worker Burnout?
While treating patients is stressful, physician burnout is exponentially exacerbated by the systemic imbalances and inefficiencies that characterize the modern American healthcare industry and its workplace environments. While much stress and pressure is a result of the administrative requirements of individual medical practices and hospitals, there can also be dissatisfaction with job responsibilities, as well as the felt pressure of personal responsibilities outside of work. This sense of chaos results in feelings of lack of control and overwhelm.
There is an insufficiency of gratitude in our current healthcare environment and a lack of wonder. What we do is amazing, yet many regard it as an obligation, rather than a gift. They don’t appreciate how difficult what we do can be. People take their own health for granted and often don’t express or show empathy for others. Entitlement saps my energy and enthusiasm. So does arguing with an insurance company about why I am recommending surgery or testing to a patient I am trying to help. The insurance reviewer claims superiority, as if denying care is protecting their resources from my avarice, never once acknowledging that condemning patients to ongoing suffering while posing that their decisions are motivated by virtue, rather than greed, is evil. Regular experiences like these lead directly to my feeling burned out.
Have you seen burnout impact your own organization? Can you give a first hand description of how burnout can impact the operations of an organization?
Burnout is having an ongoing direct and negative effect on my healthcare organization. I see this on a daily basis. The only way to be effective is as a member of a healthcare delivery team. This requires mutual support and respect. When team members no longer feel supported, they stop showing up. This can be physical absenteeism, but can also be not putting in full efort. When people stop showing up, that shifts even more burden onto the people who always say “yes,” always show up and often sacrifice themselves for a greater good. If this sense of obligation isn’t shared, it isn’t sustainable. These people, the bedrock of the organization, begin to leave as well, and at that point, the spirit of the organization may be permanently changed or broken. I am seeing many of my physician colleagues retire or leave earlier than they had originally planned. They no longer feel supported by the organization, no longer seen or heard. The easiest thing to do at that point, is to leave. The same is true in the nursing staff, which are leaving in droves. Those remaining behind cannot pick up the slack and are at extreme risk of burning out and of becoming depersonalized. Ultimately, many feel they have no other choice than to walk away altogether.
Does your practice currently offer any mental health resources for providers or clinical staff? We’d love to hear about it.
For many practitioners, while these services are offered, they are shrouded in a sense of shame and a perception of weakness. Taking advantage of mental health services is often perceived similar to substance abuse; no one wants to admit they have a problem. These services are focused on the individual; organizations need to recognize how isolated and alone practitioners have come to feel and to rethink the ways we provide support to them. The organizations themselves are hurting, so mental health services need to reflect this more general sense of despair that pervades them and provide healing directed at restoring a sense of community and common purpose. Proactively addressing system failures, rather than providing mental health services to those who can no longer tolerate or thrive in broken systems, would go a long way towards providing leadership and solutions to these vexing and dispiriting problems.
In my work I have found that streamlining operational efficiency with digital transformation and automated processes helps to ease the workload of providers and clinical staff. Has that been your experience as well? Do you think that streamlining operational efficiency can be one of the tools to minimize medical burnout? We’d love to hear your perspective.
Here, I would say that the digital transformation of healthcare has had the opposite effect on practitioners. This has increased workload and burden on practitioners. Simple tasks, such as signing in to healthcare information systems, which are HIPPA-compliant are extremely cumbersome. I do this many times a day–two-factor identification adds at least 30 minutes to my day.
When our health system went to EPIC, the majority of hospital transcriptionists lost their jobs and it became the obligation of the medical staff to become transcriptionists. This shifted a significant additional work burden onto the medical practitioners, who have become unpaid transcriptionists.
EMR’s (electronic medical records) are intrusive and interfere with the doctor-patient relationship. How often do patients resent this intrusion? Patients no longer feel acknowledged or appreciated for who they are. As a physician, am I caring for a human being or for a computer record? A well-designed EMR should enhance the doctor-patient relationship (or at least not interfere with it), rather than becoming a burden and distraction. My way of dealing with this burden is to do my charting after hours and on weekends, so that I can be fully present with my patients, but this detracts from my personal and family life. Scribes can help, but I have not found this to be as helpful as I would have hoped. It is intrusive to be having a deeply personal conversation with a patient and family member in the company of a scribe listening in and taking notes. This is also a position with a high rate of turnover.
The systems themselves are all about billing and reimbursement. The charts of even the most poorly managed patients look polished and near-perfect after the fact. These systems have a long way to go to becoming more human, humane, and an asset to patient care, rather than serving as a detractor and major time-sink. Any IT problem I have fills me with dread. The words “I’ll give you a ticket…” leave me with a sinking feeling close to despair.
Fantastic. Here is the main question of our discussion. Can you share 5 things that hospitals and medical practices can do to reduce physician and healthcare worker burnout?
Hospitals and medical practices can….
- Provide longer appointment times for physicians to work with patients.
- Allow physicians adequate time for administrative tasks, as well as providing IT support and streamlining these tasks with other thoughtful measures.
- Monitor physician workload and hours, and put policies in place to promote a healthy work-life balance.
- Create a line of communication between physicians and executives in larger medical systems.
- Give all medical providers and staff access to mental health resources that offer “professional development” in the form of cognitive behavioral techniques like meditation, as well as mentorship or coaching programs that help doctors build coping strategies such as emotional agility, empathy, vulnerability, and resilience.
Before doctors begin practicing with hospitals and medical practices, it is also critical that our medical schools train students in emotional agility to give them a key tool for handling the day-to-day reality of practicing medicine.
What can concerned friends, colleagues, and life partners do to help someone they care about reverse burnout?
The people who are closest to a physician who is experiencing burnout may notice symptoms such as increased isolation and irritability. This disconnection results in greater misunderstanding and miscommunication in relationships, which may also be a first sign of burnout. Loved ones can help by talking it out. Helping them to locate professional mental health support is a great place to begin.
Once burnout is identified and all parties agree the issue should be addressed, an informal at-home “care plan” can be implemented to reduce further impact. That plan can include agreements to engage in more quality and leisure time, setting boundaries for daily work engagement, and planning time for physical or emotional connection.
What are a few of the most common mistakes you have seen people make when they try to reverse burnout in themselves or others? What can they do to avoid those mistakes?
Addressing burnout is never simple or straightforward, nor is it likely that a physician experiencing burnout will find a path to permanently “reversing” these feelings. Many doctors sense this, and as a result, put off taking care of themselves — and this is a mistake.
It’s key to hold time and space for yourself and your feelings — even (and especially) in high-stakes fields such as neurosurgery, emergency medicine, or oncology. Take time to develop new habits, new healthy thought patterns, but also talk with other doctors and those who have the power to create change at your institution. After all, taking care of yourself and other physicians experiencing burnout will only lead to better patient outcomes in the end.
It has been said that our mistakes are our greatest teachers. Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
I wish I could say that my mistakes are funny, but the most memorable ones are not. They often involve unintended harms, occasionally with terrible consequences to patients. As a surgeon, I have struggled with the inevitability of making mistakes and how to acknowledge them, own them, and learn from them. In my training and likely also by way of self-selection, neurosurgeons are driven towards perfectionism and are often intolerant of mistakes and failure. Yet, the reality is that we aren’t perfect and we inevitably make mistakes and fail. How we accept these and grow from them defines our character. I have found that pursuing “emotional agility” has allowed me to accept my mistakes without feeling personal defeat or failure, but looking honestly and unflinchingly at my mistakes is definitely not easy. This has taken me a lot of work to develop these skills.
Can you share your favorite “Life Lesson Quote”? Why does that resonate with you so much?
“I can do things you cannot, you can do things I cannot; together we can do great things.”
Mother Teresa.
This quote animates One World Surgery and its missions in Honduras. It is the foundation for mutual respect and support that reflects a thriving team. There is no hierarchy here, only striving to achieve common goals, together. Doing so, we are able to achieve far more collectively than we can as individuals.
Ok, we are nearly done. Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
Outside of my work as a practicing neurosurgeon, I also advocate for awareness of emotional agility among healthcare providers. Emotional agility, as I define it, allows us to experience a range of conflicting emotions without becoming bogged down or unable to do our jobs. What many physicians don’t realize is that we gain power from facing, rather than avoiding, difficult emotions. This practice can aid people in any profession — not just doctors.
The habit of experiencing the emotional aspect of practicing medicine allows us to connect more deeply with our patients, and in that way, emotional agility can prevent feelings of depersonalization and burnout. As a doctor, you do not have to choose between being ‘neutral’ (in order to make sound medical decisions) and empathizing with your patients — you can do both.
Self compassion is also an important part of emotional agility. Physicians have to be able to forgive ourselves for our inevitable shortcomings.
How can our readers further follow your work online?
At josephsternmd.com I have created an online resource library and a community of medical professionals, patients, and caregivers discussing topics such as bereavement and the role of emotional agility in a physician’s practice. My memoir, ‘Grief Connects Us: A Neurosurgeon’s Lessons on Love, Loss, and Compassion’, discusses how I navigated personal loss and came to understand the importance of compassion in medicine.
This was truly meaningful! Thank you so much for your time and for sharing your expertise!
About The Interviewer: Dan Rodrigues is the founder and CEO of Kareo, a Tebra company, a leading provider of cloud-based clinical and practice management software solutions for independent healthcare practices and billing companies. Rodrigues is known for his visionary leadership in the healthcare technology industry. Rodrigues’ future-forward expertise has led companies such as Scour and Skematix. He is highly committed to providing patients with a seamless, digital experience in healthcare. Rodrigues’ business insights have been featured in publications including Forbes, Fierce Healthcare, and AP News.
Minimizing Medical Burnout: Dr Joseph Stern On How Hospitals and Medical Practices Are Helping To R was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.