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Tackling Physician Burnout Requires Unprecedented Leadership

By Robert D. Morton, CPHRM, CPPS, Assistant Vice President, Department of Patient Safety and Risk Management, The Doctors Company

 

The term “burnout” has been questioned as a labeling error—and rightfully so. What many healthcare professionals on the frontlines are experiencing is a normal response (symptoms) to an abnormal situation (cause), like sick fish in a tank of toxic water. A diagnosis of burnout suggests that the solution is to medicate the fish. A more holistic view is to say, “There’s really nothing wrong with you; let’s clean the tank.”

 

The World Health Organization (WHO) announced plans to label “burn-out” as an occupational phenomenon in the International Classification of Diseases (ICD-11). The syndrome, which results from chronic workplace stress, is characterized by feelings of exhaustion, increased mental distancing from one’s work or cynicism about work, and reduced professional efficacy.[i] The WHO’s actions seem to further legitimize what many are experiencing: a chronically stressful healthcare system that makes connecting with patients and providing quality care more challenging and contributes to burnout, healthcare professional distress, or to what some have even labeled moral injury or human rights violations.[ii][iii][iv]

 

Drs. Simon Talbot and Wendy Dean, who co-founded the nonprofit organization MoralInjury.healthcare, borrowed the expression “moral injury” from Jonathan Shay, MD, PhD, a clinical psychiatrist who coined the phrase. Briefly, it is (1) a betrayal of what’s right, (2) by someone who holds authority, (3) in a high-stakes situation.[v] Discussions of moral injury include the view that repeated daily betrayals by authorities within the system are manifest. These types of betrayals run counter to patients’ best interests—which pains doctors, whose unifying creed is that patients come first.

 

While other physician thought leaders like Dr. Dike Drummond (thehappymd.com), Dr. Paul DeChant (author, Preventing Physician Burnout), Dr. Zubin Damania (aka ZDoggMD), and Dr. Pamela Wible (idealmedicalcare.org) may differ on the terminology, each makes a similar call for leadership and action equal to the severity and scope of the dilemma. They all call for partnering with enlightened leaders to change the systemic and institutional patterns that inflict betrayals on the practice of good medicine.

Dr. Howard Marcus, an internist in Austin, Texas, responded, “Most of us do not see our administrators as oppressors but, rather, as stuck along with the rest of us in a system that has piled on time-consuming burdens—which saps us of the time and energy required to do the best we can for our patients in the time available.”

 

EHR rescue and optimization work is becoming more common to regain lost relationships with patients. Executive leaders who are desperate for help often contact firms like Medical Advantage Group (MAG), a subsidiary of The Doctors Company. MAG conducts system database audits, followed by workflow analysis, previsit planning, and redesign of work screens to make the EHR function better as a convenient, accessible clinical source of truth. Ironically, this improvement in EHR accessibility and usability makes the EHR function more like old paper charts when everything was at hand.

 

Like any meaningful change, improvements require leadership with a growth mindset that demonstrates a deep respect for people and for the nature of their work. This means exhibiting leadership behaviors such as deference to expertise and sensitivity to clinical operations—two characteristics of the continuous improvement mindset on the journey toward high reliability. Effective leaders meet physicians where they live—on the frontlines of care—and seek to understand what is getting in the way of connecting with patients and providing quality care. The best leaders then work tirelessly to remove the barriers.



[i] Burn-out an “occupational phenomenon”: International Classification of Diseases. World Health Organization. https://www.who.int/mental_health/evidence/burn-out/en/. May 28, 2019. Accessed June 12, 2019.

[ii] Swenson S. Esprit de corps: turning vicious cycle virtuous. Talk presented at: NEJM Catalyst event Essentials of High-Performing Organizations; July 25, 2018; Institute for Healthcare Policy and Innovation, University of Michigan. https://catalyst.nejm.org/videos/esprit-de-corps-vicious-virtuous-cycle/. Accessed March 4, 2019.

[iii] Talbot SG, Dean W. Physicians aren’t ‘burning out.’ They’re suffering from moral injury. Stat website. https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/. Published July 26, 2018. Accessed April 30, 2019.

[iv] Wible P. Not “burnout,” not moral injury—human rights violations. https://www.idealmedicalcare.org/not-burnout-not-moral-injury-human-rights-violations/. Posted March 18, 2019. Accessed May 10, 2019.

[v] Shay J. Moral injury. Psychoanal Psychol. 2014;31(2):182–191. https://www.law.upenn.edu/live/files/4602-moralinjuryshayexcerptpdf.

 

 

 



Orthopedic Practices Must Know The Supervision Requirement

Submitted by The Florida Healthcare Law Firm

Orthopedic practices that provide ancillary services like physical therapy, diagnostic imaging and durable medical equipment must understand the laws that pertain to supervision or else risk huge monetary and even criminal penalties. There are three major areas of law the govern the issue: the State self referral law (The Florida Patient Self Referral Act of 1992), the Stark Law and the Medicare Incident To Services rule.*

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Revenue Guarantees And Orthopedic Practices
Submitted by The Florida Healthcare Law Firm


One of the ways hospitals attract physicians to their communities is to promise that the doctor will earn a certain amount of money each month.  This sort of “revenue guarantee” can be a great opportunity for an orthopedic practice, but you have to watch your step.  Read more

 


Looking to Enter the Stem Cell Market? 3 Key Considerations for Orthopedists 

Submitted by The Florida Healthcare Law Firm

There are no off the shelf solutions when it comes to adding a new component to an ortho practice.  Between navigating regulations, receiving training, and marketing the service, there's a lot to address in a short time.  To get started, here is a short summary of what to expect when responding to the steady stream of patient requests for regenerative medicine treatments like stem cell, PRP or exosomes. 

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FDA Steps Up Enforcement Against Stem Cell Clinics 

Submitted by The Florida Healthcare Law Firm

With the rapid growth of the regenerative medicine field, the U.S. Food and Drug Administration (FDA) is trying to strike the right balance between preventing harm to the public and fostering innovation of new treatments.  This happens of course right when the public view and confidence in regenerative medicine services like stem cells, PRP and exosomes is rising steadily, leaving many orthopedic practices no alternative but to offer them. 

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Orthopedic Practice Buy Ins Are Unique

Submitted by The Florida Healthcare Law Firm

An orthopedic practice with a terrific associate will likely want to offer "partnership" to the doctor at some point (usually two to four years).  Owner issues tend to be--
 
            1.         Protection for the founders;
            2.         Ensuring some degree of operational control; and
            3.         Pricing the buy in.
 
These are common issues for any medical practice considering offering partnership to an employed physician. Read more

Stark’s 75% Rule Still Confuses Orthopedists

Submitted by The Florida Healthcare Law Firm


Healthcare regulations are enough to choke a horse.  Even healthcare lawyers scratch their heads over the meaning of many regulations.  Nevertheless, understanding some of the more specific aspects of the regulations may be easier that you thought.

By now, orthopedists know the word “Stark” as well as “Medicare.”  It's the federal law that does two things: (1) forbids doctors from referring their patients to businesses they own which provide “designated health services,” and (2) contains a long list of permitted financial relationships between health care providers.  What it takes away with one hand, it gives with the other.  Read more

 

 

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2020 FOS Annual Scientific Meeting

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