Misaligned Expectations Lead To Conflict, Burnout, And Disillusioned Physician Leaders

Would you expect the chef at a restaurant to be told that they are not only required to prepare the food in the kitchen but also deliver it to each of the tables and manage the billing? What about sorting out the restaurant’s finances or understanding the number of patrons that need to flow through per night to optimize income? If this sounds unreasonable, how did we end up asking physicians to undertake multiple roles in our health care organizations for which they have not trained? This expectation has led to untenable work environments, and we need to find solutions.

Being a great physician traditionally involves applying knowledge and communicating compassion with health care teams, patients, and families.

When a physician graduates from medical school, they are taught the importance of helping their patients and their primary role of serving them. They are trained to treat and manage the patient’s health complaints and form an empathetic yet professional relationship with their patient.

The demands from a physician today are not the same as they were in the past. Physicians spend twice as much time on administrative work than they do treating their patients. Physicians are also expected to be experts in leadership, quality, conflict management, hospital operations, patient flow, project management, quality and innovation, health information and equity, diversity, and inclusion, to name just a few.

The rising pressure to deliver high-quality medical care while also adopting parallel roles in the health care setups has been a source of distress for many physicians. Additional demands on physicians, without adequate training, add stress on the physician leading to conflict, burnout, and eventually deteriorating physical and mental health.

The physician leader is crucial yet not empowered.

The foundation of a physician is laid down during their time in medical school. This is where they learn all that they know, whether through theoretical lectures, practical ward or clinic experiences, or direct teaching from physicians in practice. Despite being taught within medical schools, the transition from medical school to a health care setup has been challenging for many.

Many physicians have little training in health care leadership. The lack of administrative training in medical schools is one of the leading causes of distress and burnout in most physicians today. Physicians are put into an environment they are not used to, given roles that they are not trained for, and must carry out extra tasks for which they are not paid.

Over time, the lack of preparation makes physicians feel unprepared and unable to adequately insert their voice at the organizational table. The unrealistic expectations that leaders have extensive non-clinical knowledge and training are not discussed. This leaves physicians without a clear understanding of how organizations want to utilize their knowledge and influence.

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Integrating physicians into organizational human resource (HR) teams

Human resources have their importance in every workplace setup, whether it is a law firm or health care set up like a hospital. The HR department in a health care setup may comprise a group of clinical and non-clinical persons responsible for the services and quality of care of the health care providers and their own health and wellbeing.

The HR team also identifies sources of conflict and burnout and tries to resolve them to promote a healthy working environment. They support workers in onboarding, offboarding, leave of absence requests, sick leave, patient care coverage, retirement criteria, conflict management, and professionalism issues. As physicians have been traditionally self-regulated, they have been left to perform these tasks on their own, with some definite gaps. Once again, physicians have been asked to perform skills in which they have not been trained. Integration into HR within our organizations can help this disconnect.

What needs to change?

• Physicians should continue to focus on the provision of clinical care, teaching trainees, and interacting professionally with their health care communities and patients.
• Physicians who wish to be leaders should be educated and renumerated, as other health care leaders are.
• Physicians who wish to be involved in other areas of health care such as health systems and operations, quality improvement, wellness, health information, conflict and mediation, and other specialized areas should be allowed to pursue these aspects of medicine to achieve positions in their organizations that allow them to integrate their multiple areas of training in a recognized (and remunerated) capacity.
• The physicians’ frontline voices should be at “high-level” tables, with an expectation that they will be providing the clinical voice. This voice, along with the experts around the table in other areas of the organization, can lead to an integrated and collaborative approach to allow for the best decisions to be made for our patients.

The bottom line

Taking a close look at organizations’ expectations for our physicians will allow doctors to get back to medicine. We can spend less time on tasks for which we are not educated to perform and more time communicating with experts in complementary areas to impact decisions that need to be made in our health care organizations. Those of us who have passions in other areas of medicine can pursue training and expertise knowing that there will be respected positions that are paid, which will allow us to have our voices heard in that capacity.

I hypothesize that careful thought into this type of physician integration will decrease conflict, retain practitioners, decrease burnout, and allow practitioners to get back to medicine. Doctors will have renewed sense of accomplishment and respect, which will be apparent to patients under their care.

It is time for physicians, health care organizations, and medical schools to come up with a collective effort to create a framework with more specified opportunities in which physicians can contribute to the optimization of health care operations, support a focus on higher quality health care, and integrate the physician voice into all aspects of the rapidly changing health system.

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