Even those of us with a meditation cushion and a gong app are likely to recoil when mindfulness practices are suggested as solutions for physician burnout. Sure, these practices are important. No, they do not address the causes of physician burnout. Certainly, a more genuine effort by organizational leaders would be to respond to the data. There’s lots of it. The burnout — now “wellness” — data is collected endlessly and sliced and diced to populate hundreds of published articles. None of the survey results I’ve seen clamor for resilience retreats or new wellness infrastructures. On the other hand, where is the swift investment and action on those career-wrecking problems that do emerge in one physician survey after another? Where is the big dollar investment required to fix the “death by a thousand clicks” EMR? And where have organizational leaders mustered the political will to mitigate the toxic sinkhole of prior authorizations or arrange staffing that facilitates (rather than impedes) excellent patient care? Now those are issues that show up as flashing neon headlines year after year when burnout (I mean “wellness”) surveys are tallied. The fixes are not forthcoming. Instead, a new chief wellness officer is appointed in a high-profile display of leadership largesse. A resilience retreat follows soon thereafter. The fixes are not forthcoming because there is a clash of ideologies: Medicine vs. the Business School Mindset. And the “BSM” is winning. Another term for the BSM is managerialism. This is the ideology promulgated inside the gleaming towers of business schools. I use the term “Business School Mindset” rather than specify the MBA degree because the ideological mindset can exist with or without an MBA. And of course, there are people with graduate business degrees who have not adopted a BSM. The BSM is characterized by the belief that management is a learned profession with a body of knowledge and special “scientific” tools. I suppose a fly in the “learned profession” ointment is those pesky pop-up ads for “fully accredited/fully online MBA degrees — no GMAT/GRE required.” Nevertheless, graduates are assured that an MBA degree has prepared them to manage in any industry: a tattoo parlor, a government entity, or a hospital system. Other BSM elements: Managers are an elite caste, separate from those who are managed, monitored, and controlled. Efficiencies gained by controlling the behavior of professionals and other workers garner financial rewards and power for the elite caste. The principle of rational egoism that declares an action is rational only if it maximizes self-interest (witness super-sized CEO salaries in not-for-profit health care systems, lay-offs while executives collect bonuses, and private equity decimation of medical practices, community hospitals, and nursing homes). While physicians, the health care industry, and other swaths of society have been left swirling by subjugation to the managerial caste system, we haven’t named it. But brethren inside business schools have sounded the alarm for decades. Martin Parker wrote a 2018 article for the Guardian titled, “Why we should bulldoze the business school” with the subtitle “There are 13,000 business schools on Earth. That’s 13,000 too many. And I should know—I’ve taught in them for 20 years.” Parker states that “business schools have a huge influence, yet they are also widely regarded to be intellectually fraudulent places, fostering a culture of short-termism and greed.” Henry Mintzberg, the author of 150 articles and 15 books, says management is not a profession and not a science. He said that you can’t teach management in a classroom outside the context and culture of an actual business — and telling graduates that they are “managers” creates hubris. Warren Bennis and James O’Toole wrote a 2005 Harvard Business Review article “How Business Schools Lost Their Way,” describing comprehensive failings of business schools to be effective or ethical. That article foreshadowed the 2007 subprime mortgage crisis—attributed in part to the opportunism fostered in graduate business education. So back to burnout. The BSM in our health care institutions is what causes burnout. The BSM and the profession of medicine are incompatible. The steps to address physician burnout are anathema to managers who prioritize profits over patients. Monitoring, controlling, and cost-cutting are reflexive necessities when leadership doesn’t fully understand the industry. The current EMR is a revenue collection system with a remarkable feature from the BSM perspective: The data entry clerks work all hours, and they double as doctors! And since the work always gets done, why increase support to physician practices or attempt to mitigate the crazy-making prior authorization demands? We can’t expect those with a BSM to solve physician burnout. What is needed is leadership throughout health care organizations by those with expertise in the core business, deep commitment to health care workers and patients, extensive tacit knowledge, and credibility. Physician CEOs have better outcomes in all critical metrics, including engagement among staff. And physician leaders have an ethical and fiduciary responsibility to serve patients. Those with a business school mindset do not. Source
