Burnout and moral injury are terms that litter the landscape of ongoing research and debate about what is happening with American Physicians.  With increasing awareness and acknowledgment, there is an increasing number of leaders and health care organizations willing to attempt a solution.  However, while there is utility and looking below you to the physicians you lead and to the organization around you, you also need to be looking inward to identify how your leadership style may be contributing.  Some questions to ask yourself:

Do you give your physicians positive feedback when things go well and actionable steps when they are not?

Despite protestations to the contrary, people (that includes physicians!) like knowing they’re doing a good job.  As medicine becomes more regulated and there is increasing tracking of quality, safety, and productivity data, it actually becomes increasingly difficult to tell if a physician is doing well.  If your physician does something particularly well, a hand-written note can go a long way to reminding him/her of the reason for entering this profession.  If your physician has room for improvement, do not just leave data in an envelope in the mail.  If the area for growth is something you can help with, then give constructive feedback.  If it isn’t something you can help with, then help find someone in the organization who can help.  Few things are more demoralizing than no acknowledgment of what is being done well, followed by mounds of data that points out things that could be done better but with no idea how to make any changes.

Do you view physicians as people, or are they “cogs” in your business wheel?

Somethings to consider, do you know if your physicians are married or have children?  Do you know if they’re under extra stress because of a recent family death?  Do you know what their ultimate career goals look like?  Sometimes it is so easy to get caught up in the work that we forget who we are working with.  However, real leadership requires you not just to check the boxes of tasks to accomplish but to connect with people.  You may be able to manage cogs, but you’ll never be able to lead them.

When you have to give physicians new work due to new governmental regulations, changes in organizational rules, etc., are you also considering the increase in total work and looking for ways to remove work at the same time? 

Adding one more thing doesn’t look like much at the time, but even the smallest grain of sand becomes an immovable mountain if you add one more every day over time.  It may not be possible to always trade one added thing for one thing removed, but the removal of tasks (or improvement in workflow efficiency) is essential to always be on your radar.  Don’t wait until your physicians are crushed, but the mountain, be proactive in finding out what tasks they think could be moved or reworked.

Do you promote and support physicians in a public way?

Culture is changing, and the public perception of what physicians are has shifted.  Due to obvious reasons, physicians do not really have the ability to explain to their patients and prospective patients when they have done a great job.  Could you identify a great patient comment and post it (in a HIPAA compliant way) on your clinic’s social media page?  Could you advertise their research or talks they’ve given at meetings in the local paper?  The options are endless, but physicians are in dire need of good PR, especially given how quickly the story of one un-ethical physician spreads from coast-to-coast.

Do you value and respect physicians’ opinions?

If one of your physicians wants to tell you about a paper detailing success with an alternative model that might work for your clinic, do you listen or automatically try to shut the idea down because you have other plans?  You will not be able to implement every idea a physician brings you.  Some of them may be terrible!  However, listening gains you two advantages.  You may very well get some great ideas from the people on the frontlines taking care of patients.  Even if the idea is not great, listening and considering demonstrates respect and collaboration, which improves job satisfaction.

Physician leaders, do you remember the hard days of your clinical practice?

The bar for you is higher.  As you interact with other health care leaders, do not forget that you have a unique perspective not only on patient care but on the actual people delivering that care.  If you have forgotten the stress of trying to see a busy clinic while also getting your documentation done, the harried feeling of trying to manage a full inpatient service while fielding nursing calls and family requests, or the pain of standing on your feet all day for a difficult surgical case, then it may benefit you to get back into the clinical environment in some way to remind yourself.  If you are still practicing, maybe pick up an extra shift.  If you are not, you can make arrangements to shadow.  Great physician leaders tend to be bridges between administration and clinicians, which may require you to re-immerse yourself periodically.

No one said great leadership is easy.  In fact, in the changing health care landscape of shrinking margins and increasing concerns for quality and patient satisfaction, health care leadership is increasingly difficult.  As physician burnout, physician suicide, and physician shortages continue to plague this country, great leadership is going to be required to turn the tide.  If you want to be one of those great leaders, then you need to make sure you’re asking yourself tough questions about your own leadership style.

Clarissa Barnes is an internal medicine physician.

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