The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers

Too many specific theories about physician burnout can cloud the real issue and allow healthcare leaders to circle around the “elephant in the room”.

The cause of physician burnout isn’t just the EMRs, Meaningful Use, CMS regulations, the chronic disease epidemic or any other single item.

Instead, it is simply this: Healthcare today has no clear definition of what a physician is. We are more or less suddenly finding ourselves on a playing field, tackled and hollered at, without knowing what sport we are playing and what the rules are.

Historically, physicians have been viewed as professionals and also, more lately, as skilled workers. But we are more and more viewed and treated as neither. Therein lies the problem.

The way professionals are treated is this: You present them with a problem and they use their knowledge to solve that problem Since they know more than the requester, they aren’t micromanaged. They usually also set their fees and determine the time needed to realistically finish he job.

Skilled workers are asked to apply knowledge and workflows to relatively strictly defined tasks and it is the employer’s responsibility to make sure they have what they need to finish the job. If the tasks are unrealistic, the manager is held responsible: If the assembly line is moving too fast and the majority of workers end up passing on unfinished product or start pulling it off the line to finish later at home, the manager is likely to take the consequences. No one is likely to say that all workers, individually, are responsible for such chaos.

But in today’s healthcare, we have a rapidly moving assembly line. The foremen blame the workers for not attaching all the parts or not keeping up with the workload. Upper management doesn’t always take full responsibility, instead shrugging and saying: “it isn’t our problem, they’re professionals, they should be able to figure this out”.

Put simply: If anybody wants to define and manage our work for us instead of letting us do it, they become responsible for the outcomes if we aren’t given the time or the tools we, as the ones who went to school, know we need.

The cure for physician burnout is simple: Listen to us when we say what we need in order to do our best. We didn’t spend all this time and energy so we could collect our salaries and goof off.

Most of us still have a professional mindset. We want to do a good job and we know how to do it. Let us.

17 Responses to “The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers”


  1. 1 summonzeus December 20, 2018 at 8:43 am

    The same has become true for we university professors with PhDs as the bloat of a new class of workers, the higher education administrators who treat professors like 9 to 5 staff.

  2. 2 Mary Symmes December 20, 2018 at 2:19 pm

    Very well said!

  3. 3 Ralph Allen December 26, 2018 at 1:09 pm

    Good for you. Thanks

    Sent from my iPhone

    >

  4. 4 Debra Conrad January 5, 2019 at 9:12 pm

    This was to the point and eloquently said. It is apropos for now but hasn’t there been physician burnout before managed care and assembly line doctoring?

  5. 5 Dr George Saridakis January 5, 2019 at 10:18 pm

    This is very true !! The assembly line analogy is correct. If physicians were Unionized, they would have a stronger voice, and high paid Administrators,along with Insurance Executives, would be forced to act and respond , instead of just shaking their heads yes , and never following through with positive results or productive changes !! Physicians are now treated as replaceable employees , even though they are replaced with lesser trained healthcare providers. The other added burnout involves less skilled and lesser trained ancillary help for the Physician. More forms and more paperwork then we had before computers, and nobody knows how to fill these out ! So guess who fills out these forms ? I’m glad to be on the 18 th green and retirement is near! Ten years ago I thought I would work forever. Times have really changed ….

  6. 6 Christopher L Snyder January 6, 2019 at 12:31 am

    Perfectly stated 0″The cure for physician burnout is simple: Listen to us when we say what we need in order to do our best. We didn’t spend all this time and energy so we could collect our salaries and goof off.”

  7. 7 Wm. Bart Pate, MD January 6, 2019 at 11:05 am

    Yep! Physicians are no longer in a position to say “NO!”

  8. 8 Phill Johnson MD January 6, 2019 at 1:49 pm

    Well said!! And unfortunately very true. Ive been in practice 36 years and the last 10 have been in this “corporate” owned office. When I explain what we need to be more efficient, more productive and improve everyones’s life quality they look at me like I have grown three eyes and pointed ears!! We can have what we need but we will have to pay for it out of our own pockets. Employer supporting employee stops at salary and benefits. Those are wonderful and even generous but in a medical office we need support. How do we make them listen??

    • 9 acountrydoctorwrites January 6, 2019 at 1:58 pm

      There are pockets of hope in conventional medicine (remember how Patient Centered Medical Homes were supposed to be “Physician Led”), but perhaps the biggest hope is in some form of Direct Primary Care, probably with elements of Functional Medicine.

  9. 10 Ben A. Smith, DO, FAAFP January 7, 2019 at 12:41 am

    Well stated. We feel so overwhelmed with this due process, that in the middle of it all we forget ”why” we do ”what we do”. We came into this field to serve & help others, yet the bureaucracy of medicine makes this so difficult to obtain

  10. 11 Liz Beal, DO January 12, 2019 at 5:23 am

    Your analysis of the situation is spot on.

    Your cure, however, is not going to work.

    Here’s why:
    You can not make someone listen to you or get them to behave, especially if they have no respect for you (even if they do, their bosses don’t). Their thoughts are that you have signed on to be an assembly worker and thus this is what you are. Their next thought is that they are the boss so that means that they know what’s best and don’t have to listen to the likes of you. From there, the thought is that if you are causing them too much trouble, then you need to change, not them, to conform to the assembly worker bee as per their plan. If this doesn’t work, then that’s okay because you are replaceable.

    The cure is to take back all aspects of being professionals. We set the fees. We set the rules. We work for ourselves or for other physicians directly, no non-doctor bosses. If this is not an affordable option, then it’s time to get creative and figure out a way to make it affordable and practice in a setting that works for us. We do not continue to take this type of treatment.

    We are not assembly line workers. Time to take control back and say, “No.” We can do this. We must.

    (Note… adding the bird or other lovely gestures or phrases as you walk away is optional… :))

  11. 12 Gabor Lantos P.Eng MBA MD January 25, 2019 at 6:49 pm

    Well said, and so true. But the solution is NOT ‘simple”, because
    THEY will never listen to us.
    The difficult, but only realistic solution is to be independent;
    independent of hospitals, independent of corporations,
    independent of HMO’s, independent of insurers.
    Yes, it is much harder than being an employee; just as it is much harder in any field to be self-employed; less money to start, longer hours working at some secondary source of income while building up the independent practice, but the INDEPENDENCE is worth it in the long run.
    The result is a direct doctor-patient relationship and payment for professional services is by the patient, NOT some insurer nor government institution with all their incompetence and bureaucracy. The patient can deal with them to get reimbursed by whatever means.
    None of this is simple, but can be done with time and great effort, and well worth it in the long-run. The one thing it will not achieve is burnout.


  1. 1 The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers – Health Econ Bot Trackback on January 2, 2019 at 9:55 am
  2. 2 The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers | Health Advice and more Trackback on January 2, 2019 at 9:58 am
  3. 3 The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers – BrighterLife Trackback on January 2, 2019 at 10:01 am
  4. 4 The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers – Site Title Trackback on January 2, 2019 at 10:18 am
  5. 5 The Root Cause of Physician Burnout: Neither Professionals nor Skilled Workers – Health News Trackback on January 2, 2019 at 12:05 pm

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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