The Physician Philosopher Podcast
TPP 50: Is Coaching the Cure to Physician Burnout and Moral Injury?
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When it comes to physician burnout, there are a lot of really strong opinions out there. In fact, many don’t even prefer the term burnout. They prefer the term “moral injury,” because they feel that physician burnout implies that the problem is the doctor’s fault. Moral injury, on the other hand, makes it clear that burned out doctors are the result of a broken medical system.
Because of this sentiment, I’ll occasionally get emails or messages from people who follow The Physician Philosopher on this topic. Here is a recent example,
“ I don’t think coaching is the long-term solution to the problems in medicine. If burnout is a symptom of the disease of broken medicine, then coaching, meditation, and money management are all temporizing bandaids to the true underlying issue. I can change my mindset, money, life, achieve financial independence from medicine, but the underlying moral injury still exists.”
And that is what I want to discuss here. How does coaching fit into the bigger picture of helping doctors who are burned out? Who feel trapped in medicine?
The Systemic Causes of Burn Out in Medicine
I always want to be loud and clear here. Burnout and moral injury are systemic and systematic problems.
The causes of physician burnout are many, and the list just seems to keep growing. A few causes worth mentioning are listed below.
The causes of burnout out in medicine include things like:
- Insurance companies telling us how to practice medicine → For example, pre-authorizations for procedures that do not get approved. Needing to “fail conservative therapy” even when we know it won’t work, leaving patients to suffer until we prove our case. Then, there are times insurance companies do not cover the medication or treatment that we know is best for the patient.
- Non-competes in physician contracts → it turns out that if you take good care of your employees, they don’t want you to leave. Instead of creating an environment where physicians love to work, they trap them instead.
- Publish or Perish culture → at some academic institutions there is a culture that if you do not publish, you will not succeed.
- Non-physician tasks (paperwork, online modules, etc)→ Non-physician tasks are another constant weight. Having to take required modules on recognizing a heart attack, stroke, or LVAD awareness. These are all topics that – as a physician – if I need an online module to recognize means I should not be practicing medicine.
- Electronic Medical Records → EMR’s that are glorified cash registers designed for billing and not patient care. They add hours of charting to physician lives and with little reward to the patient or physician caring for them.
The Real Reason for Physician Burnout
If you take all of these causes into a collective, they really result from a single source, which is a lack of autonomy. Physicians simply do not feel like the captain of their own ship, despite working many long hours to become an expert in their field.
We often know what the patient needs, but we are unable to provide it to them. Instead, we must watch them suffer harm because of a system that does not allow us to take care of others. And it certainly does not allow physicians who feel trapped in medicine to take care of themselves either.
Instead, medicine is now run by administrators and insurance companies. None of whom can do our jobs.
Instead, we repeatedly learn what Vagabond MD so aptly pointed out in a guest post on The Physician Philosopher… The Hospital Will Not Love You Back.
How Does Coaching Help Burned Out Doctors?
So, if the causes of burnout and moral injury are systemic and systematic, how can coaching a single physician help fix the systemic causes?
The answer is that it can’t. Not at least directly. The direct fixes to medicine will involve changing the system itself.
However, this does NOT mean that professional coaching for physicians does not help the individual doctor. It just means that it will not fix the overall system.
And if we are to wait until the system fixes itself, what is a physician who feels trapped or burned out to do? Are we to leave them suffering without helping them?
The truth is that we have a broken medical system. Physicians are burning out at epidemic rates. Physician suicide rates are even more alarming.
I, for one, refuse to standby as physicians who feel trapped in medicine need help. I’m not going to wait until the system fixes itself. That’s where coaching for physicians comes in.
Empowering Burned Out Doctors Through Physician Coaching
If the overall cause of physician burnout is a lack of autonomy, then the goal must be to help doctors reclaim their control. To empower them to be able to practice medicine on their terms.
And this helps fix physician burnout on two fronts.
First, it helps the individual doctor. There is evidence showing that professional coaching for physicians decreases their burnout and improves their quality of life (JAMA 2019). We have seen similar results internally for our clients in the Alpha Coaching Experience. You can hear it in the video testimonials. And in the messages that they share with us.
So, to claim that physician coaching cannot fix burnout is not really true. While it may not fix the systemic causes that lead to physician burnout, it can absolutely help the individual physician who is struggling.
Second – since we know the hospital will not love us back – it is up to physicians to change the system. It is pretty clear at this point that it won’t change itself. Yet, this change we want to see in medicine will not happen until we have enough physicians who are empowered to stand up for the change that we need.
In this way, we need a group of empowered physicians who are able to stand up. Hand in hand. And to force this broken medical system so that the generations of physicians who will come behind us (and the patients they will care for) do not have to go through the same experience we have.
How do we Empower Trapped Physicians?
That’s where coaching comes into the picture.
Physician coaching is the secret sauce that helps doctors to stop positioning themselves as a victim of the broken medical system and, instead, teaches them to become the empowered hero of their story. To experience physician freedom.
In order to do this, doctors must have the personal and financial freedom that they need to stand up. Otherwise, they will feel like they have no options.
Once a doctor has mastered their money and their mindset, they start to realize they have choices. That options exist. That they are not nearly as trapped as they think that they are in medicine.
Power in Numbers
And when this group of empowered physicians gets large enough, we will be able to stand up to the insurance companies and administrators.
We will be able to:
- Change the electronic medical record system.
- Refuse to allow medical schools to continually raise the cost of attending medical school at rates that financially enslave doctors.
- Make sure that our doctors have enough time to take care of themselves.
- Remove unnecessary physician tasks that inundate doctors, like unnecessary online modules and maintenance of certification requirements.
- Reform law so that insurance companies do not get to dictate the care that our patients receive.
Bringing it All Together
It is for these reasons that physician coaching is a part of the solution to fixing physician burnout. It can directly help and empower physicians who are struggling.
And once we have a critical mass of empowered physicians, then we will be able to fix the systemic sources of burnout that lead to physicians feeling trapped in medicine.
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