Why Just Telling Doctors To Be More Resilient Isn’t The Answer

Every human being faces adversity.  That adversity can be an extreme event such as a trauma or a tragedy like when a loved one unexpectedly dies. Or it can be more mundane things like continual stress from paperwork piling up every day on your work desk in a never-ending fashion.  How well you adapt to adversity is the definition of resiliency. Darwin

All humans display resiliency, admittedly some better than others. Resiliency is not a unique superhuman power. We are all hardwired from an evolutionary standpoint–genes passed on from ancestors who wouldn’t have survived without it.

 

But resiliency is not just displayed by individuals.  Nations, cities, and communities also show resiliency.  Resiliency helps societies rebuild.  It can also be transformative when facing adversity.  Take the city of Rotterdam in Netherlands.  After WWII,  the city was left mostly in ruin from German air raids.  When the city set out to rebuild, they decided to rebuild and modernize.  A major port hub for the Dutch, the port was its first priority to rebuild. Rotterdam has become a sustainable port city in the world by allocating land around the harbor to renewable energy companies, developing ways to better capture and store CO2 admissions, and using collapsible containers that could save space and cut shipping trips.

Due to its resiliency, NYC rebuilt itself after 9/11. And this will be how my hometown of Houston will rebuild after Hurricane Harvey.

new rotterdam
The city of Rotterdam rebuilt and modernized after near ruin from World War II


What is important to realize about resiliency is this: Don’t expect success in being resilient without relying on others for support.

What will make resiliency more successful in Houston after the Harvey is the massive outpouring support, resources, and donations.  FEMA and the Red Cross didn’t just show up to Houston to hand out “Resiliency” reading material.

This is why many doctors roll their eyes when they are given reading material like “How to be more resilient” but sent on their way to figure it out.  Doctors cannot be expected to be more resilient without sufficient support from hospitals, payors, legislators, and the public.

According to the American Psychological Association, the primary factor for individuals to become resilient is to have caring and supportive relationships both within your family and your outside environment.  So it is important to have employers, communities, and a government that is supportive to really create the full potential of human resilience.

The healthcare system is facing rapid changes that are leading to significant increases in burnout.  Recent studies are showing that the majority of physicians are experiencing burnout.

Being a doctor is inherently a high stress and high demand career–always has been, always will be. But the sources of stress leading to burnout are becoming more vast, and the healthcare system has been unprepared to deal with them.  In essence, the healthcare system is facing a resiliency problem, not just doctors.

There is a significant evolution of the practice environment for physicians.  For one, there has been a universal implementation of a complete electronic health record (EHR) system that many doctors find both frustrating to operate and inefficient to use. Interoperability–one of the primary goals of EHR to improve healthcare system communication and decrease costs– is still a pipe dream.

Second, there is a billing and coding system that is both confusing and incomprehensible for many doctors.  Add to that a fee for service payment model that rewards hospitals and doctors based on the number patients seen, and vastly rewards procedures and tests. As a result, this creates a system that measures productivity by RVUs meaning the more patients, the more procedures, the more tests a doctor orders or performs, the more financially lucrative they or their hospital will become.  And with narrowing reimbursements from insurance payors, this has pressured doctors and hospitals to increase the number of patients they see which in turn increases the likelihood of lower patient satisfaction and less effective care.

The work structures and attitudes of physicians are also changing.  There is an increasing shift of doctors from solo and small private practice to a large employee based practice.  There are the demographic and generation changes of physicians resulting in a change in attitudes of work.  Doctors today want more work-life balance.  They don’t want to work more just for financial incentives.  There is a greater emphasis on meaning and purpose at work.

Add to all this the increasing regulatory demands, a shortage of primary care doctors, and a patient population that is living longer but becoming more obese–increasing the prevalence of chronic diseases which places a greater burden on healthcare resources.  All in all, you have a healthcare system with all the ingredients for epidemic burnout rates.

If you take a step back and look at the big picture, these issues are caused, primarily, by a systemic problem.  These are not mostly individual physician problems.

So expose doctors to these systemic problems in the healthcare system regularly, then no matter how resilient your doctors are or how much resilient training is provided, they will eventually become burned out.

Don’t get me wrong, we don’t need to throw the baby out with the bathwater and just disregard resiliency training.  As physicians, we need to take responsibility for our lives, the care for our patients, and our work environment.  Self-management and excellent communication skills are probably more important for doctors today than ever before.

But the healthcare system will need to adapt to these underlying changes and not expect that physicians alone will fix it by only becoming more resilient.  Keeping business as usual with the same way of thinking of how to run a healthcare system is going to fail if we don’t adapt.

Hospitals and healthcare systems will need to transform and become resilient along with doctors.  Importantly, if the healthcare system and hospitals do not create supportive or caring relationships with doctors, resiliency will be a lost cause.  There needs to be trust and mutual respect.  There needs to be a sense of caring not only towards patients but also towards doctors, nurses, physicians assistants and all the providers that are on the frontlines of patient care. What drives resilience in the workplace is creating supportive environments that provide encouragement and reassurance. For those who are early in their career, there needs to be good mentorship.

What doesn’t drive resilience is just giving lip service or self-help reading materials with no culture change. Leaders in healthcare systems need to be engaging and supportive. Todays best leaders understand that to drive transformation and resilience in their organization, it is necessary to take care of those that will need to adapt.  When change is required, effective leaders provide the tools providers will need to do their best work.

Providing support and care is a primary driver of resiliency.  This is fundamentally human nature. Rotterdam was not rebuilt and modernized after WWII because the city provided “resiliency” training for its architects and engineers.  Rotterdam was rebuilt because of enthusiastic support and resources from the public and its government. Behind the force of the city’s support and vision, architects and engineers set out to rebuild the city to what it is today.  Just remember we are social creatures and through support and adaptation is how our civilization and institutions have succeeded and thrived.

So who is supporting doctors so they can transform and modernize healthcare for the 21st century?  With our rising burnout rates despite the changing healthcare system landscape,  that answer remains elusive. And indeed just providing resiliency training will not be enough.