Why Employed Physicians Quit – The BIG 3
In my work with hundreds of over stressed physicians, only about 30% must actually quit or change jobs to recover from physician burnout. The last straw in their decision is often one of these BIG THREE reasons employed physicians quit.
Most of the time – with better leadership, life balance and mindfulness skills – you can recovery from burnout by changing the way you are being rather than having to resign and walk away. Unreasonable workloads and blind spots created by our programming often cause the most stress, but they are not enough to get a physician to actually quit and voluntarily go through the pain of a job search.
Remember too that the conditions of your current work environment are only one of four causes of physician burnout. For those physicians who feel they have no choice but to leave … the BIG THREE below separately or in combination are the final motivator. And …
I sincerely hope you don’t recognize any of these in your current workplace.
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1) Employed Physicians Quit Because of a Toxic Culture
Most physician groups have no conscious culture or code of honor that binds them together to a standard of behavior.
If I ask a doctor to describe the culture of their group I often get blank stares. The question just does not compute.
In the absence of a consciously created group culture (this IS possible, BTW) most groups simply continue the culture of our residency programs. Competition, everyone working as hard as they can on their own personal gerbil wheel, no acknowledgement of humanity, never show signs of weakness, get out of the office as fast as you can, the biggest producer gets their way … and on and on.
No wonder it is rare to feel your group is a “home” or that your partners “have your back”.
If you are fortunate enough to find yourself in a situation where your group’s culture is healthy … you look out for each other and trust is actually a word you use do describe your partners … savor it and count your blessings.
Most groups have nothing that binds them save a contract, reimbursement formula and a call schedule.
In the absence of a cohesive, supportive culture amongst the physicians, they are usually pushed around by a non-physician administration that focuses only on financial returns and work conditions slowly drift into the toxic range.
2) Employed Physicians Quit Because of the Way the Group Makes Decisions
OK, let’s assume you have a consciously created culture in your group. The next issue is how you make decisions that affect the members. Do you have a voice? Does the group seek out and respect all members opinions? Or our your concerns unheard or unappreciated, no matter how patients are being put at risk. In large part, your answers to these questions will depend on the method you use to make decisions.
Most physician meetings (the WORST business meetings on the planet, bar none) are run by Robert’s Rules of Order.
Robert’s Rules of Order set you up for conflict, dissention and bullying that is officially sanctioned by the group. Here’s how …
– Robert’s Rules of Order limit discussion. They allow two people to bring a premature close to a discussion no matter what the size of the group
– They actively block consensus amongst group members by using a “Majority Rules” decision making process
Majority Rules will always create a “disloyal minority” unless the vote is unanimous. Most doctors run their meetings with Robert’s Rules of Order by default. You have never seen a meeting run any other way – you carry on in the same fashion without thinking of the implications to the quality of your decisions.
I strongly encourage you stop using Robert’s Rules of Order.
The best way to make decisions in your group is by Consensus. Consensus is by its very definition a unanimous vote every time. Consensus virtually guarantees the decision reached was win:win for all parties and everyone is bought in from the start.
I advise you use this Consensus Definition:
“I can live with that and support it.”
Write this definition on a page of flip chart paper and hang it on the wall so it is visible to everyone at the meeting.
You call for Consensus by simply asking two questions.
1) “Raise your hand if you can live with and support this decision?”
2) “Anybody not?
Whenever you have a dissenting member .. your follow up question is equally simple.
“What would it take for you to live with and support this decision?
In my experience the wishes of your dissenting member are simple and Consensus is usually a matter of revisiting the decision in a month or some other reasonable time frame.
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When you combine poorly run meetings, Robert’s Rules of Order, Majority Rules and a toxic or absent culture … the chances of you fitting in long term are slim. And then here comes strike three …
3) Employed Physicians Quit Their Immediate Supervisor
No one can make your life a living hell more easily than an immediate supervisor who is missing the skills of emotional intelligence, communication and strategic vision. This is a tragically common triad of missing skill sets in physician leaders and non-physicians in charge of doctors these days.
Is your supervisor/boss …
– Clueless as to the day to day operations of your department
– Does not notice or care about the workload and stress levels of you and your staff
– Takes their orders from above and dumps them on you and vanishes (“seagull management“)
– If they do drop by to try to “fix” something – they have an alarming way of making it worse and actually increasing your work load as you clean up their mess
What can you do?
In an ideal world you don’t ever sign a contract with a group like this.
When you understand the BIG THREE, you can be proactive. Take a set of questions to your job interview that will root out these disasters in the making BEFORE you sign a contract and find out by first hand experience.
If you find yourself in a toxic workplace like this and choose to stay (with your eyes open), I recommend you concentrate on getting the satisfaction you can from practicing good medicine and building relationships with the people who call you their doctor.
When it comes to your group’s culture and decision making and your own boss … I suggest you choose your battles wisely and memorize the serenity prayer – at a bare minimum.
“Grant me the serenity to accept the things I cannot change;
courage to change the things I can; and wisdom to know the difference“
I also suggest you sit down and make your Ideal Job Description and take a good long look at whether this is the way you want to live your professional life in the long term.