Leonard Zwelling




The president of MD Anderson chooses to focus on wellness not burnout, but cooking classes are not the solution to what troubles the MD Anderson work force. Fixing the work environment is.

These three articles give a full picture of the problems that face medicine and all other work forces.

The first is a superb analysis of burnout in medicine today from the August 18 issue of The New England Journal of Medicine by someone who knows what he’s talking about—the Surgeon General Vivek H. Murthy. One sentence really caught my attention:

“Burnout manifests in individuals, but it’s fundamentally rooted in systems.”

In other words, those who are in charge of how an organization runs bear the brunt of the responsibility for the well-being of the work force and building systems that minimize the chances of faculty and staff burnout. Murthy goes on to write:

“One study found that in addition to spending 1 to 2 hours each night doing administrative work, out-patient physicians spend nearly 2 hours on the electronic medical record and desk work during the day for every 1 hour spent with patients.”

Whose fault is that? Administrators, lawyers, and insurance companies.

It really all comes down to focusing on the real work of patient care, minimizing the associated administrative “stupid stuff,” and optimizing staffing so doctors do doctor work, nurses do nurse work, and clerks do clerical work. These things cannot get mixed up.

The second article from The Wall Street Journal of August 25 talks about a new phenomenon permeating the work force–“quiet quitting.” Quiet quitting is when members of the work force draw firm boundaries between work life and outside work life and do not go the extra mile at work. This would be disastrous at a place like MD Anderson where clinical staff are renown for seeing the extra patient in dire need of care. It is this selflessness that lies at the heart of MD Anderson’s recurrent ranking as the best place for cancer care. But that too can change.

I have often said that the leadership of MD Anderson will pay attention once the clinical faculty turn a Wednesday into a Sunday by scheduling no out-patient visits and only providing in-patient and emergency care for a single weekday. That will never happen because there’s too much fear in the organization that heads would roll despite all attempts to reason with the institutional leadership about its heavy-handed decision making in the absence of consultation with the faculty.

But a friend posited that many faculty members are turning Wednesday into Friday—leaving early and taking extra “me time” and doing it now. Quiet quitting.

Burnout is a real threat to medical faculty and patients alike. Leadership needs to stop pushing wellness and start addressing the causes of burnout. No amount of yoga or meditation will fix burnout. Aggressive interventional therapy will help but getting rid of stupid administrative tasks, harassment about professionalism, and continuous computerized trainings from Human Resources would be a better approach.

The faculty are at MD Anderson to care for patients, do research, and educate the next generation of cancer care givers. They cannot do that and all the “stupid stuff” too without burning out.

Reduce the burnout. Wellness will follow (see third article from The New York Times of August 30).

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