Recently, roughly 400 primary care and urgent care physicians at Allina Health System voted to unionize. In doing so, they became the largest group of unionized private-sector physicians in the country. Their decision is indicative of a hard reality of American health care–physicians are burned out. Research shows from 2021 to 2022, 63 percent of surveyed physicians experienced at least one symptom of burnout such as feeling exhausted or increased mental distance from work. This marks a steady rise from 46 percent in 2011. What’s equally concerning is that there has been a 30 percent decline in the number of physicians who expressed contentment with their work during that same period of time. These feelings have been shown to have negative effects on quality of care, patient safety, and patient satisfaction – items we should all be concerned with. This situation is a ticking time bomb, as numerous health care providers are considering reducing their working hours or even departing from their practices entirely. Given the existing shortage of physicians, the potential consequences could be dire unless we act soon. While the causes of burnout are myriad, we might find a crucial clue by contrasting today’s physicians with those of the generation before us. My father was a physician in a small, rural town for over 40 years. Each day, he got up early to see his hospitalized patients and then headed to his office, where his waiting room was packed with patients. He saw patients before the era of handing your credit card over at check-in. Although he wanted to be paid, it was never a condition of treatment. Grateful patients would give him pecans, peaches, and all sorts of things they had grown as small tokens of appreciation and sometimes as payment. Each day, he would enjoy breakfast or lunch in the physicians’ lounge, spending as much time building relationships with his peers as they ate. During the holidays, he and I would visit all the referring physicians in town to hand out boxes of Belgian chocolates. Although I thought of my father as a doctor and not an entrepreneur, that’s exactly what he was. He built a successful small business by focusing on his customers and partners. My father wasn’t unique for his time. Looking back, I believe his entrepreneurship protected him against burnout and helped explain his long and productive career and the similarly sustainable careers of other doctors of his generation. In a study published in 2022, researchers at the University of Amsterdam tracked 348 entrepreneurs and 1,002 employees for a period of up to six months. Despite working longer hours, the entrepreneurs in the study were no more likely to experience burnout than salaried employees. The risk of burnout was lower among entrepreneurs due to the positive psychological effects of entrepreneurial work, which provides a greater sense of meaning, personal autonomy, and job satisfaction. Compare the entrepreneurs’ experience from the study to my experience as a physician, which resembles that of many physicians of my generation. I’ve worked in a number of clinical settings – academic, community-based, urban, rural, big and small. Despite being surrounded by brilliant clinicians and caring colleagues, I always felt like a cog in a giant machine. I rarely felt like I was in control, was usually overwhelmed by administrative work, and was unable to drive meaningful change. I was never able to derive the joy of turning vision into reality, which sustained my father for so long. Today, nearly three-quarters of all physicians (74 percent) are employed by a hospital, health system, or corporate entity. In fact, a single entity, Optum, owned by insurance giant UnitedHealth Group, employs approximately 55,000 physicians, or about 6.5 percent of the roughly 850,000 physicians actively providing patient care. Unsurprisingly, physicians in that environment don’t have the kind of agency that most entrepreneurs have. It’s time to unlock the power of entrepreneurship to combat burnout. While rolling back the consolidation over the last 30 years is neither the right answer nor feasible, there are things we can do to advance the spirit of entrepreneurship and promote physician well-being. First, we need to look at policies that favor larger corporations and hospitals. For example, today, Medicare pays more for services conducted within hospital outpatient departments than independent clinics. This incentivizes hospitals to consolidate and is a disincentive for physicians to become entrepreneurs. Second, it should be easier for physicians to open their practices. Today, it’s not as simple as it was for my father. The odds are stacked against the little guy when navigating byzantine regulatory matters, investing in modern information technology, and negotiating with massive suppliers and insurance companies. To overcome this, we can support companies Privia Health, Adelade, and CardioOne, which partner with independent physicians and provide them with the resources and know-how to be successful. These companies do just about everything outside of seeing patients. In the process, they leverage physicians’ entrepreneurial drive while enjoying the benefits of scale. These smaller, more nimble models have been especially effective in executing new models of payment, known as value-based care. And lastly, we could decentralize the work that exists within large provider groups to empower physicians. For example, large corporate entities could treat small groups of physicians (by site or department) as entrepreneurs, giving them far greater latitude to “run their businesses.” In this model, the corporate entity would provide a number of shared services that would benefit from scale such as purchasing, information technology, or revenue cycle, while ensuring doctors have control over their work and preserving the entrepreneurial energy of independent physicians. This is as much a cultural shift as an operational one, where the corporate brand matters less than the patient-doctor relationship. It’s a big shift for most organizations. To be sure, entrepreneurship isn’t a cure-all. Entrepreneurs also experience burnout, especially when they fail to make time for self-care and replenishment. However, The good news is that they experience burnout at lower rates than employees. Additionally, the corporatization of health care may have benefits for physicians. Larger practices have more resources to invest in professional development and quality improvement. And lastly, I know many physicians who would never want the hustle that entrepreneurs often feel. They prefer to treat their job as just that – a job. There isn’t a one-size-fits-all answer to improving physician burnout, but the good news is that health care is big enough to have many winning approaches. If we want doctors to stay off the picket lines—and stay in the profession—we need to use every tool at our disposal, and entrepreneurship could be a key one. Arun Mohan is a physician entrepreneur.
This content was originally published here.
