In this episode of Value-Based Care Insights, host Daniel Marino tackles one of healthcare’s most persistent challenges: physician burnout. Joining him are two experts who bring both clinical and research perspectives to the conversation. First, Dr. Stephen Hippler, a retired Chief Clinical Officer at OSF HealthCare, oversaw more than 1,500 physicians and advanced practice providers and has led initiatives to support provider well-being and a thriving work culture. Second, Dr. Laurence Weinzimmer, an endowed research professor at Bradley University, is a nationally recognized healthcare researcher and advisor to Fortune 100 companies.
Together, they share insights from their latest study on “physician fortitude” examining the deeper, human roots of burnout, the organizational and cultural factors at play, and the strategies needed to drive meaningful change. Listeners will gain an understanding of why burnout persists, and what leaders can do to better support clinicians, build resilience, and improve workforce well-being over the long term.
LISTEN TO THE EPISODE:
Daniel Marino:
Welcome to value-based care insights. I am your host, Daniel Marino. Over the last number of years, we've talked on this program a few times about physician, burnout, physician, well-being, if you will, and kind of balancing all the stresses and the challenges that physicians have within their practice. In both in seeing patients in the hospital as well as seeing patients within the clinic. And I have to tell you, through a lot of my recent conversations that I've had with physicians and with healthcare leaders, I don't see it really improving. As a matter of fact, I see it getting a little bit worse. I recently had a conversation with an internal medicine physician, and she was just totally up in arms because of the continuous challenges that she's having. Just even with her epic system, and answering all of the messages and the challenges related to that. And it really got me wondering, is it more about the individual physician and the stressors of the industry that are forcing a lot of these issues around burnout? Is it the culture of the organization, or is it is it just you know, the norm of our of our industry. Well, recently, as part of the work that I'm doing as a board member of the Illinois MGMA, we have a fantastic conference coming up on November 7th and as part of that, there are 2 great gentlemen who are going to be presenting at that conference, and I'll share more of the details at that at the end of our program.
But here to talk with me about physician burnout, physician well-being is Dr. Steven Hippler. Dr. Hippler is a retired practicing physician and former chief clinical officer at OSF Healthcare, and then Dr. Larry Weinzimer, he is a business advisor to numerous fortune 100 companies, author of 4 books, including 2 national bestsellers, and has done a lot of research on Physician burnout. Larry, Stephen, welcome to the program.
Steve Hippler:
Thank you, Dan.
Larry Weinzimmer:
Glad to be here today.
Daniel Marino:
So, Steve, maybe we could start with you. As a former chief clinical officer, you know you worked with with a large health system for a number of years. You've seen ebbs and flows with Physician Burnout. In your opinion, what's been some of the big drivers of Physician Burnout? And why hasn't, why haven't we seen this really making a turn?
Steve Hippler:
Well, Dan, when I was in my previous role, I thought burnout among physician, and really, among all of our staff was one of the biggest problems facing healthcare today. And truly, as you mentioned, if you look at the AMA triennial surveys, the incidence of burnout has not really gone down in these triennial surveys over the past 12 years. So I set out on a search to understand better what was causing, what were the drivers of burnout, and honestly to look for programs that would help the well-being of those that we employed.
And at the time I was really left underwhelmed, I thought the explanations for what causes burnout were somewhat incomplete, and the solution seemed one size fits all. In our experience we see people who love the EMR, who don't have problems with prior authorization, and it wasn't the busiest people who were always burning out. So the explanations were somewhat incomplete.
That's when I partnered with Dr. Weinzimmer to start to explore this a little bit further. And one of the things Larry and I hit upon is so much of the literature today talks about it's the work environment causing burnout. Yet why is it, then, that 50% of physicians in similar work environments, working in the same culture do not get burned out? So we spent a lot of time. Larry had done a lot of work on burnout resilience, so we partnered up 5 or 6 years ago to try to get a deeper understanding of the causes of burnout, so that we could come up with more effective solutions. And we've hit upon the topic or the fortitude as one of the key pieces that we think has been missing in this conversation, that we're having globally in physicians and all other people and workers in regard to burnout.
Daniel Marino:
Yeah, well, and I agree with you. I have not, you know we've done a lot of work with physicians over the years. The I think the burnout factor really came to a head right after Covid, and it just doesn't seem like it's gotten any better. So Larry, talk a little bit about some of the research that that you've done when you think about those core drivers of burnout.
Larry Weinzimmer:
Yeah. So when we really initiated the research on this Dan, we tried to take a holistic approach. As Steve mentioned the majority of interventions that try to reduce burnout focus on the organization. And there was a recent meta analysis published, actually 2 recent meta-analyses published that both showed organizational interventions aren't moving the needle in terms of mitigating or reducing burnout. And there's also a set of literature out there that looks at the individual. And is it, is it the individual or the organization that really helps to reduce burnout? And so what we did was we took a look at both of those literatures simultaneously. And it's not the organization or the individual that helps predict burnout. It's the individual and the organization. And so that's really what the the primary focus of our research has been, and previous to our research there were numerous attempts to understand, is it resilience? Do you have the ability to bounce back after a setback, or is it grit, or hardiness, or mental toughness, or hope, or optimism? There are all these different literatures out there that try to understand burnout better from multiple industries. And this isn't just healthcare. But many of these areas of research have looked at other industries and Steve can get into that in a little while. But we thought that it was actually an interaction or combination of these individual of these attempts to understand burnout at an individual level that could give us new insights, and as Steve mentioned, we landed on this concept we define as fortitude. And where fortitude is different than the others is. Fortitude is proactive rather than reactive. With fortitude rather than bouncing back after a challenge. How do you avoid the challenge? In the 1st place.
And so we spent Steve. What probably about 3 years developing this, a measure of fortitude? We really wanted to make sure that the measure that we were going to move forward with on our research was statistically valid and reliable. So many measures out there aren't. And so we really we, we spend a lot of time to make sure that our measure of fortitude measures the psychometric properties we set out to measure.
Daniel Marino:
Lets dive into that a little bit, because I'll tell you, you know I've worked with numerous organizations who've done their physician provider surveys right and burnout always comes out as number one. And then undoubtedly what leadership does is they go out and they find a consulting company who has a program right? And they purchase this program to address Physician Burnout to improve physician well-being, and they just measure the satisfaction of it. And what always, really, what strikes me about that approach is they're not addressing the root cause of burnout. It's a general program addressing what they believe those causes are, but not really driving into the true root cause for that individual or for that organization. So maybe you know, Steve, dive into a little bit about your concept of fortitude. I think it's an interesting approach as you start to think about how to really redirect the or address these issues of burnout with physicians.
Steve Hippler:
Yeah. Well, back to your last comment, you know we do, we give seminars. We'll ask people what's causing you the most distress, frustration, and burnout now. And we create a word cloud. And it's fascinating, Dan, when we look at that, it's all different.
Daniel Marino:
Yeah.
Steve Hippler:
And that's probably why the one size fits all approaches have never really worked right?
Daniel Marino:
They never work.
Steve Hippler:
Because what one person's biggest frustrater is today, might not be it for the other person. So we looked at, how do people build the skills and attributes to be, have more fortitude in the face of work, stress, and pressure. And this, Dan, we believe, is applicable to all people. It's not just physicians. Burnout is prevalent now in all industries and even in non-working people. So we looked at all the literature out there on burnout, across all industries and all people. You know, in healthcare we talk a lot about resilience or bouncing back. But when I used to talk to physicians they'd get a little bit angry talking about resilience. It's almost thought or received as that they're not tough enough, or they're not strong enough. And so resilience had sort of a negative connotation. So we looked outside of healthcare and looked at the literature in academia. There's a tremendous amount of literature on how grit helps people improve performance, and to succeed, and a little bit on preventing burnout, especially in healthcare. We then looked at self-efficacy and skills. You know, we don't talk a lot about skills in healthcare a lot. But if you look at the teacher literature, you know, not being able to control your classroom is a big cause of burnout. And now, after Covid, having poor telecommunication, remote teaching skills is a big cause of teachers burning out and leaving the literature. So when you look into healthcare, poor EMR skills, poor communication skills, diagnostic uncertainty, have all been linked to burnout, yet we don't talk about that enough. So grit, self efficacy. If you look at the literature on athletes and performers, hardiness and mental toughness are key skills and attributes that they need to build in order to succeed when under high stress situations, when the chips are on the table, and the stakes are high. Which, although it's talked about in athletes, you know think about our surgeons and our doctors and the ER docs and the nurses. They need mental toughness and hardiness as well. Resilience is always always important as well as well as hope and optimism, because a career is long. So we looked at all these individual attributes and looked at them in the literature across multiple professions. And they all argue that they're different from each other. But what Larry and I did is looked at them and pulled them, pulled them all together, found some similarities, and then created a scale of fortitude based on all these. Our premise was that people needed all of these to really be able to overcome the stress and do better in spite of the stress. So it's not one or the other, but it's all of these. So, Larry, I'll let you speak to how we developed the tool.
Daniel Marino:
If you're just tuning in, I'm Daniel Marino. You're listening to value based care insights. I'm talking today with Dr. Larry Weinzimmer and Dr. Stephen Hippler, relating to physician, physician, burnout. And Larry, absolutely, I want to dive into that a little bit. But I would also like for you to really define fortitude. Right? You keep on talking about fortitude. And Steve went into a little bit of detail on that. But in our setting of physician burnout, how is fortitude defined as an activity of measurement and improvement for physician burnout.
Larry Weinzimmer:
Yeah, great question, Dan. So fortitude is defined as the courage to withstand setbacks and challenges in the workplace. And as we talked about before. It's really a proactive approach. How do we have the courage to not only overcome them, but avoid having them happen in the 1st place. And the focus on fortitude is really attitudinal. It's a perspective. And what's exciting about that, Dan, that means it's malleable, or it can be coached. It can be learned, it can be changed.
Daniel Marino:
Is it organization driven when you're building fortitude, or is it individually driven.
Larry Weinzimmer:
Yes!
Daniel Marino:
Both.
Larry Weinzimmer:
Yeah. So what we found Dan is again, there's some great efforts on trying to reduce burnout at the organizational level, trying to improve organizational support. There's been a plethora of research looking at individuals trying to build, you know, build self-improvement self-help. And it's really the interaction of the 2 and one fascinating thing we found with our research, Dan, was that when an organization attempts to reduce burnout, let's say, for example, they're trying to improve organizational support for their people. If somebody has a threshold level of fortitude, as the organization introduces that intervention, we see a significant decrease in burnout. However, if a person doesn't have that threshold of fortitude, the organizational intervention has no statistically significant impact on reducing fortitude. And so it's really the interaction of the 2.
Daniel Marino:
That's an interesting, that's an interesting perspective. I want to dive on that a little bit. So it seems to me, as you're thinking about addressing from an organization perspective, addressing issues with burnout and improving physician well-being if you will, you really do have to measure the individual's level of fortitude. And how then, you know, they're going to adapt to some of those changes, because to your point, you probably can put in all of these initiatives which we often see, and yet burnout never really improves.
Larry Weinzimmer:
Absolutely. And that's what we found in those 2 meta analyses is so much effort is being made to try to manage and mitigate burnout in organizations. Yet it's actually increasing in some industries rather than decreasing, even though we have all this effort. So are we focusing on the wrong thing? Not necessarily. But we're there are other things we need to focus on as well.
Daniel Marino:
Yeah. So let me dive into a couple of things that that I hear often in working with physicians, 2 things come to mind. One is obviously the stressors around EHR. I think the second is around patient access. And you know, what we saw was, we sort of created our, we exacerbated the problem of burnout with access certainly around Covid, because, as more and more physicians got frustrated, they retired early. Which then created less physicians, less providers in the industry access didn't change right. The patient demand didn't change, and yet there were less providers, right? And so the supply went down, which put more pressure on it. So those were 2 areas there that in my mind were really drivers of burnout. But what does the research show? How does that then align with fortitude, and then, as you start to address those things, to improve burnout, both with the physician and with the culture, how do you take that into consideration because those are tough challenges.
Steve Hippler:
Yeah, you know, Dan, the literature on EHR. Shows that if you train people how to be more facile with the EHR burnout goes down. I know there are a lot of individuals who have different EHR skills. That training, And again we talked about self-efficacy can be an important tool to help people. You know, I grew up in, started my career in the paper chart world. And I look back and there were these similar issues with paper charts. Nobody likes to document. And I'll be honest, I think it's those coding and documentation rules.
Daniel Marino:
Right.
Steve Hippler:
That are almost a bigger driver than the EHR, which is the vehicle to implement those that sort of caused a deprofessionalization of the medical profession. But learning how to use the EMR better, taking time out of the day. To sit with a trainer, do short, learn shortcuts, smart phrases, and whatever really has been shown to be a strategy to reduce burnout in some. Scribes this AI enabled dictation, I think all those are great tools for it to help with Burnout related to the EHR.
Daniel Marino:
So when you, when you then think about putting in programs in place. When we think about addressing this, speak to, you know, maybe, Larry, you can jump in here. Speak to how you align the research with the programs I mean is this, should this be very individually focused? Or can you create a program that is organizational based? That's addressing a lot of these issues. Or maybe it's both. I don't know.
Larry Weinzimmer:
Yeah. And Dan, it absolutely is both. And so with the work Steve and I do we, when we work with organizations, we 1st of all spend time educating people on fortitude and on, as you mentioned earlier, Dan, on drivers of burnout, what's causing burnout to help them really understand what the problem is. And then what we'll do is typically is facilitated group coaching where we work with them to develop, where each person develops their own individualized strategy. Then we create accountability to make sure that they're really focusing and committing to the change. And one thing that's pretty exciting a paper we're about to submit for publication shows that we took a group of 31 physicians and APPs and put them through the training for what we call our fortitude training and develop their individual strategies. And we also measured a control group, people that they worked with in the same environment that didn't receive the training. After 4 months we remeasured both the experimental group, those that received the training and the control group, those that didn't receive the training. We saw a significant increase in fortitude, and, more interestingly, a significant decrease in burnout for those that receive training. And for the control group we actually saw a slight increase in burnout over those 4 months.
Daniel Marino:
Oh, really? That’s interesting.
Larry Weinzimmer:
Yeah, so yeah, so we're really excited about that. And as I said, Steve, this week, we're submitting that for publication.
Daniel Marino:
Yeah.
Steve Hippler:
So the organizations, Dan really need to create the environment and individualized training programs and support their people, to help them improve their own well-being. One of the things we want to do with this work is to shift the conversation a little bit from it being all about the workplace and leadership's job to prevent burnout, to it is about the workplace and the leadership job. But individuals also bear some responsibility to have insight into what their greatest driver burnout is for them individually, and to be able to develop their own individual, unique strategies and build the skills they need, and build the fortitude they need to help overcome that.
Daniel Marino:
Well and a lot of times, it's easier said than done right? Because what you're talking about is creating self awareness of leadership of individuals. And having them understand that or become aware that, hey If we're going to address this, we need to really, we need to change, right? We need to create a paradigm shift within the organization that both is addressing the individual and to your point, which I love different levels of fortitude. Because what's important and how one person is going to address or react to it is different than another. But also then, understanding how the organization needs to react to it.
Larry Weinzimmer:
Yeah.
Steve Hippler:
Right and an understanding that individuals need to be coached to help build their own unique strategy skills and well-being. As part of this culture within the healthcare system.
Daniel Marino:
Yeah. Well, gentlemen, this is this has been a great discussion, and I'll tell you a topic that is definitely near and dear to my heart. You know, as I mentioned early on, youboth are presenting at an upcoming Illinois MGMA Conference. The conference is on November 7th at Soldier field. So you're going to be presenting, you know where the Bears play, and I think Larry, to your point earlier, maybe on the 50 yard line. Who knows? Right?
Larry Weinzimmer:
We're hoping. Yeah.
Steve Hippler:
We're looking forward to it, Dan.
Daniel Marino:
That's great. Talk a little bit about, maybe share with our audience for those that are interested in learning more, maybe, about the research that you're doing, or you know, the concepts that we've addressed here, I think, are somewhat new concepts. How can they get a hold of you? How can they share some of the, or how can you share some of the information with them?
Larry Weinzimmer:
Yeah. And so they have a couple of different ways to learn more about the topic. We are publishing quite a bit in the area. We have a paper forthcoming in the Journal of Healthcare Management that should be out in the next couple of months. If they want to take a look at our recent research, a great source would be our website. It's nexusinsights.com, where we post all of our research. Where our speaking engagements are. So they can get some of the leading research that we haveor leading edge publications that we're putting out right now. And additionally, we're both on LinkedIn as well.
Daniel Marino:
Yeah. And Steve, how about for you any things you could share about your contact?
Steve Hippler:
Yeah, likewise. And people, we have a contact us link on our webpage, on our website. So for people who want more information, who want to contact us. Please just go to our website and fill out the Contact Us form, and we'll get right back to them.
Larry Weinzimmer:
Yeah.
Daniel Marino:
Great well, and as I mentioned you, gentlemen, both will be presenting at the Illinois MGMA Conference on November 7th so anybody's, particularly in the Illinois market or in and around that, please plan to attend, because it will be a great conference. Well, gentlemen, I want to thank you for coming on the program. You know again, an important topic, one that absolutely, you know, we need to address, and we can only address this together. I really appreciate your time.
Larry Weinzimmer:
And thank you so much for the opportunity. We are passionate about this, and excited about the future, with the research.
Steve Hippler:
Yeah, thank you. And remember, we want to continue to focus on the fact that it's not just the organization or the individual. But it's a combination of the 2 that, based on our research, we believe will help people improve their well-being and reduce burnout.
Daniel Marino:
Great point. Great point. Well, Steve, thanks again. And, Larry, thanks to you, And to our listeners, if you're interested in finding out a little bit more about this topic, or additional information related to our conversation with Steve and Larry please reach out to me at dmarino@luminahp.com, or visit luminahp.com for more information.
I want to thank everybody for tuning in, and until our next insight I am Daniel Marino, bringing you 30 minutes of value to your day. Take care.
Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners