The Cure for Concierge Physician Burnout
Physician burnout is not a new phenomenon.
Burnout is prevalent enough that a great deal of advice, education and even research exists to help physicians and organizations address it.
The American Medical Association defines physician burnout as “a long-term stress reaction characterized by depersonalization,” noting that burnout is “often associated with increasing administrative responsibility due to regulatory pressures and evolving payment and care-delivery models.”
Concierge medicine actually removes most of the factors the AMA cites as causing physician burnout. And the concierge model has long been touted as an all-encompassing burnout solution.
But you’re in concierge medicine already. So what happens if you experience burnout? Is it time to change models? Retire?
The truth is, physician burnout is universal. Any physician can experience burnout, even a concierge physician. But that doesn’t mean there’s nothing you can do about it.
While there’s no silver bullet for physician burnout, identifying the signs, pinpointing the causes, and implementing a few key strategies should help you combat this ubiquitous malady.
Identify the Signs of Burnout
There are no differences between traditional and concierge physician burnout signs; the symptoms present just the same. While this may not sound positive, it really just means you have a well-documented collection of signs to watch for.
The signs of burnout fall roughly into three categories.
The first hallmark of physician burnout is physical and/or emotional exhaustion. You feel tired and drained regardless of how much you rest. You may get sick more often or be unable to get out of bed in the morning.
Every Sunday night, you may experience anxiety or feel physically ill at the thought of going to work the next day.
Another aspect of burnout is depersonalization, or compassion fatigue. This is characterized by increasing cynicism, negativity or frustration and an increasing detachment from other people.
With compassion fatigue, you lose the capacity to care about your patients (and others) because your emotional resources have run dry.
The third indication of physician burnout is sometimes referred to as a lack of efficacy. In other words, you feel purposeless, useless and like you’re not making a difference.
You lose satisfaction in your work or feel helpless and defeated. You question the value of your work as a physician and wonder whether what you do even matters.
You lose the fire that once motivated your work, and you know you can’t continue like this.
Pinpoint the Causes of Burnout
While the symptoms of burnout remain the same across the board, the causes of burnout can differ. As mentioned above, per the AMA’s definition of burnout the triggers have all but been removed. So, for concierge physicians in particular, these are some of the main causes.
COVID-19
The COVID-19 pandemic, though perhaps obvious, is worth mentioning here as a source of burnout. The mental and organizational burden of the pandemic has been enormous.
The increased stress, heightened anxiety of patients and staff alike, risk of exposure, limited resources and disruptions to normal operations all piled on to increase burnout among all health care providers during the pandemic.
Lack of Professional and Practice Growth
Lack of growth in a concierge practice can also lead to physician burnout.
If you’ve set goals for practice growth but continue to hit roadblocks, you may begin to feel discouraged, overwhelmed or even trapped.
The frustrations of trying to move forward without seeing much progress can stem from some common factors like too many patients, low margins, an unfocused niche and business overwhelm in areas like finance, management, marketing or sales.
Eventually, the weight of all these frustrations can load you down until you lose the fire and motivation for what you do best, resulting in burnout.
Lack of Personal Growth
Moving into the concierge model of practice often affords physicians more freedom and flexibility to pursue personal passions, hobbies, travel or increased time spent with family.
However, practices can begin to require greater and greater investments of time and mental energy, leaving you little room for personal pursuits. This encroachment into your personal life can lead to a lack of personal fulfillment and growth, resulting in burnout.
Lack of Direction
If your business is tugging you in multiple directions at once, you can feel as is if you don’t have control in your own practice.
This can happen if the direction of the practice isn’t clear, or the goals become muddied. Suddenly, the reason you got into concierge medicine in the first place isn’t what’s keeping the business afloat anymore. This too can lead to burnout.
Isolation
It’s lonely at the top.
You’ve left a large group practice or academic medical center, but now that you’re on your own, it can be isolating — especially if you’re experiencing success.
If you’re a solo physician practice, even if you have a team around you, you’re the decision-maker, boss and head of the organization. It’s difficult to find true peers to discuss specific practice issues with. Staff and patients look to you as the sole MD for leadership and direction. And that’s isolating in itself.
Carrying the weight of an entire medical practice without peer support or companionship can easily lead to burnout.
Take Steps To Combat Burnout
Physician burnout is such a pervasive problem that it may appear to require dramatic action or a massive upheaval in a practice to combat. But you don’t have to completely overhaul your business to avoid this phenomenon.
In reality, it just takes some straightforward actions and mindset shifts to help concierge physicians reduce, combat or remove the causes of burnout.
Re-Center Goals and Vision
In the midst of day-to-day operations, it’s easy for private physicians to lose sight of larger goals and their vision for the future. Previously, a larger organization set imperatives for the day, month, year, etc., but concierge physicians now have this task all to themselves.
If you stop setting goals, then you’re on an epic journey with no destination. Are you making progress on your journey? It’s hard to say. Eventually, that Odyssean sense of aimless wandering leads to discouragement and loss of motivation.
A simple solution is to set regular goals — both short-term and long-term — to mark milestones, identify progress and give you a North Star to aim for. Then when you meet one goal, you can set another.
Remember too that your goals and vision are fluid. None of us are static. We receive new information and make new assessments constantly. We develop new opinions informed by that new information, set new goals and chart a new course. Your vision for the future shouldn’t be chained to the goals you set in the past.
When you started your practice, you didn’t know the same things you know today. You’ve had new experiences, new growth, and you may have a new vision. Have you allowed your goals to change along with you? Don’t let yesterday’s goals sink the ship that’s taking you into tomorrow.
(One of my favorite resources on goal-setting for leaders is the book The 4 Disciplines of Execution by McChesney, Covey and Huling.)
Align Personal and Professional Priorities
If your professional life encroaches too heavily on your personal time, it’s helpful to identify what elements in your business regularly eat up your time. Do you need more administrative staff? Another provider? Is your patient load too heavy?
If you recognize that your practice is taking away from your personal priorities, you can spend some time to realign the professional with the personal and make the changes necessary to preserve that alignment and prevent physician burnout.
Balance Working In and Working On the Business
There’s a difference between working in your business and working on your business. One isn’t better than the other, but you might prefer one over the other.
Was the reason you jumped into concierge medicine mainly to work in the business — to see patients personally, develop relationships and make one-on-one connections? If you find yourself working more on the business, then you’re missing out on the essence of what brings meaning to you in your work.
Or maybe running the practice, producing great marketing and working on other business aspects really get you fired up. If you don’t have time for those, then your enthusiasm could begin to wane.
No two physicians are alike, so you have to identify your perfect balance between working in and working on the business. Often, though not always, hiring in the area that’s taking too much of your time can restore balance and combat burnout.
Maybe you need to hire more support staff or find professional services to help with marketing or finance to free you up for patient care. Or maybe you need to hire more providers and cut back your patient load.
Once you find your ideal balance, you can take straightforward steps to facilitate it.
Find Real Community
Because concierge physicians no longer have ready access to peer physicians every time they go to work, they need to find a new community of peers who really understands their situation.
You’re both a physician and a business person running a thriving independent practice. A new doctor just out of residency or a physician in a large hospital group simply can’t be the helpful sounding board you need. But community is a crucial component of resiliency, so you must find it somewhere.
Joining a physician network like ROAMD, which is tailored specifically for concierge physicians, can supply community without infringing upon your autonomy. ROAMD members are independent — not alone.
In this kind of group, you’ll find true peers who understand the unique challenges of practicing medicine while running a business, who won’t resent your success, and who can provide the community you need.
Conclusion
Physician burnout is real, and it isn’t limited to physicians in traditional practices. Burnout is not a commentary on a physician’s competency, fortitude or stamina, and you shouldn’t feel ashamed if you experience it. Instead, you can simply take a step back, re-evaluate your goals, priorities and preferences, and find a community that will keep you out of isolation and moving forward on your journey.
Dr. Scott Pope serves as the Chief Growth Officer at In Scope Ventures, a growth consulting firm focused on early stage healthcare companies. Scott is passionate about healthcare entrepreneurship and has been involved in various advocacy efforts to promote innovation in the industry.
Scott earned his PharmD from Ohio Northern University, where he participated in Habitat for Humanity, Phi Mu Delta, Order of Omega, and NCAA basketball. After graduating from ONU, Scott completed a pharmacy residency at Cone Health, followed by a specialty residency in infectious diseases, internal medicine, and academics at Campbell University and Duke University Medical Center.
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