In gauging physician burnout, not all surveys measure up

Physicians are at the forefront of patient care, often working long hours under intense pressure, which can lead to emotional exhaustion, depersonalization and a diminished sense of feeling valued. By systematically measuring burnout, health systems can identify the problem and target areas for improvement to ensure a supportive work environment and sustain overall well-being for physicians. That’s why Marshfield Clinic Health System chose to measure with the AMA.

While Marshfield Clinic had measured burnout before Samantha Klebe, DO, became its chief medical officer, all they received were results and no action items.

“Knowing the results, but not really knowing what the action plan was, we couldn’t do much to change,” said Dr. Klebe, an internist in Weston, Wisconsin. “It’s very akin to knowing what total cholesterol is for a patient, but not knowing the specifics such as LDL, HDL and cholesterol. Each component is treated slightly differently. You need the details to enact change. Without it, you don’t know what drug to use or what would be the best method of treatment.”

But Alpa Shah, MD, a psychiatrist and chair of the physician and allied professional health committee at Marshfield Clinic, had an idea: Use the AMA Organizational Biopsy^® to measure physician burnout and well-being.

Marshfield Clinic Health System is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

“We’ve measured engagement and used other tools. With the other surveys, the challenge was we were measuring engagement and not necessarily the depth and breadth of well-being, and burnout being one spectrum of it,” Dr. Shah said. “It’s hard to get a good grasp of what are the factors that are impacting morale, that are impacting engagement. We want people to be engaged, but without knowing whether people are well, it’s hard to have people be engaged.

“So, it was important to be intentional about what we wanted to look at. We also knew that if we don’t measure, we won’t know and won’t be able to address it. That intentionality was important,” she added, noting that “the AMA’s tool truly is intuitive and more aligned with understanding medical practices, not just the acute space, but the ambulatory space.”

“The Organizational Biopsy was something we’ve wanted to do for a while and with the leadership support and all the timing, it ended up being just right with us being able to move forward,” Dr. Shah said.

As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine™.

“As we’ve gone through the survey, what we saw was you could make an action plan,” Dr. Klebe said. For example, “Are you happy with your EMR? Are you working after hours? That’s something that you can actually do something about.”

“When we first went through the survey, the immediate results that the person received right after they did the survey were really important because we take so many surveys and then sometimes you hear about the results and sometimes you don’t,” she said. “Most of our providers had not even looked at our results. They knew what the result was but didn’t necessarily know where they fell in the spectrum. So, having that immediate feedback where they were compared to other people is really important.”

“When we first engaged one of the first questions I had was: We’re in a bad spot. We know our folks are not engaged. We know that we’re going to have burnout. Tell me about another institution that you worked with that went through the same thing,” Dr. Klebe said. The AMA team “did a fantastic job. They gave us comparable information from an unnamed institution they worked with, this is where their scores were, these were the action plans that came out of this, and this is where they wound up.”

“Knowing other people have been through this, they’ve gotten through it, they are on the other side, there’s a positivity there,” she said. “That was really helpful because that was not something that I necessarily garnered from some of the other survey sources. It was here’s your results, do whatever you need to do or what you think would be best for you.”

“So, for me, that was really something that made me immediately feel that the AMA survey would be best for us,” Dr. Klebe emphasized.

With the Organizational Biopsy completed, “we’ve had the results reviewed with the AMA team,” Dr. Shah said. From there, “we’ve started the communication cascade. We’re in the middle of rolling out to the physicians and nonphysician providers regionally.”

The communication process involves providing “more transparent, granular information on the survey results,” she said. “But more importantly, it’s sharing what actions are being taken in response to what we’ve heard.”

Additionally, while “there’s been a lot of work that’s been happening in the background to address the EHR challenges and other things, we found that it just doesn’t resonate or connect,” Dr. Shah said, noting “although they’re well-intentioned activities, some of the things the AMA has pointed out that have been going on is people don’t see them as connected as ways to be relieving their burden or addressing burnout.

“So, as part of this communication cascade, Dr. Klebe and I partner. I share the results and Dr. Klebe shares what we heard in the survey and what we’re doing to address this concern on the survey,” she added. “That helps because people don’t automatically connect the dots.”

When it came to figuring out where to start, the AMA “made it really easy for us. We took a slide from the Organizational Biopsy results that says, ‘What are the things that would make you stay?’ And truly it made it very easy,” Dr. Klebe said. “This is what our people said are the things that we need to stay, and we took the top five and said, ‘OK, we hear you on this. This is what we’re doing.’”

Whether it was the need for consistent staffing or reducing documentation after hours, it allowed Drs. Klebe and Shah to share what was being done at Marshfield Clinic Health System to address those pain points identified by physicians.

“That’s what was really nice about the AMA survey—it was a little bit too easy to some degree. We didn’t have to analyze anything. It was: Here are the things. This is what we need to do,” Dr. Klebe said. “Other surveys that I’ve had in the past, you sit there, and you huddle with people and talk about why the results are bad and what we can do to impact this. But with the AMA, we had the answers.”

“It was nice that it wasn’t a subcommittee trying to figure out what necessarily was needed. You were hearing directly from the people who did the survey what they needed,” she said.

“Reducing burnout has been shown to save money, but it’s really more about saving a career,” Dr. Klebe said. “Physicians and nonphysician providers are hard to train and we are lucky that we have some really phenomenal people that have really great intentions.”

“To work in a rural market, you really have to love the people who you serve. We don’t necessarily have a big downtown—we have a Target and a Walmart—but people are not coming here for those things,” she said. “They’re coming here to serve patients, so we know that the people who work here are special, that they’re not replaceable and they’re very dedicated. We want to be just as dedicated to them as they are to our patients.”

“Doing this survey and then what we do in response, of course, is a critical piece,” Dr. Shah said. “It shows that we care and we care beyond just looking at your productivity and your quality scores.”

“One of the first steps to turn the tide is really helping people know that we care, that the leaders care, the well-being is important and the pain points in the practice are important,” she said. “It saves a career, but it also saves families because it takes a toll on the families. It’s a lot to move to a rural setting, raise their families here and then uproot and move is also a huge deal.”

“I’m definitely hopeful with the current approach and intentionality around it and the compassion and empathy that this is a good direction we’re in,” Dr. Shah said.

“It’s just going to be a journey. We know it’s going to take years and we need to continue to work on this,” said Dr. Klebe. “We’ve already committed for our resurvey in January of 2025, so hopefully we’ll have some positive traction by that time. I think that we will, and we appreciate the accountability partnership to get us there.”

Find out how the AMA partners with health system leaders to improve physician well-being by:

• Effectively measuring and benchmarking burnout levels.
• Taking action with tailored leadership workshops and coaching sessions.
• Accurately evaluating progress.

Also, learn more about the AMA’s organizational well-being assessment (PDF) work or email the AMA practice transformation team for more information.