Marschall Runge

Forum Message from the Dean

Changing Times

The world of a physician is much different today than in times past. We need to evolve and innovate to reduce physician burnout.

Winter 2019
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In 1980, I bought the top-selling typewriter for $100 to prepare manuscripts. In less than 10 years, personal computers had hit the scene and my typewriter became an obsolete paperweight. Sometimes, what was great yesterday is not so great today.

This is something I think about in the early morning or late at night, my two favorite times of the day. These are the only times that are truly mine, when I am free to stop and think, rather than meet the rigorous demands of my career as a physician: patients, staff and colleagues, administrative duties, and now, primarily, leadership responsibilities. It’s why so many of my emails go out at 4 a.m. or 10 p.m.

As I failed to recognize until recently, if we are to build and maintain a physician workforce, we need to change.

Like many physicians of my era, my career prospered by following my role models. I quickly acclimated to the unyielding culture of medicine: always be on-call, never say no to any request, prioritize your job, and adapt to every demand. The idea of prioritizing responsibilities outside of medicine, including important family commitments, was rarely discussed until the last 10 years.

This old and still powerful system that served me well is on the precipice of becoming the typewriter of our times.

“It’s just the lifestyle,” I’m told by colleagues. Not really, is my answer. Accepting that belief trivializes the complexity of the world our new physicians encounter. By all measures, those entering health care are bombarded with exponentially more information than prior generations. In the 1980s, it really was possible to memorize and know nearly everything needed in a medical specialty. Today, information is instantly available and continually improving, and society lives and breathes 24/7. It should be no surprise that physicians are overwhelmed and looking for solutions.

Study after study demonstrates that physician burnout — generally defined as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment — is a major problem across the country. Physician burnout is more than just feeling wrung out. Burnout can lead to medical errors and lapses in care; it diminishes our workforce. Burnout is a major reason that physicians switch jobs or leave medicine altogether — an ominous trend as the U.S. experiences a growing doctor shortage.

We also know that burnout takes a special toll on women, who experience greater societal pressure to maintain work-home balance, making it twice as likely that they leave the profession.

Is there a solution? No, there is no single solution. But here are a few ideas:

First, those of us who grew up in another era need to understand this is not a lack of professionalism or commitment.

Second, we need to innovate how we perform our clinical and other duties. For example, is it really necessary to start procedures at 7 a.m. or clinic schedules at 8 a.m.? If we adhere to yesteryear, we effectively eliminate the portion of our workforce that cares for young children or aging parents, or has other morning commitments. At the end of the day, we control how flexible our schedules are, and how other clinical obligations are implemented.

Third, and maybe most importantly, we must constantly reduce administrative overhead. We are quick to add new mandatory credentialing and slow to shed those that are less relevant.

You and your colleagues surely have more great ideas. Please join me in becoming an engaged and transformative leader in your setting — from small groups to large group practices to major academic and health care programs. We can and will transform tomorrow, today.

Marschall S. Runge, M.D., Ph.D.
Dean, Medical School
Executive Vice President for Medical Affairs, U-M
CEO, Michigan Medicine

Photo by Leisa Thompson Photography