How do we build that case [that] managing and monitoring burnout in ED doctors matters to the leadership? I saw this a lot in social media, that people were expressing angry sentiments like, “I do not want to come to another mandatory yoga class for dealing with my burnout at 6 a.m. in the morning. Seeing a stack of pizzas in the doctor’s lounge does not make me feel like the leadership cares.” Mitch, you and I know [a CEO], who does not ignore how the employees are doing. He is engaged at all levels. The guy that shows up to see what the employees are actually doing. He expects his leaders to get out into the hospital, get down into the emergency on the night shift and on the weekends.

MK: We as physicians and certainly in the emergency department are all familiar with metrics such as patients per hour or time to discharge and admission. It seems like we often jump from one metric to another. Is it a potential solution to expand metrics to administration to be accountable for burnout percentages as a countermeasure to physician metrics?

GC: I think you’re talking about the quadruple aim, and employee satisfaction is an important part of that. I think at times it’s sort of a Dilbert-esque management philosophy that pushes employees toward these metrics without fully considering their mental health.

DM: Carin Knoop, who directs the case writing department for Harvard Business School, has been writing and thinking about the importance of mental health in the workplace from the management perspective. And she talks about this catch that managers fall into, but physicians are particularly vulnerable to, is: The Hero. “I’m the only one. And when everything else fails, I will be there. I will show up.” So there’s this hero syndrome. Where we figure we have to do it all. They never say “no” to anything. And what ends up happening is they get worn down and by the time they realize that they’re worn down, it’s too late.

MK: It‘s a really interesting topic and also comes back to staffing. With this idea of, if I don‘t show up, who‘s going to replace me? And these days that‘s an increasingly big question mark in a lot of systems that struggle to have adequate staffing.

GC: That also gets back to the business case though, because you need to look at turnover. It’s six figures to replace a physician. Retention is important for organizations. And when turnover gets to a certain point and everyone’s leaving, that is when hospitals start closing. Organizations that figure out how to retain physicians are at an extreme competitive advantage.