Burnout is only one piece of the puzzle. In this episode of the Direct Well-Being Podcast, Dr. Anders Apgar sits down with John McMahon, Director of Client Experience at the Well-Being Index, to explore why measuring clinician well-being must go beyond burnout, and how a simple nine-question tool, COVID-era insights, and low-hanging systemic fixes can change the trajectory for physicians, nurses, and entire health systems.
Burnout is a symptom, not the whole story. Created at Mayo Clinic by Drs. Tait Shanafelt and Lotte Dyrbye, the Well-Being Index was designed to measure clinician well-being holistically, capturing not only burnout but also severe fatigue, risk of medical error, turnover risk, suicidal ideation risk, meaning in work, and work-life balance.
In this conversation, John McMahon shares how the tool works, why COVID both worsened distress and temporarily improved meaning and well-being scores for many physicians, and why nurses often did not see the same gains. He explains the difference between a risk assessment and a diagnostic tool, the power of longitudinal self-tracking, and the real-world impact of subtle, cumulative stressors that clinicians often miss until it is too late.
The discussion turns practical: the low-hanging fruit health systems can address immediately (workflow friction, broken equipment, unnecessary administrative burden, communication gaps between leadership and the bedside), why “hire more staff” is rarely the first answer, and how empowering department-level leaders and truly listening to frontline feedback can turn the Titanic. From early-career awareness to late-career retention, this episode offers clear, actionable insight for individuals and organizations committed to keeping clinicians in medicine and thriving.
Episode Highlights:
About the Show:
Direct Well-Being is hosted by Dr. Anders Apgar, MD, FACOG, M.S., An Ob/Gyn physician leader and nationally recognized voice in clinician well-being. The show is a trusted, peer-driven space for honest conversations about what actually supports physicians, beyond resilience training and surface-level wellness.
Each week, Dr. Apgar sits down with physician leaders, partner organizations, and frontline clinicians to talk about the real drivers of distress: financial stress, mental and emotional health, family dynamics, and the systems in which physicians practice. Conversations are evidence-aligned, research-informed, and grounded in lived clinical experience, never promotional, always physician-first.
Produced as a Direct Self Care production in partnership with the Doctor Podcast Network, the show draws on insight from the Well-Being Index, Champions of Wellness, Tend Health, and the broader Direct ecosystem to move listeners from awareness to agency.
About the Guest:
John McMahon is Director of Client Experience at the Well-Being Index. He works with health systems and organizations nationwide to implement, interpret, and act on well-being data so that measurement translates into meaningful systemic improvement for clinicians at every level.
About the Host:
Anders Apgar, MD, FACOG, M.S., is a physician leader dedicated to transforming clinician well-being. As host of the Direct Well-Being Podcast, he leads honest conversations about the real drivers of distress : financial stress, mental health, family dynamics, and broken systems, for physicians and the organizations that support them.
A trusted voice in health care, Dr. Apgar blends lived clinical experience with evidence-aligned insights. He’s part of the Direct Ecosystem (Direct Self Care, Direct Wealth Care, Direct Practice Care), partnering with organizations like Tend Health, the Well-Being Index, and Champions of Wellness to move the conversation from awareness to agency.
Connect with Dr. Anders Apgar:
Websites:
directwellbeingpodcast.com , dwbpodcast.com
Emails:
[00:00:00]
All right, everybody. Welcome back to the Direct Well-Being podcast. I'm your host, Dr. Anders Apgar, and I am thrilled today to have a very special guest, Mr. John McMahon, who's the director of client experience at the Well-Being Index, one of the foremost authorities on clinician well-being. John, thank you so much for being with me.
Absolutely. Thanks for having me on. Yeah, appreciate having you here. We've been talking for the last few episodes, and we wanna continue to do so, and ask and try and answer some very important questions about how we can investigate and maintain clinician well-being. And your Well-Being Index is one of the best tools that's used to evaluate, and then not only evaluate the initial one, but also hopefully improvements, right?
Hope we're not going in the wrong direction with this stuff, but, you know, those changes in clinician well-being that's monitored. the obvious question I think is when did it become clear that burnout wasn't the whole story? how did this all come about with you? Yeah. So, the Wellbeing Index was [00:01:00] created at Mayo Clinic by two doctors there, Dr.
Tate Shanafelt and Dr. Ladi Derby. and it was first created, you know, early 2010s and there are tools already out there that can measure things like burnout, right? The Maslach Burnout Inventory has been out there for decades and it's a great tool, validated very well, recognized and known in the industry and just throughout research around things like burnout and distress.
But one of the things that they very quickly realized, and one of the reasons they created the Wellbeing Index, was because they knew that burnout wasn't the whole story. Burnout is a symptom of other problems that are going on. It's one portion of distress, and even burnout itself, right, is a very easy term for something that's a little more complicated because you have depersonalization you know, you have emotional hardening aspects to burnout.
There are multiple different characteristics that actually come under the umbrella of the term burnout. And [00:02:00] so, you know, they knew they wanted to develop something that didn't just measure burnout, but measured wellbeing at a more holistic level. so for the Wellbeing Index, we measure not only burnout, but things like severe fatigue risk for suicidal ideation, risk for medical errors in clinical staff you know, turnover risk, things of that nature, because these are all things that are tied into wellbeing, that connect to wellbeing.
And so we like to say we go beyond burnout because burnout is important, but it's one aspect and there's a lot of other angles to wellbeing and we want to make sure that we're seeing that whole picture. Yeah. and you and I spoke, about a week ago in a double secret probation, type of get together, and you had told me that a lot of this came out from in studies or at least experiences that were going on during COVID, which I think will, go down in history as a very influential and well-observed, period of time.
Can, tell me about how COVID really threw a wrench in this whole thing. Yeah, absolutely. COVID is one of those things that I always try to find silver [00:03:00] linings in a horrible situation. and Burnout amongst physicians in particular was well-documented even prior to COVID, right? there's a Medscape survey back, I wanna say, around 2013 or so that was like, "Hey, 44% of physicians are burnt out," right?
And burnout is much higher prevalence in healthcare than in the regular population and those types of things. So that was a problem that was well-known and well-documented even prior to that. But I think for a lot of people, both in medicine, practicing, but also in leadership roles the concept of wellbeing was very, like, just it's an amorphous thing, right?
There's not a hard definition of this is what wellbeing is, or when people hear the term wellbeing, they immediately go to physical wellbeing. A- and so I think what COVID did was it accelerated the understanding of the impacts of medicine on our providers and our clinicians and how certain circumstances within [00:04:00] healthcare can really be a detriment.
And there's gonna be things that happen in healthcare just naturally that are going to be impactful on wellbeing in a negative way, right? We lose patients sometimes. There's difficult conversations you have to have with families around a sick, loved one. you know, all of these types of things that just come up as a natural part of the, profession.
And COVID was definitely that. But one of the things that we see in COVID too is we also saw a very increased level of meaning in work for our clinicians. You know, and that actually provides a buffering effect against things like burnout and things, so we actually started seeing scores improve a little bit early on in COVID.
But then you also see, you know, the longer term after effects, and we can kinda talk about that. But that's really to me what COVID did for wellbeing in healthcare and kind of the understanding of burnout and distress was like, oh, there's a lot of different factors that go into it. Part of it is the nature of what we're doing in healthcare, but also there are systemic [00:05:00] things that get involved because when we saw some of those scores improving, part of the reason for that was not only increased meaning, but it was also lowered red tape, lower administrative burden for different specialties that weren't necessarily impacted directly, and they're not in an ICU or those types of areas where they were really seeing COVID patients.
A lot of the electives were getting canceled for a while at the beginning of COVID 'cause, like, we don't wanna see people. We're trying to keep distancing. You know, we aren't doing some of these elective procedures and things. So the workload started to come down a little bit, and that helped people's wellbeing.
And so you could really see it really highlighted some of the systemic issues that we see that impact wellbeing as well. So what it sounds like to me, let's flesh that out. So during a time of just vast death, destruction, bad news, people staying home, all kind of bad stuff going on, what I'm hearing and what our listeners are probably hearing too is that COVID, wellbeing scores actually went up and this was [00:06:00] because of a sense of meaningfulness, that there was purpose to our work.
Yeah. That's definitely one of the things. We actually did a, quick kind of roundtable discussion with a physician coach and with also a behavioral, health, psychologist to try to help get a better understanding from them of what they were seeing too. Because when we saw those scores improving for physicians during COVID, we were very confused.
We're like, "Why is this happening? What's going on here?" this is not at all what we would expect to see. But you could see it too, right? We have a question, one of the questions on the wellbeing index is, the work I do is
meaningful to me ,
and it's a Likert scale question, you know, where you can strongly agree all the way to strongly disagree on that question.
And so You always see higher levels of meaning in work within our healthcare professions. That's something else too that we can dig into later in terms of, some of the things
that
normally would be buffers against things like distress and burnout, but that aren't the only things or they're not, they can't be protective over all of it.
But you know, you're seeing those high levels meaning and you were hearing from people like, "This is why I got into medicine. We're gonna beat this [00:07:00] thing." There's a lot of that really enhanced feeling of the work I'm doing now is purposeful. Whereas when we look at something like an EHR What we hear a lot around that is people look at it and go, "I'm a robot.
I'm just checking boxes and doing what they're telling me to do, and I'm not practicing medicine at the top of my license. I'm not using my experience and my training. I'm just, a data entry person could do this. What am I doing here?" and you know, that's an example of a thing in healthcare right now that's actually really harming meaning in work for a lot of clinicians because it's so, regimented with what they have to do that way.
And so, you're kinda losing some of that stuff with COVID, and you also had that just increased feeling of we're gonna beat this. You had all the support too coming in. You know, you have all the video and things from large cities where people are cheering at shift changes and really appreciative of the work that healthcare providers were doing to help meet this, horrible situation, and putting themselves at risk to do that, you know, and recognizing that.
And, that increased feeling of support from outside sources, whether that's [00:08:00] leadership internally saying, "Hey, we need to do things to help our providers to bolster wellbeing to try to make sure that we're taking care of people," but also from the public. And obviously that has changed over the years as well some of that as a direct result of,
the
situation with COVID and kind of the discourse around COVID and vaccinations and all that kind of thing.
It really seems to
have ,
unfortunately, on the bad side, accelerated a lot of that and just kind of changed views from a public's perspective, for certain people that way too It's interesting how societal views have definitely changed that we've talked on previous episodes and specifically with Brian Case who brought up the fact that, people look at a doctor and they're thinking, "Okay, rich doctor, they're fine.
They don't need any help. They're, you know, ooh, must be nice type of thing." And that image is not necessarily true. And then you get to COVID when you're like, "Oh, they actually do have value in this society. It's not just, to your point, elective surgeries and, you know, go home, play a little golf and, do your 9:00 to 5:00 and you're out of there."
So i- it's interesting to see how those scores are impacted by our [00:09:00] societal images. And a couple of things you mentioned was the decrease in red tape and the decrease in elective surgeries, which, you know, some of those elective surgeries, it's interesting. Some of our audience might know that elective surgeries really are not surgeries necessarily that are going to change people's lives like some type of emergency surgery.
Now, we don't all wanna be trauma surgeons and mad props to them for what they do, right? but and no shade on those people who do a lot of more elective procedures, maybe your cosmetic type of procedures. They're all riddled with risk. But when you're in the middle of something that you know is going to potentially save somebody's life, I think that provides a ton of meaning to our daily regimen.
Cutting down red tape's a big thing, and some might argue that cutting down on some of those laws that delivered alcohol to the homes was severely beneficial. And again, I'm not promoting any abuse, but those types of things are a little bit helpful as well. did you see improvement in scores a-across all caregivers?
Was it specifically to physicians or was it you know, [00:10:00] nurses, support staff, Who saw the benefit? Yeah. I would say it was for the most part kind of across all roles that we look at, with one exception. And that exception being the nursing staff. And we don't have a direct, this is exactly what happened and why.
but we do know that a lot of nurses were impacted because that was the group that was being brought from other areas in healthcare. So maybe you have, you know, some of those surgeons, you're not bringing a, surgeon that's normally doing orthopedic surgery and replacing knees and hips and things, and having him come and help with getting people on ventilators and doing what needs to be done in a situation like COVID.
Whereas some of those surgical nurses absolutely were getting pulled in to help and
assist
with, just we need more bodies, we need more people to give relief to the people that are already here working. But also some of those people are now getting sick and now we're losing numbers ourselves, so we gotta replenish those numbers.
And it seemed like nursing was really where a [00:11:00] lot of that was pulling from. and so we definitely did not see that same improvement with nurses. They stayed at a fairly high level of distress throughout that entire process you know, even when we saw improvements elsewhere. And that's really the theory as to why we saw that or one of the major kind of reasons why we would've seen that.
Yeah. Another reason to give mad props to our nursing staff and, our nursing heroes because It sounds like, they're getting pulled into situations where they may be confused and feel like they are overwhelmed and out of their educational area of expertise whereas the rest of us got to kind of stick in our little niche
and we got to feel like, "Okay, I can do what I can do within what I can do." but mad props to the nurses for getting plugged in areas that they were not necessarily trained for, and yet saving lives left and right. So that's amazing. It's too bad that their scores didn't go up for getting out of their comfort zone and providing care, probably life-saving care to many outside of their scope of practice.
So I would think that would be a benefit [00:12:00] but, clearly when people are in a tough spot, they're just in a tough spot. Yeah, absolutely. and I think it's, part of it too is, we see a higher level of risk in nurses. we've seen physician scores improve. they all kind of peaked around 2022.
and then we've started to see over the last few years a decline, nurses being one of the groups that has more or less flatlined. They haven't seen as much improvement. Now part of that is around too, organizations tend to focus on clinical staff first. They focus on their physicians.
They focus on the advanced practice groups. Part of that is if you have a physician that leaves and you need to replace them, typically the range in that space is anywhere from a half million to a million dollars, with lost productivity recruitment costs, you know, all the things that go along with replacing a physician.
A nurse is probably closer to, 60 to $80,000 in order to replace a single nurse. Now where that [00:13:00] changes is the scale, right? Economies of scale. There's a lot more nurses out there than physicians. We need a lot more nurses at the bedside and doing those things that they're doing. and so that also I feel like, typically the focus initially is with physicians, and typically when we're working with a group, it starts with the physician group and then it kind of builds out from there.
The other reason for that too is because nurses and the general employee population and support staff are huge numbers of people especially compared to like your physician staff and those types of things, whether that's just at a single hospital or you're looking at an entire, network.
And so it's a lot more difficult to do that for that many more people. And so it's easier to kind of pilot a program with your clinical staff that's a little bit smaller, a little more contained, a little bit easier to access than it is to kind of go to some of those large ones. But it needs to happen, and we are thankfully seeing more of that coming forward.
We're seeing more attention being paid to nurses and things from a wellbeing standpoint because it's critical. they are the backbone of our healthcare system, and if they're not taken care of, we're gonna be in a lot of trouble. And [00:14:00] so that's definitely something that I'm glad to see is changing.
Yep. I agree a whole 100%. let's dig a little bit more into the Wellbeing Index. Some people have never heard of it before. How do they find it? What kind of questions are on there? where did it develop from? Yeah, absolutely. So the Wellbeing Index is, made to be quick and easy to take.
It's nine questions. there's seven yes/no questions that made up the original Wellbeing Index, and then they added a couple questions, one about work-life balance, one about that meaning in work. They're more on the Likert scale. And so it's just those nine questions, so super quick and easy to take.
And what's great about it, too, is it's designed to be taken every month, by an individual if they want to. we typically recommend individuals take it every 30 to 90 days to just track your own wellbeing over time. You can see where it fluctuates. You can get an idea of "What's my baseline?"
and then where are those changes in that. And it's really, really helpful as just an awareness tool for individuals. We're actually in the process right now of looking at revamping the participant side to make it even more helpful even between those [00:15:00] assessments and to give people more guidance on next steps and different things they can do.
But just as even a baseline understanding, most people, when you ask, "How are you doing today?" They go, "Oh, I'm fine." Mm-hmm. And that's the end of the conversation. Yep. and that's about, for a lot of people, what we give ourselves in terms of thinking about our own wellbeing. It's just not something people are thinking about a whole lot.
That again is starting to change. You're starting to see that in the training programs specifically when we work with, like, med students and resident programs. You know, the, the residents and the med students that are coming into these programs now have a much different understanding of wellbeing.
They're much more aware of their own mental health and wellbeing more broadly than, people that were starting their medical practice, even a decade ago. And so the things are shifting a little bit. You know, the ACGME has requirements now for accreditation where you have to be looking at those types of things, so it's definitely changing, which is great to see.
But absolutely the Wellbeing Index, when it was developed, was like, "Hey, this is just... You need to be aware of this. You need to be understanding this. You need to be looking at this because it [00:16:00] does have an impact on your performance both- At work and also, you know, your home life and your life away from work.
And so, that's really the important piece about it. And then, for the organizations, there's the entire administrative side of it with reporting. It's all anonymized. It's all aggregate scores, so nobody that's taking it has to worry that, oh, they can identify me, they can come speak to me directly about my wellbeing scores, or it's gonna affect my licensing or any of that kind of stuff.
anonymity is our top priority with that because we know those are concerns and they're legitimate concerns, a lot of times. And so, we do our best to make sure that information is anonymous but also that is meaningful for the organization. And so they have, more quantitative results of this is the wellbeing of your staff, here's their, breakout from those that are in the distressed category at highest risk for adverse outcomes to those that are thriving and doing really well.
Here's how that all breaks down. You know, you can see where are my hotspot departments or locations, what are the bright spots that are doing well, those types of things. But then we also have a [00:17:00] qualitative feedback section where they can create their own questions. They can put open-ended questions in there to really give more context around why are we seeing what we're seeing?
What is our staff saying? What are their needs that they're identifying? And then you can kind of put it all together into a holistic picture and say, "Okay, this group's a hotspot. Here's some potential drivers of that, that we're seeing, you know, broken out. Here's what they're telling us are the challenges they're facing.
Let's take that together and work with our team there to improve things, address those challenges, and ultimately improve wellbeing." So it's clearly actionable but does it work both as a self-assessment tool? To be fair, I've taken the test, so I kinda know about this, but I wanna address it as though I never did.
If I take this test, is this gonna be a good self-assessment tool? Am I gonna look at this and see these dials and go, "Yeah, this is where I need help." How's that gonna help me? Absolutely. so the participant portion of it, for that self-assessment you know, again, you see your overall score when you take the assessment, and anybody can take the [00:18:00] assessment.
We have a free version that's open for any individual that wants to take it. You know, maybe we can get you the link for that, and we can, put it in the notes for the show and that kind of thing so that, people have access to it if they want. We have that participant experience where you see, your score, kind of where it lies from, you know, your wellbeing's high, your wellbeing's low, it's average, wherever that is, the comparison to your role, so if you're a physician compared to other physicians nationally, if you're a nurse compares to the other nurses.
And if you're within an organization, you could also see with your peers within that organization if they're doing that. Otherwise, if you're just taking it as an individual, it's just the professional comparison to that role. And then there's the different, six different gauges of the distress and that risk, and You can see, oh, I'm more at risk for burnout, or I'm more at risk for a medical error, or whatever it is, or actually doing pretty well and better than the average risk, for those things, and so I'm not at high risk with that.
And the real key there is it is a risk assessment. It's not a diagnostic, and I think a lot of people miss that and it's a little subtle difference, but it's a big difference because we're not [00:19:00] diagnosing anyone with burnout. We're not saying somebody is currently experiencing suicidal ideation. We're not saying that you're going to have a medical error 100%.
What we're saying is, based on your responses for that assessment, things don't change, you keep going that, down that road, the likelihood that you're gonna experience those things is elevated. and so that's why it's so important, too, to take it as a longitudinal tool and to keep up with it and to be measuring on a regular basis because that allows you to get that baseline and say, "Yeah, on average, I'm doing okay.
Things are pretty good." You know, or maybe my average is low, and it's like, okay, yeah, there is actually something going on here. What is that? And that's the other thing that's really helpful with this tool is it gives you that kind of you know- risk assessment, but then it also allows you to see, if something's changed or a lot of times what happens for somebody, right?
there's an event that triggers a low wellbeing, right? You can have a death of a family member, there could be an issue at work, could be relationship issues, whatever it is. You take the WBI all of a sudden your score is [00:20:00] really low and it's like, wow, that's changed a lot. Can I pinpoint that?
Do I know what caused it? Like, oh yeah, my mom just died. I understand, my wellbeing's gonna be impacted by that. Like, that's not a surprise for me, but I expect to bounce back. And so you take it again later, and you see your score coming back up, and you get back to where you wanna be, and it's just like, now I've got this record too that I can point out where it is.
We actually had a physician share a story with us, and he's like, "I took the Wellbeing Index a lot. I was a regular user of it." And he's like, "I had three instances where I saw a dip in my wellbeing, and I went back and looked at that and thought about it. It actually equated to three instances where either a colleague or an acquaintance of mine in healthcare died by
suicide
And he's like, "If you had asked me when that happened how I was doing, I would've told you I was okay and
sad .
It's a terrible situation, but I'm okay." And clearly it had a bigger impact on my own wellbeing than what I actually was
expecting
for myself or how I felt like it was actually impacting me. And so that's the other [00:21:00] piece of this is that it's not only giving you that risk assessment and giving you that ability to track, but it's really helping you to better understand just how impactful certain events can be in your life.
Because you may feel like you're doing okay, but it's still impacting you. And it still has the ability, you know, to change how you interact with people at work. And you may not feel like there's a lot of difference, but other people you work with might see that, right? Maybe you're being a little bit shorter with people.
You know, you're getting a little bit more upset a little bit quicker, you know, whatever it is. Maybe the, quickness with which you're usually putting in your work and doing your work is slower than it normally is. Those types of things, they can be really subtle and especially earlier on before there's something that blows up into a whole blown, you know, I'm burnt out, I need to make a change, whatever it is.
Those are the little kinda keys that start popping up that again, you as an individual might not notice. And so being aware of it, taking something like the wellbeing index in order to understand your wellbeing really helps start to find those things early on as kind of an early [00:22:00] warning system.
Because otherwise what happens is you're like, "I'm fine, I'm fine, I'm fine,"
until all of a sudden you're not ,
right? Mm-hmm. And all of a sudden, "I'm burnt out, I'm overworked, I'm done with this, I'm outta here. I'm gonna go someplace else where the grass is greener. I'm gonna leave the profession altogether."
You know, obviously the worst case scenario, right, is there's a medical error happens and somebody's harmed or somebody harms themself. we definitely wanna try to catch this slide before you get to that point 'cause that's the ultimate result of a long-term kind of building, building, building.
It's usually not something acute happens and all of a sudden that triggers an event. It's usually a longer term piece, and if you can monitor and measure and catch that early, you have an easier time of correcting course. I like that. A couple things come to mind. and you mentioned it, I wanna say it again, that burnout is a symptom.
It's not a diagnosis. Your tool is not a diagnostic tool. It's a risk assessment. I think that's really important. And I think people get a lot more support around acute events. You can see those things. They're a lot more obvious. Yeah. Yeah. It's [00:23:00] the subtle stuff that, you know, the grinds, very little bit at a time, little bit at a time.
and God knows I've never been short with anybody. I just wanna be clear about that. You know, lying. But those little things people get a pass a lot of those times. They get a pass. And, you know, God forbid for those people who died by suicide, rest in peace but you never know at what point that grind gets so far down that somebody may wanna make a change that's a permanent solution to something that's probably a temporary problem.
You also mentioned clinicians leaving, just, throwing their hands up and going, "You know what? I'm outta here. 1-800, trucking or something like that. I'm done." and there are people that should do that, and that's fine and wanna encourage those people that do need to get out, to get out.
There's no shade, no shame in that. And there's a lot of great professions out there. What the medical system loses and continues to lose is the experience of those clinicians who really have a lot to give to a system that just didn't understand the value of the humans. and I wanna give a shout-out again to [00:24:00] our nursing staff that, clearly have been left behind in that consideration.
I wanna share with you something that came up today. It's, 2026 from The Permanente Journal that came up. It was a survey of 971 clinically inactive physicians. 971 clinically inactive physicians who left clinical practice early. The average age of exit in 2008 was 57. The average age in exit in 2026 is 48.
Jesus. You know, and there are clinicians I know personally, clinicians who are still practicing in their 80s and doing excellent, giving out excellent care. Now, it's for like two hours a day and then they go out play golf for another four hours, something like that. But there are four to eight patients who they've been seeing literally for three or four, you know, generations.
48 years old is-- You know, back in the day when I was 48, I thought it was old. Now that I'm no longer 48 so slightly greater than that, it seems a long time ago, but that's a lot of time. 40, say 48 to 62. Let's say you retire at 62. I'm not [00:25:00] a fantastic mathematician, but that seems like 14 years of great care of seeing somewhere between 2,000 and 3,000, maybe even more patients per year.
3,000 times, 14 is a lot of thousands, you know? So I think any tool that we can use for self-assessment and create a situation where people go, "Yeah, I think I gotta tilt that pendulum a little bit more towards self-care and get out a little bit more and put my computer down and, let some things pile up and take care of myself first before it goes in the wrong direction."
Those dials and those meters I think are really important Absolutely. So- Yeah. You know, I have a personal story for that as well. My grandfather was a general practice physician, and this was back in, like, the '50s and stuff, where he's doing house calls and, all of those things.
And they were private practice. They had their own practice. And I remember he retired earlier than he would have otherwise. And for him, what
triggered
it was dealing with insurance companies and the changes in insurance, and having to start basically [00:26:00] justifying his medical decisions for his patients to an insurance person on the other end of the phone that's going, "Well, you have this patient that's in surgery, and our card says this surgery is an overnight stay in the hospital, and you're saying they need to be there for three days.
What's going on?" Yeah. And he's like what your card isn't telling you is my patient is a 75-year-old woman, and she's older, and she takes longer to recover. And based on her medical history, I'm recommending she stays for observation for a longer period of time to make sure that she's okay before she gets sent home."
And, you know- ... those types of conversations were happening more, and more, and more, until the point where he just said, "Enough. I'm done with this. I'm not doing this anymore. I can retire, and I'm retiring now, and I'm gonna go enjoy my life." And so, That's one example of with the insurance situation and having to deal with insurance companies and that kind of thing.
That's one side of this story. But there are a lot of things systemically in healthcare, with the way that things are changing in healthcare, a lot of the mergers, and so you're getting these very large you know, health networks and things, and you're losing a lot of the [00:27:00] localized, whether it's, a single hospital or private practice clinics or, kind of local systems.
It's all kind of merging together and you're getting these very large systems, and people are feeling less supported. They're feeling less recognized. They're feeling like just a cog in the machine. And they're just like, "This isn't for me anymore. I'm gonna leave." You know, and so definitely like you said before, if you feel like that's the right move to make and leaving is what you need to do, absolutely.
You know, take care of yourself and do that. But there's a lot of room to be had, and one of our core goals is helping health systems Be able to correct those systemic things that are leading to that so that people don't feel like they need to leave medicine. We want them to stay in medicine because one thing about people in medicine, whether it's a nurse, whether it's support staff, whether it's a clinician, they're there because they want to be there.
They're not there because they're like, "Oh, yeah, I could be a doctor and just make a bunch of money," right? Like, that is not the reason that people get into medicine. People get into medicine because they feel it's a calling. [00:28:00] You know, anytime we ask that question, you know, what do you feel about your role in medicine?"
It's a calling. It's something that I felt I was meant to do. I wanna help people. and this has given me an avenue to do that. It's a very altruistic profession that way. There's a lot of self-sacrifice that happens in medicine and it's there because they wanna help people.
And so it's our job and it's the job of the networks to make sure that we're taking care of their providers, and the systems and things are not detrimental to people's health to as much as we can make that right. You can't make everything perfect, but you can do your darnedest to make sure that, the systems and what you're asking your staff to do isn't piling on more trauma and more issues than what's already present.
Just again, by what we talked about earlier, some of the nature of healthcare, there's gonna be difficult situations. Don't compound that with poorly run systems and different things that are not set up optimally. Yeah. In a previous episode, Dr. Ridge ta-talked to us about resilience too, and, you know, even in the most resilient clinicians, [00:29:00] 30% of them, were still feeling symptoms of burnout.
So even in those, perfect storms, if you will, or not actually not perfect storm, but rather in those perfect situations, you're still gonna have that risk for burnout. So it's a risk the minute you walk through the door. and I think, one of the purposes of this podcast is to help define that and give people reasons to feel comfortable, people to feel hopeful that what they're doing in long term has meaning and will create their own familial or self-safety throughout their careers.
And, the bigger the systems get, and then we're not here to crush the machine necessarily, but as it becomes a little bit more of a machine, and there are some benefits to that, to be fair. Mm-hmm. we have to bake wellbeing into every system, or every decision that we make in the boardroom that carries down to the patient.
Absolutely. And I think that's a great point too, right? It does carry down to the patient, because if your staff is not doing well, they're getting substandard care from [00:30:00] patients. and I was trying to find it and I didn't have it, but I'll see if I can find it. There was a study published recently within the last year or so that looked at Medicaid patients and what happens when they have to change providers.
And basically what it found was costs go up because now you have a new provider, it's not the same person that has seen you, knows your history, understands. Like, "Oh, I have this little thing." It's like, "Well, based on your history and everything that I know about you, it's probably this." You know, so now you have somebody that's not aware of those things, and they just run every test to try to make sure they're covering their bases and make sure they're not missing something and all that kind of stuff, and so the costs go up that way.
You actually have worse outcomes for the patients. You have more recidivism. You have more people going back in as a repeat after a procedure because something didn't go quite right or there was something there that wasn't understood well. And you actually see higher rates of patients dying, when they have to change providers as well.
And so there's a lot of negative impact for patients, and this was, again, looking specifically at Medicare patients. But just in general, there's impacts [00:31:00] for patients when their healthcare provider changes, and their primary care provider changes. And so having earlier retirements and some of the things we're talking about there and, you know, not addressing wellbeing to try to keep people around as well as they can, you end up also harming the patients that way because now they're changing providers and they're forced to find somebody different.
And you're also putting that strain back on the rest of your staff that's still there because now they have to take on more work and all those things. So it's this compounding kind of downward spiral. so again, the goal is to understand what's going on be able to address those core issues that are leading to these types of outcomes and right course.
And that's what's so, Motivating, I guess, is probably the best word I can think of about my work. one of the things I love about it is being able to help these health systems and health organizations to understand what's going on and be able to start turning that Titanic, because none of these things are easy or early, quick changes.
There's no silver bullets. There's no, "Oh, we just do this one thing and now everything's better," right? It takes time it takes effort, but there is a [00:32:00] lot of low-hanging fruit that most organizations can benefit from working on right away, and then you kind of build from there into some of the larger, more complex issues.
Okay. You predicted my next question. So what are those low-hanging fruit in, that you've seen work in your line of business? Absolutely. one of the things I'll say is, you know, a lot of times when groups ask, "What's one thing we could do to help improve wellbeing in the next six months?"
And you hear over and over again, hire more staff. We need more people." And one of the things that we always discuss with groups when that is one of the responses they're getting is, "Yes, but" you may need more people and more staff, but you should start with your procedures and your systems, right?
Look at efficiency first. What are we doing? Are we asking people to do things that aren't necessary? Are we asking the wrong people to do
things
that need to be done, right? are we asking a physician to do work that could or should be done by an administrator?
Could we
have [00:33:00] them doing things that a scribe could do?
You know, those types of things. Like what are we looking at for you know, who's doing what if we know what it needs to be done. But a lot of times, too, you have different initiatives that happen under different leadership, or we're gonna start this thing, and then we go, "Ah, no, we're actually gonna do this other thing."
But some of the changes to the procedures and some of the changes to how your workflow, still holds over from some of these initiatives that even aren't really being done anymore. And so it's really good to first start with what can we cut back on? What can we
stop
people from doing instead of just adding more and more and more and more.
So that's a really good place to start, and then once you do that and you realize, okay, we're as efficient as we can be,
we've got
the right people in the right spots, but the workload's still too high, we do need to hire staff, then at least you have a very much better understanding of who you need to hire, what roles they need to fill, where those bottlenecks are, and so you can make a better hiring decision that way instead of just throwing bodies at a problem and hoping
it fixes it.
so that's always a great place to start especially if you're [00:34:00] hearing from people, "Oh, we need more staff." higher pay is another thing that you hear a lot in compensation. That is difficult because everybody's got budgets and everybody's got restrictions on what they can do, and so that can be a little more of a tricky one to work on, but I think compensation is important.
And sometimes there's other things that you can do for compensation outside of just the paycheck, right? Mm-hmm. You know, what does a retirement account look like? what kind of amenities do you have that you can provide for your staff? You know, there are different ways that you can kind of measure that.
It doesn't all necessarily just have to be, okay, what's their salary? so there are certainly conversations to be had around that as well. And really what it all boils down to is communication. You have your staff at the bedside that's doing the work of the hospital. You have leadership And there's usually a pretty wide gulf between the two.
All right? They're making decisions up here, but they aren't really keyed into what's going on at the bedside, and so those decisions kind of don't always hit [00:35:00] right. and we see that a lot. A lot of times, leadership team's like, "Hey, we're gonna put this wellbeing program together and, you know, we're gonna make recommendations for, making sure you're getting your exercise, making sure you're sleeping well.
maybe we're gonna make some updates to what we're doing at the cafeteria to give you more healthy food options. We're gonna put in, you know, maybe even having people come and do like a quick chair massage, or we're gonna have like a relaxation room," those types of things.
And those are all very well-intentioned and very well-meaning, and nine times out of 10 your staff is gonna look at it and go, "Okay, that's nice, but that's not helping." Right? Yeah. "It's not changing the fact that I can't get a five-minute break to go use that, you know, wellness room because of all the patient load that we have and all the work that we're doing.
You know, it's not changing the fact that I have a piece of equipment that isn't operating properly and I haven't been able to find anybody to come fix it for us." You know, we had a great example from one of our healthcare summits of a group where they had a workstation on wheels that didn't work, and so their nurses were going from the bedside back to the nursing station and back and forth, and back and forth, and back and [00:36:00] forth, and they couldn't get somebody to come
fix it.
And so a new chief wellness officer was appointed at the organization. She went around and was very good about talking to people, seeing what's going on, what their needs are. She got to this group and they're like, "Yeah, this thing hasn't worked in like three months." She's like, "Okay, we're gonna fix that."
This is crazy. Went, asked around, found one that was kinda in a closet someplace not being used, got IT in there to get it set up right and got it working, came back a couple days later to check on them, see how they were doing, and had people in tears and just giving her hugs and like, "You have no idea how much this
impacted me ."
You know, and when I say low-hanging fruit, it's those kinds of things. It's not a huge wellness program that you need to invest a ton of money in and you need to, you know, do all these crazy things and hire a bunch of people to run it and all that kind of stuff. It's really about getting down to what are the pebbles in the shoes that are making your staff every day when they come into work go, "
Oh my gosh, I have to go deal with this thing again."
like- Yeah ... "I'm gonna drive into work today and I'm gonna dread this." Find out what that thing is and see if it's something that you can fix, because [00:37:00] that's what's gonna have the biggest
impact ,
you know? And then if you can get into some of the other nice-to-haves, that's great, but it's really about finding those core things.
And a lot of times if you can empower people at the departmental level, if you have a department chair in a hospital that's part of a much wider network- But they understand and see what's happening. If they're empowered to be able to make changes for their staff without having to, you know, run it up four levels of administration and leadership that can be really helpful.
Now, that can't happen on all things, but there are certain areas that maybe it can happen. and you wanna give them the ability to make those changes where and when they can and have some clear guidelines about these are the things that, you know, if you see something going on here, you have the ability and the authority to change it.
touching on any of these things, it needs to come up to a higher level because it's impacting potentially other areas of the hospital that you might not see, and there might be a reason for that. Yeah. and so those types of things are really helpful, and it just comes down to talking to people and figuring out what's going on and listening to them, and then taking action on what [00:38:00] you're hearing.
Or at the very least, helping them understand, why do we have to do it this way? It's because while it may not be exactly the way you would do it, when you tr- refer this patient to radiology, this is the way they need to be able to see it, to bring it in, to make sure that their workflow is not getting completely bottlenecked and, causing them a bunch of problems.
Because that happens a lot, where you have two different departments that are maybe referring patients to each other and they do things differently or they have different policies or procedures for how they do their work, and all of a sudden now there's a disconnect there. And because the way they're getting the information about a patient from one area, it's putting more work on the secondary
department because
they have to try to
translate
everything into how they do things.
So just, making sure those types of systems are matched up. EHR, as much as the, kind of pie in the sky utopian view of it was, has caused a lot of problems
instead of, fixing a lot of the things .
And one of the biggest ones is if you have a patient coming in from another system and they're on a different EHR, [00:39:00] it can be completely different.
You know, if they're using Oracle and you're using Epic, it's like we're translating Chinese here or something. Like
it can be
very difficult that way, So I think that's on a very much larger macro scale, but things like that, and once we get those types of things kinda figured out, if we can try to streamline it even more so it is the same across networks that would be super helpful.
But that's like, policy level at the national level. That's not a thing that any of the individual people that
we're working with or talking with can really affect.
But internally you can have those things, and that is an
area that you can impact .
Yeah. So communication, attack the workflows, and attack friction points on the granular basis, the daily basis is really the thing that I think will make long-term and lasting change for people.
That's what I'm hearing. John, we're about to wrap things up and I really appreciate you being here. Thank you for spending time with me. I got one more question that we like to try and ask at the end, which is what actionable item could our listeners take from this episode that could create meaningful improvement in their professional [00:40:00] or their personal lives, whichever?
And part of that I'm sure is look up the Wellbeing Index. It's a fantastic tool. But aside from that, do you have any, Or I shouldn't say do you, I know you do 'cause we've had this conversation. But what actionable item would you put out there for us? Yeah. I do think taking control of your own wellbeing in terms of really understanding how different situations impact you, giving yourself some grace and understanding that, clinicians are people too, right?
We all have emotions. Things impact us, and I think a lot of times, especially going through, like, medical school and stuff, people are trained to, "I nothing impacts me, nothing affects me, i'm the caregiver and I'm just out there taking care of everybody else, and I can take care of myself, and it's fine, and I'm good, and I don't need anything."
But just really recognizing that we're all still people, we all still have things that are gonna impact us and affect us, and it's okay to have that. And it's okay to experience those things. [00:41:00] Just know that, there are methods of working through difficult times, and that there are things that you can do to kinda help prepare yourself for if something bad comes up or comes at me, what can I do?
and then
I would say for anybody that's in a leadership role that's listening to this, really making a commitment to communicate with and listen to your
staff .
A lot of times it's not gonna be easy to hear feedback. you don't wanna hear where your organization is slipping or where things maybe aren't well, and
sometimes it might sound
like, oh, they're just complaining.
But, even when we get feedback questions that are all caps and dropping F-bombs and everything else, there is a nugget of truth in there that you can find of a real situation that is really having a negative impact on your staff. And if you listen and you can figure out what those nuggets are and address those things, everybody's gonna be doing better.
So that would be my recommendation is, just individually [00:42:00] understand that everything's okay. you're a person, you're gonna have these things c-come at you, and it's okay to not be okay, and it's okay to go ask for help when you need it. And then, from a leadership perspective, just really making a commitment to wanting to make change and not just feel like, ah, everything's status quo, everything's hunky-dory, everything's fine.
Because I guarantee you, there are things going on. Even if your organization is doing well overall, there are things happening in there that aren't great, and there's always
room for improvement.
that's a great wrap-up, John. I really appreciate that. And thank you so much for spending some time on the show and, if you don't mind, I'm gonna be having you come back, to continue this process and this discussion.
Thank you again. Absolutely. Sounds great. Thank you, sir.