Solutions for physician burnout should emphasize reduction rather than accumulation.

Problem-solving is in my DNA, a trait I share with many doctors. During a period of personal burnout, I turned to research, hoping for a blueprint to erase my fatigue.

My investigations through academic writings and online resources were disheartening. While burnout is well-defined, its root causes remain elusive. There's acknowledgment of burnout risk factors and its prevalence, but the answers are murky. Disturbingly, there's an inclination to fortify already-resilient physicians. The responsibility for managing burnout is thus shifted onto the doctors themselves.

This crisis has spawned an entire industry. There are coaches, courses, and books prescribing remedies for burnout (I've benefited from a burnout coach). They often suggest adding activities like meditation or therapy to reduce burnout. Yet, it's evident that even physicians practicing wellness can still face burnout. This advice exacerbates the issue, pinning the solution on the individual doctor.

My experience and research have shifted my perspective. Overcoming burnout requires reduction, not accumulation. Instead of piling on more tasks, we should eliminate the distractions preventing us from caring for our patients effectively.

In my role as a urologist, burnout is prevalent. We manage high patient loads, surgeries, and emergencies while grappling with a urologist shortage. Our chosen profession is inherently demanding. Yet, much of our stress originates from non-clinical duties: intricate coding, procedural authorizations, excessive paperwork, and endless digital communications. These add to our burnout. Until these pressures are alleviated, wellness strategies won't be effective.

Significant "reductions" must be instated by payors and regulators. The 2021 E/M coding reforms for outpatient care were a step in the right direction. Scribes can also help by handling documentation, albeit with some caveats. Effective burnout coaches emphasize reductions, aiding in setting boundaries and reframing challenges. However, more reduction strategies are crucial.

While health care administrators genuinely aim to mitigate burnout, their influence is restricted. They can promote a positive culture and employ support staff but can't overhaul the broader clinical and regulatory landscape, which leans more towards appeasing payors than patient care.

Realistically, the physician's role is challenging. Not every facet of our profession is gratifying. However, the equilibrium between the positive and draining aspects is skewed. Encouragingly, influential figures like Surgeon General Vivek Murthy are prioritizing burnout. Yet, when stakeholders address burnout, the emphasis should be on alleviating strains rather than adding wellness routines.

Regulatory action should empower caregivers over payors. In discussions about physician well-being, our primary goal should be lessening the load. Societally, we often rush to introduce solutions. But if we continually focus on adding, we risk exacerbating the challenges without addressing the core issues.