Combatting Burnout in Ophthalmology

Combatting Burnout in Ophthalmology: A Q&A with Executive Coach Savory Turman

Savory Turman is an Executive Coach and Consultant with 20+ years in healthcare, medical teaching, and consulting. She heads a consulting practice based in Virginia.

Did 2024 leave you feeling burnt out? If so, you're far from alone.

Feelings of job dissatisfaction, reduced enjoyment of work, and heightened work stress are common, and they're warning signs that should be addressed rather than ignored.

Burnout can have serious consequences that go well beyond caregiver stress. According to a report published in 2022 by Retina Today, “a higher incidence of medical errors, an elevated financial burden, and poor patient care have been implicated as major consequences of [burnout] in doctors.” High burnout in the 2022 survey was associated with low levels of job control, misalignment with department leaders, and insufficient time for documentation.

Burnout has accelerated across the medical field since the COVID-19 pandemic, and ophthalmology practices have not been spared from the broader trend. A survey of ophthalmologists published in June 2022 in the Journal of Cataract & Refractive Surgery found that more than 37 percent of respondents self-reported symptoms of burnout, but it varies across specialties — the number grew to over 45 percent among respondents specializing in uveitis.

Despite more than 1 in 3 survey respondents experiencing burnout, Retina Today separately reported that burnout in ophthalmology practices may actually be underreported. A widespread misconception that ophthalmologists have higher levels of job satisfaction, as compared with other medical professionals, may mean burnout is overlooked within the specialty.

Burnout isn’t limited only to physicians, either. In a survey conducted by the Medical Group Management Association, 80 percent of healthcare leaders reported an increase in stress levels in recent years.  

The causes of burnout vary widely, but staffing shortages are among the contributing factors most often cited by practice managers. One anonymous respondent to an American Academy of Ophthalmology survey noted that staffing difficulties lead to a sense of overwhelm that affects every corner of the practice.

“It has become increasingly challenging to recruit new support staff (clinical and administrative), which leaves our clinics short-handed and feeling overwhelmed,” she said. “Without being properly staffed, operations suffer.”

Interview With Savory Turman

Executive Coach Savory Turman has counseled dozens of leaders in the medical field to help them manage burnout, which can take a heavy mental and emotional toll. After more than 20 years of experience in the medical field, Savory coaches ophthalmology executives on how to better manage both their practices and, by extension, the rest of their lives.

The writers of the Revival Health Blog sat down with Savory to learn what’s driving burnout in the ophthalmology field, what harms it can cause, and how practice managers can help reduce its effects in their own offices.

The bold text below indicates questions from the Revival Health Blog’s writers, followed by Savory’s responses. This interview has been edited for clarity and length.  

What do you think are the major drivers of burnout in ophthalmology practices today?

One of the biggest constraints practice managers are facing is decreased reimbursement, which is causing a higher demand for employers to meet their financial benchmarks. So managers are being forced to do more with less, basically.

We’ve also got a lot of experienced staff retiring in recent years, and when those years of experience walk out, you're getting someone who has a fraction of that experience walking into your practice. And that's limiting what organizations are able to accomplish. That puts pressure on everyone.

How do reduced reimbursement rates affect the ability to find and keep talented employees?

The funds that were readily available 10, 15, 20 years ago — to provide enticing benefits like bonuses and other financial incentives — just aren’t there anymore.

With the economic state that we're in at present, inflation is the word on everybody's tongue. We're paying more for everything, so employees are dealing with this — we're all dealing with this, right?

So what may have been an adequate raise 5 or 10 years ago is not sufficient right now. And employees are feeling the strain of that. Managers are feeling pressure too, having to continue to make the same margins [with the overall business], because they cannot necessarily increase what they offer to attract staff.

So it’s harder to retain good employees, and everyone is feeling overworked and maybe a little underappreciated. How can practice managers combat that without those traditional financial incentives? Are there non-monetary tools they can use?

When I coach or consult, the first thing I tell clients is: find out what matters. Find out what matters to the team member. Get curious around the burnout, get curious around what is causing this person to have issues.

Getting this feedback regularly shows that you understand, and that you're willing to listen. It's really an opportunity to learn, because the answer they give could be completely unexpected, and easily fixable. You can fend off trouble in some cases when you do this.

Also — these conversations can’t be last resort conversations that only happen when an employee is underperforming. Touch-base conversations should be happening regularly. You should be asking questions like, how are you? What's the hardest part about your job? What do you enjoy the most about your job?

You mentioned that offices are increasingly multigenerational. What is the connection between that and the pandemic, and how has that changed the workforce?

Sociologically, we've always seen the priorities for each generation shift. From the Baby Boomers to Gen X, to the Millennials to Gen Z, each generation has different priorities, and different views of what work means.

Maybe in previous years, employees were willing to stay at a job they hated for 40 years so they could get a pension. Now, folks will leave after two years because they're bored or not being challenged.

These things have consistently shifted within generations. But what happened when we hit COVID was — COVID poured gasoline on that. In the three or four years of COVID, we went through about a 10 to 15-year generational shift.

And everybody's looking around shell shocked, saying when are we going to get back to normal? Well, unfortunately — or fortunately, depending on how you look at it — this is normal.

And a lot of what matters now is that employees feel like they’re able to make a difference. They want the ability to feel connected to the mission, the vision, the values of an organization. What is the organization doing for the greater good of the world? Are there clear and fair benchmarks of pay, benefits, etcetera?

Does the generational shift in the office show itself in other ways, and what can be done to manage it?

Well, one of the first things we start to see is people making judgments and generalizations about their colleagues.

Let’s say there are members of the older generation — and I want to make sure that I'm not stereotyping that generation, this isn’t what all older folks say — but there are members of the older generation who say, oh, these young people — nobody wants to work.

Well, if you really trace that thought back, you can find news articles from the 1800s filled with people saying nobody wants to work anymore. And maybe the 'judgement' of young people not wanting to work anymore is causing more alienation rather than cohesion

So rather than applying judgment, managers should get curious around what's happening. Let’s say I, as your employee, tell you I need to be able to come to work 30 minutes later in the morning. Rather than saying no — get curious around why I’m asking for that accommodation.

Maybe it’s because of my childcare — I need to drop off my kids in the morning, and that’s the only time that works. And maybe I’m happy to stay a half hour late to make up for that.

So instead of saying that person doesn't want to work, lets’ ask what's keeping you from this eight o'clock start time? Let's get curious around it, as opposed to putting some judgment on it.

So being more flexible is a way to turn down the temperature in the office? And that can help stem burnout?

Sure. What I often see is that we're not being agile enough to question what's happening in our clinical space and go, "Okay, what could we change?" We’re not seeing the flexibility and the agility that needs to be there.

Now, some of that's the nature of the industry. Employees may like remote work, but you can't do a ton of remote work when your job is facing patients, right? So, I think employers are feeling this demand, but they don't really have a solution for it. And that can lead to burnout.

At the end of the day, there is an opportunity to really look and say, Okay, what are we doing? Let's challenge the status quo. Let's get flexible.

Whether that's the clinical hours, the staffing schedule, the types of patients doctors see on specific days, just really starting to crank up the creative thinking. You may not be able to solve every constraint but opening the floor for new ideas will itself provide more agility and less overwhelm.

How can practice managers themselves cope with some of these pressures? They’re doing more with less, but the pressure of that can be pretty overwhelming.

Too often managers believe that it's their job to fix everything for their employees, or their shareholders, or their doctors, or their patients. In actuality, that's not possible.

It’s important to have the ability to step outside of the situation and recognize that you aren't Superman or Wonder Woman. You can’t do it all, and it’s really important to look at what your resources are. You need to look for help.

Now, I'm obviously a fan of coaching, but not everybody has access to coaching, right? So having a mentor, having a trusted colleague who you can reach out to is important.

It’s also important to have someone who can say the hard thing that you don't necessarily want to hear. When's the last time you took a day off? Are you feeling spent? I'm hearing a lot of frustration.

As a coach, I suppose you are sometimes in a position to say the things that people don’t want to hear.

Right.

Often the first thing I do — and this can sound a little harsh — I’ll listen to their issues, and I'll say, well, I'm hearing you have a few choices here.

You can throw it all away and leave. Quit your job. You can stay in the mental space that you're in, and just hope for a difference. Or you can stay and try to change what is controllable in your world.

The bulk of people say, look, I'm not in a position where I can leave my organization. I have financial responsibilities, my kids are in college, etcetera.

So then the answer is — okay, so let's talk about what's really causing you angst here. And we start digging into that. It goes back to getting curious about the problems you're facing, their causes, and your opportunities within them. That’s really what it’s all about — learning and evolving.

Understaffing is a huge contributor to burnout in ophthalmology practices. ‍Next generation technologies like revBot from Revival Health can help automate rote tasks and keep your office running smoothly. revBot can also free your staff to spend time where it counts — on patients, not data entry.