Professional Dissonance
Dr. Agarwal says, these factors can be described as professional dissonance, which he defines as the “psychological discomfort or stress when your values as a physician conflict with the values of the setting in which you work.”
The term fits Dr. Agarwal’s own experience as a PCP. But he was originally surprised when he realized the focus group discussions were crystalizing around the idea that the healthcare system is built on misaligned values. Essentially, the focus groups told the researchers their burnout results from being on the frontline of absorbing that dissonance.
Unfortunately, according to Dr. Agarwal, many healthcare providers experience professional dissonance, and he feels the conflict between the values of the profession and the values of the system “should raise some alarm, and not just in primary care physicians.”
One example he cited was that physicians value staying up to date with medical literature. “We need to align the system better with our professional values,” he adds. “We need to increase reimbursement for cognitive-based care.”
Solutions
The authors suggest that institutions actively engage PCPs in the development and implementation of solutions to burnout. In the focus groups, the PCPs suggested eight solutions: managing workload, caring for PCPs as multidimensional human beings, disconnecting from work, recalibrating expectations and reimbursement levels, promoting PCPs’ voices, supporting professionalism, fostering community and advocating reforms beyond the institution.
Of these solutions, workload reduction was the primary recommendation made by participants. According to the participants, workload reduction solutions could include reevaluating the relative value unit targets that place unreasonable productivity demands on healthcare providers and hiring more nursing support, especially registered nurses. However, they emphasized that any decision to hire more staff should not hinge on the expectation that PCPs pay for the expense by increasing the number of patients seen. Efforts should be made to free up time for physicians and provide physicians with support for professional development, such as stipends.
The focus groups also identified a desire for flexible work schedules and family-friendly policies to facilitate a healthier work-life balance. These modifications could be supplemented by initiatives that enable PCPs to disconnect from work after hours, during vacation and on sick days.
Lara C. Pullen, PhD, is a medical writer based in the Chicago area.
Reference
- Agarwal SD, Pabo E, Rozenblum R, et al. Professional dissonance and burnout in primary care: A qualitative study. JAMA Intern Med. 2020 Jan 6. [Epub ahead of print]
