The silent stress of health system CEOs

Alexis Kayser (Email) Becker’s Hospital Review

It’s lonely at the top. Unaddressed isolation and burnout could be contributing to healthcare’s high turnover rates, one health system CEO told Becker’s.

Why CEOs are burnt out.

Healthcare leaders have the highest turnover rates of all major industries, with 75% of executives considering leaving their profession due to burnout, Jeff Comer, PsyD, told Becker’s. However, most books, webinars and initiatives to solve the issue are geared toward clinicians. Burnout accounts for 70% of leadership turnover — compared to 40% of staff turnover — but few executives speak out on the exhaustion they experience.

“We feel as leaders that we have to be confident; we have to walk into a room, and we have to take command, we have to show that we know what we’re doing, we have to have all the answers,” Dr. Comer said. “And of course, we can’t; that’s not possible. But that’s kind of the story we tell ourselves. And when we have burnout, a lot of us executives feel shame because we don’t feel strong. We feel that we’re weak.”

Dr. Comer speaks from experience; he has 20 years of experience as a hospital and medical group CEO and was recently named to the helm of Show Low, Ariz.-based Summit Healthcare. He also has a doctorate in psychology, focusing his research on the evolutionary, psychoneuroimmunological concepts underlying stress reactivity.

CEOs’ burdens have grown in recent years, so it makes sense that burnout — and turnover — are at unprecedented highs, according to Dr. Comer.

“We [as CEOs] have so many stakeholders we have to keep happy,” he said. “We have the board, the employees, the community groups, the payers, the government, The Joint Commission — just all these different entities, and they all have different incentives. And there we are as a CEO, kind of in the middle, being tugged by all these places.”

The very structure of health systems can contribute to CEO burnout because they add layers of stakeholders to this mix, he said. After getting one’s own board, leadership team and employees behind a new initiative or strategy, there are several functional departments at the corporate level that need to hear the pitch. Their insight at the hospital and community level tends to be limited, and it can take a “tremendous amount of time and energy, and at times frustration” to get them up to speed, cut through red tape and make change happen, Dr. Comer said.

“Anecdotally from my work, one of the first things that comes up with leaders who I talk to about burnout is their frustrations, their challenges with corporate oversight,” he said.

COVID-19 exacerbated the tug of war; financial targets do not consider declining reimbursements, and hospitals still need sufficient staff when recruitment is a challenge. As a result, the CEO’s job is “becoming much, much more difficult,” Dr. Comer said.

Overwhelmed executives often turn to multitasking, which can make matters worse. Every pivot pulls up new neural pathways, experiences and memories, which places “tremendous stress” on the brain, Dr. Comer said. But in an era when immediate responses are expected, especially from corporate stakeholders, it can feel impossible to tune that Teams chat out.

How chronic stress shows up in executives.

Burnout might display itself physically, as weight gain, high blood pressure or even minor cardiac events. It might be harder to fall asleep.

Then there are mental symptoms such as exhaustion or fatigue, which may come across as disinterest to employees — contributing to a vicious cycle at the organizational level.

“It’s like you don’t have your mojo, you don’t have that energy,” Dr. Comer said. “You don’t have that passion. And people on your teams feel it — your employees feel that your doctors feel that, your board feels that — and that contributes to their burnout. They start to think that you’ve checked out. People get frustrated, they start to become irritable.”

People who are burnt out at work are also frequently burnt out at home. Substance abuse is considerably on the rise among executives — specifically alcohol and painkillers, according to Dr. Comer.

All of this compounds, which can cause further loneliness and isolation, or even psychological disorders such as anxiety and depression.

“You need to be worried about your employees because you’ve got to get turnover down, but a lot of turnover is attributed to burnout,” Dr. Comer said. “And so you’re helping everybody else deal with it, but you haven’t dealt with it yourself.”

Circumstances can’t be changed, so what can be done?

Burnout is a stress-induced disorder, and healthcare leaders are plagued by chronic stress. Unlike acute stress, which comes and goes, chronic stress accumulates over time and does not respond to Band-Aid solutions.

In other words, burnout is a serious problem, and one yoga class or walk in the park is not going to cure it.

Although the industry turbulence is largely out of leaders’ hands, Dr. Comer recommends “taking control of what you can control”: one’s own thoughts, emotions, and behaviors.

He also recommends setting a four-hour window of daily productivity to make the most of the clarity and energy one does have. This window should be punctuated by meaningful breaks spent listening to music, meditating or planning — not mindlessly scrolling through social media.

Tuning into yourself can help you minimize recurring daily stressors, put challenging situations into perspective before ruminating on them, and set a more sustainable routine.

What not to do: suppress it or force your way through it, Dr. Comer said. There is value in having the conversation with other executives and understanding that others are going through the same thing.