Meet Michael Tutty, Emergence Board of Directors Member
Michael Tutty is obsessed with helping doctors sustain long and fulfilling careers.
We recently connected with Michael Tutty, the Group Vice President at the American Medical Association (AMA), where he leads the strategic focus area of Professional Satisfaction and Practice Sustainability.
When we sat down, Michael had just arrived back home in Chicago after a Board of Directors meeting with the Emergence team in San Francisco. He was just settling back into his routine but was happy to talk with us. Michael is so passionate about what he does – helping doctors sustain long and fulfilling careers – that he didn’t miss a beat.
Michael’s focus is on professional satisfaction and practice sustainability – how to attain it and, more importantly, how to maintain it. He engages with physicians around the country to uncover their concerns. He assesses any physician pain points and helps support more satisfying and sustainable physician practices. One thing that came up in our conversation and throughout Michael’s research is the concept of burnout.
“Burnout” is a term we’ve heard a lot lately, particularly during the pandemic. Can you explain a little about this phenomenon?
Sadly, burnout has been around long before we even knew what COVID was.
Yes, so let me define burnout. First of all, when we discuss burnout, we are talking about a workplace phenomenon. Technically, if you've got an unemployed friend, and he says he’s burned out, this is not what we are describing. Your friend may be anxious about being unemployed. He can be depressed by not having a job, but as we define the term, he is not “burned out.” The term was created to describe that sensation you experience within a workplace where you are emotionally exhausted, experiencing feelings of depersonalization, and have lost that feeling of personal fulfillment. Someone with burnout is going through the motions and is, quite frankly, checked out. While burnout is associated with the risks of other mental health issues, such as anxiety or depression, it is not a mental health condition.
So, if burnout is a workplace phenomenon, how do we make it better?
Research has found, in general, that the more educated you are, the less likely you are to feel burned out at your job.
Except if you get a medical degree. That's strange, right? Physicians who are exceptionally well-educated have high levels of burnout. We've also done research that shows physicians actually have higher resilience than the general population. So, this isn't a resilience issue, nor is it an individual issue. Burnout is a systems issue that plays out in a very unique way in the healthcare environment.
Have you been able to pinpoint exactly what causes it?
It has been a death of a thousand cuts. It's not just one thing. I wish it was just one issue, right? It would make my job easier – If we could fix prior authorization that would be great, right? (Laughs) No, it’s prior authorization, it’s burdensome documentation requirements; it’s one thing after another, after another. And it boils down to this – doctors are passionate about caring for patients. They dislike the additional burdens we put in their way to providing high-quality patient care.
Say that again — it sounds important.
Doctors like seeing patients. They dislike the otehr burdens we place on them.And they’re doing a lot of the “other burdens.” In the research we published in Annals of Internal Medicine in 2016, we found that for every hour a physician spends with a patient, they spend nearly two additional hours doing electronic health record (EHR) and administrative work. So, think about it – to get an hour of joy in my job, I have to do two hours of administrative work. At the AMA, we are delving in and really understanding these issues. We collaborate with hospitals and private practices to solve these problems. And we've had some success.
Are there any universal themes you’ve found after talking to so many different physicians?
Daniel Pink wrote about an idea in his book, Drive, that I believe can be applied here. He synthesized the idea of satisfaction into three verticals: Autonomy, Mastery, and Purpose.
We say, “physicians are caring for patients. They couldn't have a more purposeful job.” But as we discovered, if a physician is spending two-thirds of their day filling out paperwork, staring at the EHR, dealing with other administrative burdens, or calling an insurance company, we are pulling them from the moments when they do get to fulfill their purpose.
And then there’s autonomy. You might assume a well-trained physician would have the autonomy to treat their patients. But then they’ve got the insurance companies saying they can't order a specific test or can't prescribe a certain product until they’ve put a patient through step therapy. Where is the autonomy in that?
And mastery is building your skills, which doctors work for years and years to develop. They come to work with an arsenal of well-crafted tools and knowledge that they don’t always get to use because of all the administrative hurdles they’re forced to jump through.
All roads seem to lead back to burnout.
Definitely. Now, you heard me say that there are different drivers of burnout. Specifically for private practice physicians, drivers may include struggling with reimbursement, dealing with insurance companies, getting good contracts, struggling to keep staff, or finding staff.
The headaches seem endless. How optimistic are you about private practice?
I am actually optimistic about the future of private practice. One trend to keep an eye on when thinking about the physician workforce is diversity. This includes focusing on gender and racial diversity. You know, we are quickly approaching two women graduating from college for every man graduating. This means we now have more women in medical school than men as a result. We also need to work harder at making sure our physician workforce represents the racial diversity of our nation. So there are changing demographics in our physician workforce.
But the other diversity we don't talk about is the diversity of practice type. There is no longer private practice versus being employed at a hospital or academic center. Now, we have for-profit versus not-for-profit. We have insurance companies and private equity, buying up practices. There are also digital first medical organizations. So, when you talk about private practice, I think we're going to see a huge nuance of practice variation types.
But I think there will continue to be a strong base of physicians who want to work within the traditional private practice model. I see a new energy for entrepreneurship from those soon to be entering the workforce (Gen Z). These physicians just need the guide path. Unfortunately starting your own practice is not taught in medical school.
What characteristics do you think it takes to make a private practice doctor successful?
You definitely need to have an entrepreneurial spirit as well as a desire for independence because you don't necessarily have a colleague down the hall. And of course, you need a certain level of confidence that you can make it on your own.
It takes a specific type of person.
Yes, and while the number of private practice physicians is currently going down, I do believe there is still a large group of physicians who want to be in private practice. I also believe that this renewed desire for entrepreneurship that we are seeing in young adults today, will drive our next generation of physicians to own their own practices.
Do you think there is something that can help support physicians who want to go into private practice?
Emergence, of course!