System Overload & Why You Need to Change

How do we run successful and sustainable practices inside an overloaded health system? In this episode, Jo explores the role that private practice can play in changing the system and shares the most common mistake made by clinicians in setting up a practice. Finally Jo shares 3 key questions that will help to prevent burnout and enable you to get the best out of yourself and your staff while operating in this high-pressure environment.

Resources mentioned in this episode:

If you know you need more support, please visit my website at https://jomuirhead.com

TRANSCRIPT:

And welcome to another episode of the Entrepreneurial Clinician Podcast, where we talk about the issues that enable health professionals to keep doing great work without sacrificing themselves. I’m your host, Jo Muirhead. I’m a career loving mum, a coffee snob, a private practice owner and coach for health professionals in private practice who want to grow without burning out.

Now this episode I’m calling System Overload and why you need to change. Now, in preparing for this episode, I discovered that I could talk about aspects of this statement, system overload and why you need to change for hours. But I promise not to do that. I’ve actually got a watch with a timer here beside me because I am very committed to making sure that these are shorter podcasts that go for about 20 minutes so that you can take actionable content and go away and do something with it.

So what I wanna be able to focus on in this episode, and it might actually go over two, is I wanna talk about a big picture system overload. I wanna talk about private practice and health business owners and system overload. And then I wanna talk to you and your individual role in this thing we call system overload.

What I’m not gonna be talking about today, which I think I could spend an entire session talking about, is central nervous system overloading health professionals. So I might put that on the list. Let me know if that’s something you would like me to speak into.

So as I was researching for my book, the Entrepreneurial Clinician, I knew I needed to talk about an overloaded system because it was an overloaded system, health system primarily, that led me to become a private practice owner and then start to adopt entrepreneurial thinking.

But since 2017 when I wrote the book and was doing all this research, 2017, this world has seen stop. Like we have seen natural disasters, like in Australia. We went from bushfires to floods really, really quickly, about the same time as the pandemic started. And then we had all sorts of internal changes happening with one of our really big insurance schemes here. We’ve had incredible political unrest in parts of the world where we never expected to see it happen the way that it happened. And there’s been civil unrest that’s unprecedented. Like I don’t remember civil unrest like this except when I was watching what was going on with the ‘troubles’ back in Ireland in the seventies when I was a tiny little person. We’ve had new wars start in parts of the world and of course we’ve had the pandemic. The pandemic cause I don’t know about you, but I wasn’t alive when we had the Spanish flu.

So this pandemic Covid 19 was brand new for me and it has affected and interrupted and disrupted the world, including health like we’ve never seen before. And what Covid-19 did was it shone a spotlight on all the healthcare systems that were already overloaded. So before the Covid era, we had in western countries an epidemic of burned out health professionals. I wrote about it, people were burning out, we weren’t talking about it anywhere near as much as we talk about it now. It was done in secret, it was done in silence. It was a dirty word. You didn’t get burned out. There was so much shame attached to burning out. Cause essentially if you had to acknowledge that you were burnt out as a health professional, you were being interpreted or interpreting yourself to yourself as you couldn’t cut it, you’re not good enough.

And health professionals fear that level of judgment. But then covid hit and we as overloaded, overburdened, psychologically unsafe health professionals, we just got stuck in and did it. We had nurses and doctors and occupational therapists and physiotherapists and any type of therapist under the sun working longer and longer hours, taking reductions in pay to make sure that people didn’t die. Like that is what we do as health professionals. None of us went to school, to health professional school to learn how to manage a pandemic. We went to school to learn how to help people who were in pain. And we will always come back to this desire to help people. It’s ingrained in us. Otherwise, we would’ve chosen to do different types of training. We would’ve chosen marketing or business or architecture or zoology. But we wanna help people. That’s why we exist.

And today we’re living with levels of burnout in our health professionals that are so extreme that in Australia we are actually seeing a reported trend of increased suicide in hospital registrars, dentists and veterinarians. And that’s just the data that’s being collected. Now I know the same is true in the United States, but I actually don’t have access to up-to-date relevant post covid data. So if anybody’s got that and you wanna share it with me, send a link to hello@jomuirhead.com. And I would love to include that in our show notes, the health system, the demand on any health system in any western country, cause I am talking from that privilege is enormous.

Now in Australia, one of the problems that I see that we are facing is we have a universal healthcare system of sorts. It’s called Medicare. But when Medicare was enacted in the 1980s, it was to give every Australian citizen access to emergency care because people didn’t have access to emergency care before the 1980s.

So in my lifetime in Australia we’ve not always had this perception of free healthcare. It’s only since the 1980s is there a perception that healthcare should be free. And it’s not free, you pay for it with your taxes. But what’s actually happened since the 1980s is that emergency medicine is no longer the thing that’s killing people. It’s chronic health issues. And we don’t have a health system that is funded to deal with chronic health issues. Yeah, hence the problem. I have a suspicion that this is the problem that we also see in Great Britain, but I don’t know, I’m not there and I’m not working in the system. But we take a lot of our advice from Great Britain and then we watch what’s going on in the United States. But what I say is the demand on our health systems is enormous.

It can’t keep up, right? And again, I am saying this as a privileged white middle class woman who lives in a wealthy western country, okay? That is where, that’s the lens that I live my life through. And when I say that there’s not enough talent, <laugh> or the burden is so great, we just don’t have enough talent. So one of the things that Covid did here in Australia is we shut our borders. We are an island. We stop letting people come in or go out. Now I had been in my last employment role back in the zeros of the two thousands. We were doing most of our recruiting from overseas health professionals, South Africa, great Britain, Canada, the USA. That is how we were getting enough talent to fulfill the need back then. That hasn’t changed. You spend any time in an Australian hospital and you’re gonna meet people from all over the world.

We have such a multicultural expectation now or service delivery expectation now in our health system, regardless of whether it’s public or private, it’s, there’s just people from all over the world. But Covid shut that down. So we lost all this talent, which meant all the resources went. So then if you were allowed to stay in the country and able to keep working cause you weren’t sick and you weren’t dying from covid anyway, then you know what you were doing more and more and more and more work and you could see the cues out of the emergency departments at the hospitals. You could see the people camping outside. There were 10 cities going on. I know there were 10 cities going on all around the world. But we would see that as health professionals and it would break our hearts and we’d be like what do we do to help? What do we do to help?

Even before this was going on, our health systems were overloaded. I’m gonna use my dad as an example again, good old dad, he’s a great example of our health system. So you know he had a massive heart event into his sixties I think. And he was living about four hours south of Sydney at the time. And he needed to be airlifted to a specialist hospital in Sydney airlifted by helicopter. It was terrifying. I lived closer to the city than anybody else at the time, city being Sydney. So I got to drive down and and see that all be a part of that and he’d had this massive heart attack again and all sorts of, he needed surgery and all sorts of things were going on for him after he’d been in hospital, I can’t even remember how many days now, but how he was discharged was a nurse came and said to him, Hey Mr. Muirhead , do you think you’re ready to go home because we need your bed?

Now my dad doesn’t wanna be a problem and he would look for any opportunity to get out of hospital because he didn’t like the food <laugh>, he probably didn’t like the lack of privacy either. And so they discharged him without assessment into the care of his 80 year old mother who did not have the tools and equipment to be able to care for him. In fact, getting him in and out of a shower was physically impossible. That is an example of a system overloaded. Now I’m sure that you’ve all got stories like that. That’s a very tangible story for me and it’s one that I tell people quite a lot because it’s like, don’t do this. Don’t let the system pressure stop you from getting the healthcare that you need. It’s not your responsibility as a patient to fix the system overload.

So here we’re living in 2023 when I’m recording this podcast and it is quite obvious that there’s not enough health professionals to do the work. There’s not enough talent. We can’t produce health professionals quickly enough. And then if we did, we are not going to have enough people around to supervise both formal supervision, informal supervision, peer consultation. There’s just not enough to meet the need. But on top of that, we actually don’t have enough financial resources to meet the changing needs of healthcare and governments. God bless them, I’m grateful for universal healthcare in Australia. But they move so slowly and this is where I think, you know, private practitioners and those people who have health businesses, this is where we can actually start breaking down some of these access and equity issues. But I’m gonna get to that.

Another thing that we are noticing since the Covid situation and all these health professionals got engaged and got involved was that we generally have very low levels of health literacy even in these western countries that are considered to be advanced in the pinnacle of great healthcare. So those who aren’t accessing healthcare all the time or have never had to access healthcare all the time, they don’t know what to ask for or when to ask for it or when something’s unusual. And given that most of us are living with chronic illnesses these days, this stuff creeps up on us. So we kind of go from thinking, oh yeah, I used to be able to do that stuff. But you know, over the years it’s taken its toll and then all of a sudden you discover that you have got, you know, diabetes and it’s outta control and chances are you need an amputation. It’s horrible to think of the levels, the low levels of health literacy that we have. I personally know how difficult that is because in the year of Covid 2020, I was also being treated for bilateral breast cancer and I found it so freaking difficult to navigate my hospital and health systems. It terrified me to think of the people in the waiting room who didn’t know how to advocate for themselves the way I did. That was a really, really confrontational moment for me.

So we have these huge access issues, huge access issues. People dunno what to ask for. They don’t know what’s available. They dunno when it’s available. They don’t know how to use it. They don’t know how to go, they don’t know. Oh, when you say sugar, I thought you just meant stop putting sugar in my coffee every day. I didn’t realize you meant stop drinking coke. Like they’re the levels of health literacy that we’ve got problems with.

And I’m not even touching the surface of equity issues today. And there’s other people who can speak into that much better than me. So I’m gonna leave that one right alone. But just to give you an example, if you need some more convincing about access for rural and remote Australian children wanting assistance with speech or language or they might need a speech pathologist or a speech therapist, an occupational therapy, you’ve got probably a two year wait before you can be seen. That’s what we call early intervention. Two year wait. Two years on the waiting list. So this is delaying kids progress in school. It’s delaying their ability to engage in afterschool activities. It’s causing behavioral problems, it’s causing mental health problems because we have an overloaded health system. These kids are then we’re finding out that they’re leaving school not having had any intervention with below levels of literacy for entry level employment.

I was speaking to a speechy, no that’s an Australian term as speech therapist or a speech pathologist who works and lives in the northern territory of Australia. And she explained to me that she is working with high school children who are the third generation in their family to have functional illiteracy. Basically. They can’t go and fill out a form on their their own. They wouldn’t be able to create a job application on their own. These are usually families with at least three generations out of unemployment. And I’m not talking about an Aboriginal or Torres Strait Islander community here at all that, I mean if that’s what’s going on in the Northern Territory with our non-Aboriginal and Torres Strait Islander community, then holy heck have we got some work to do here about our Aboriginal and Torres Strait Islander or any indigenous community. And if you’ve never understood the link between literacy and health, please go Google it. Because if you do not have literacy, then you are likely to experience incredible ill health your morbidity and your mortality. It goes through the roof. It’s very, very important for health professionals to understand that because the way we create our internal systems and what we ask clients to do needs to reflect that.

So our health systems don’t have enough talent. Or if they do, they have very inexperienced talent. We have limited opportunities for supervision, opportunities for case consultation. And then we’ve got all these experienced clinicians who are leaving our larger health systems to go into private because they’ve got greater control and because they don’t believe the system is actually there to help people get better anymore. Because funding isn’t limitless. We don’t have access to open cheques. In fact, we feel like the funders, the insurers, the governments, the regulators are making it harder and harder and harder and more and more and more compliance driven to allow us to even practice. So there’s more and more rules to follow. And then we as clinicians, we just wanna help people so our health systems are overloaded.

So let me talk about private practice or private ownership of health businesses. Now I’m a huge advocate of private practice. I truly believe have the experienced public and private, that private practice is the way we can make a change in health the way we want it to.

If enough people in private practice start saying no to the powers that be there will have to be changed. But I digress. So when clinicians get the idea that they wanna be a private practice owner or they wanna open a group or bring on an associate or bring on a contractor or build some type of business, we often do this from a place of meeting need our clinical hat is still on. Our clinical head is still on. You know, understand in the beginning that you need to grow in leadership and management, which are two different things by the way. You need to be able to lead people including yourself. You need to be able to manage people and resources including yourself. You gotta learn about hr, gotta learn about corporate governance. Then you’ve gotta become the chief financial officer, the chief operational officer, the chief technology officer, and then the chief executive officer.

And you got no clue what any of that means. Seriously, none of us went to school to learn how to do that. And we just wanna help people. And we thought that by building a business we were gonna be able to help more people. Now, I truly believe private practice when done from a place of service while understanding the economic client that we are in will be the change to healthcare. Okay? You can’t do it without some economic understanding. Not in a western <laugh> capitalist society, you’re just not gonna be able to do that. But our businesses are overloaded. We don’t have enough talent. In fact, there’s a war for talent at the moment. You just drop a higher number in front of somebody and they’ll jump ship quickly and the employee will jump ship quickly. They will tell you an interview that they’re not interested in the highest amount of money, they’ll actually not stay with you as an employee for the highest amount of money. But that is the carrot that is getting them to move. And I am knowing people in the space of 12 months who are almost doubling their salary, doing exactly the same work because they’re doing this and they’re chasing that dollar thinking that that’s actually going to satisfy them. Then they turn up in my doorstep and we work out that it’s not. Anyhoo, so our businesses are overloaded. There’s a war for talent. We have this incredible economic instability. Insurance companies change the rules at the drop of a hat. Governments change, government agendas change access and equity changes. Rules over here on the left hand side like in social security makes a change and it has a ripple effect for all of us over here in the health system or housing changes. And then there’s a problem or schooling changes and then there’s a problem or there is a mass incident and then we have another problem.

We have changing referral parameters, different codes. Codes keep changing. Oh my god, all the talk in in Facebook community about codes. Don’t like the codes thing.

Staff performance. How do you manage staff performance in an environment where you’re terrified of staff leaving because you got nobody to do the work and your budget is built on people doing the work better still, how do you, how do you let somebody go knowing that you’re not gonna be able to replace them? I mean this is the stuff that is keeping health business owners, group practice owners awake at night. It’s like I can’t meet my budget if I don’t have enough bums in the seat doing the work, seeing the people, but they’re not doing the work or seeing the people and it’s just this massive anxiety story. So staff performance is a huge issue and then everything starts to fall on the business owner’s shoulders again or on their neck or on their head or in their gut. Wherever it is, you feel the stress and tension so that the health business owner becomes stressed, they’re burned out, or they’re burned, they’re feel betrayed, they’re exhausted and they just threatened to burn the whole thing to the ground. Now whether you are publicly expressing this to your staff members or not is not if you feel like that they’re picking up on it because you’re employing smart people who are health professionals who are experts in human behaviour. They will get a feeling and a vibe and you’re gonna watch ’em jump ship or stop performing or quiet quit. And yes, we have rules about work health and safety or occupational health and safety. And in Australia, we are starting to see some implementation of psychological safety in our workplaces, which is awesome, right? But do you as a business owner understand the work health and safety and the psychological safety needs of your staff members of your business? Do you understand where the risks are? This is a whole new level of learning that we’ve gotta get to to make sure that we’re number one compliant. Number two, keeping our people safe. Number three, enabling them to stay at work.

We all have a responsibility here. So if you are an employee or if you are just a new graduate and you’re thinking, wow, look at what the employer has to do for me and look at what the system has to do for me. Can I just get on my soapbox for a minute and let you know that you have responsibility here. We need employer employee engagement. We need cultures that actually promote safe systems of work. And we can’t do that if we actually don’t what they are. If we are too busy trying to plug in the gaps, fill the the business with band-aids and just keep asking the high performers to take on more and more work. So you actually need to turn your high performers into leaders in your business if they want to. And then you’ve actually gotta go and look at your emerging leaders.

So you’ve actually gotta become a leadership development person. But you dear individual listening to this, you have a responsibility here as well because if you don’t know who you are and how you fit into a business, why are you there? If you don’t know how your employer can get the best out of you, then how are you gonna stay? So the quickest way for any of us to burn out is to start working in opposition to our values. Now I’m a coach and I’m a pretty good coach and I help you think that is my sweet spot. That is what I am really good at. So I am gonna leave you with some questions today. If the quickest way for any of us to burn out is to start working in opposition to our values, my first question is what do you value? What are the things in your work that you can’t live without? Now for some of us it’s a consistent paycheck. You take that away as I can. But what are those things in your work that you can’t live without? And then the final question is, what is your relationship with your work like? And there’s a whole discussion here about presenteeism, quiet, quitting and work addiction, which we will have another day.

Health professionals. I wanna see us continue to do good work. And last the distance because it concerns me that we are going to have generations of people trying to access healthcare and the most experienced person in the room has maybe three years experience that concerns me. So how do we stay the course? How do we end up with generations of people in the health system passing down the knowledge, adding to the body of knowledge, feeling well enough and strong enough and vibrant enough and passionate enough to keep going. Because no one can do this for you. And regardless of where you are employed, you have a responsibility to engage in a safe system of work. And if you don’t know how to do that, then we really need to have a chat.

Now this is a brand new podcast so I would love you to help me help you. So if you’ve enjoyed what you’ve heard today, if you’ve got something of note out of this, if you thought there was something interesting, if you listen to the whole thing, please <laugh>, I need your feedback. And the way you can give me your feedback is to rate, review and share this episode on your social stories or on social media anywhere. Cause the more people who are rating and reviewing, the more people are gonna be able to find this podcast and we can then progress the conversation and add to the body of knowledge. So I’m your host, Jo Muirhead and I’m looking forward to speaking to you again.