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Creating a Culture That Empowers Providers to Thrive: A Conversation with Vituity's Dr. Gregg Miller
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- [00:00]
A
Hello, everyone. This is Brian Zimmerman with Beckers Healthcare. Thank you so much for tuning into the Beckers Healthcare podcast. Today we're going to have a conversation about creating a culture that empowers providers to thrive. Joining me is Dr. Greg Miller, Chief Medical Officer with Vituity. In just a bit, we'll explore what it takes to build a resilient healthcare workforce amid ongoing provider burnout and shifting expectations. Dr. Miller joins us to share Vituity's approach to supporting physicians and advanced providers through a culture of empowerment, engagement and well being. Dr. Miller, thank you so much for being here.
- [00:34]
B
Yeah, thanks for having me, Brian. Excited to talk about this.
- [00:37]
A
Yeah, for sure. Before we get going here, can you just share a bit more about your background just so folks can sort of appreciate your perspective here as we roll into the conversation?
- [00:47]
B
Yeah, absolutely. I'm the chief Medical officer for Vituity, which is a large medical group, a national medical group focused primarily in the acute care space. I'm personally an emergency physician and in my role as chief Medical officer, I oversee a lot of our wellness quality and data projects. And in particular we do a lot of work focused on our retention, on our burnout and on our culture. And I'm an executive sponsor for a lot of that work.
- [01:14]
A
Excellent. I appreciate that background. So let's start big picture here. I think we've seen some recent reports that suggest burnout rates are improving slightly, but still the environment that physicians are working in, I mean, they're just under immense pressure still. So what do you believe, I guess is behind some of these lingering challenges that haven't been able to be be resolved? And how can leaders really help physicians truly thrive in today's environment, not just survive? What are your thoughts there?
- [01:42]
B
Great question. I mean, you're absolutely right. We have seen reductions in burnout. There was a famous sort of well known Medscape survey that happens every year. And we saw a little bit more than half of providers last year said that they were really burned out, or actually two years ago said that they were burned out. Now this year or late 2024, a little bit under half of those providers said that they were burned out. And we're seeing similar within Vituity as well as in other nationally published studies that burnout is trending down from 2023 to 2024 and further in 2025, but it's still way too high. The Medscape survey, still almost half of all physicians said that they were very burned out. And our own organization, we see about a fifth, maybe a little Bit under a fifth of our physicians saying that they're really burned out. And so this is still clearly an issue. I think the issues are system issues. It's not provider issues, it's not resiliency issues. It's that the system is a challenging system for everybody to work in, for clinicians to work in, for healthcare administrators to work in, for everybody to work in. And it's because we're being asked to do more with less. I think patients are sicker and need more resources. Providers have more challenges in terms of accomplishing the things that they're being asked to do. And payers, you know, we're seeing reductions in Medicare rates over the past several years compared to inflation. There's this looming threat of cuts to Medicaid. So it's these huge system issues where ultimately all of us are being asked to do more with less. And so that's been a major driver. And so because of that, you know, the solutions aren't, you know, a resiliency pizza on Friday for your, for your frontline staff. You know, these solutions need to be system driven solutions addressing like big picture issues.
- [03:28]
A
It's a great point. It's so much with this is a big picture stuff that it would be foolhardy to believe that a pizza party is going to resolve anything here. So how do you think about this then in terms of the work? You said it's got to be system solutions. How do you think about this in terms of building a resilient workforce and curious to hear some of Vituity's, I guess, foundational cultural elements because culture is really what's going to do it here. You mentioned the burnout rates at Vituity. I'm sure you want to improve them, but. But they're better than the national average if my math is correct. So curious to hear what you think is working.
- [04:13]
B
Yeah. On a system level, I think the big picture issues are around autonomy and around empowerment. And so systemically this is just something that we've got baked into our model. A more physician owned, physician led organization, no external private equity backing us up. And so that gives us a lot of autonomy. And I think that's something for healthcare administrators to think about. When you're looking at your own workforce. This is how can you provide that autonomy to your workforce. And there's a lot that can be done here. Right. Like being a physician to own physician led company means that we get to make decisions that are really focused on what the bedside clinicians need to provide great patient care. And it means that they've got the autonomy at the department level to discuss that with their medical directors and work on that. And so that's for like the frontline clinicians, right? Like they have a lot of say in how the group is run and how the group is managed. Then at a level, up at the leader level, at the medical director level, the regional director level, we build systems to really help develop them. There is a lot of talent in your physician workforce, in your nursing workforce, in your advanced practice provider workforce, but that's very raw talent. It hasn't been developed. These are leaders who get there because they are great at providing outstanding clinical care. And what got you there, what got you here is not going to get you there. Right? So like, great clinicians are not necessarily going to be great leaders. And so it really takes a system approach to building up those leaders and investing significantly in leadership development programs. So we've had, we're a group of about 5,000 physicians of whom we've had about 500 physicians go through some type of pretty robust leadership development program in the past year. Not just, you know, a webinar on leadership, but, you know, we've got an administrative fellowship, we've got longitudinal leadership development programs, we've got these medical director academies for our new medical directors. And so we really invest a lot in developing those leaders. And we see that payoff, like that system investment in leadership really pays off down the road and it helps the bedside clinicians as well. Again, it comes down to autonomy and it comes down to empowerment, giving frontline clinicians and also leaders the autonomy to make the decisions that need to be made for patient care and then also empowering them with the skills that they need to make those decisions decisions and giving them the freedom to implement that wonderful overview there.
- [06:39]
A
Dr. Miller, I want to zoom in on the front lines specifically. I think in terms of how you create that autonomy, it absolutely sounds very important, but might perhaps be easier said than done. So I guess we'd love to hear you unpack that work in terms of how you create space for providers to really have that voice, that empowerment you're speaking to in decisions that really influence their day to day work. And, and if you could tie your answer to like how that is directly contributed to performance and, and retention, I'd be curious to hear that.
- [07:10]
B
Yeah, for sure, for sure. I would say, you know, there's, there's three areas that really matter to clinicians when it comes to autonomy. And first, you know, this is not the message that, you know, clinicians can Just get to do whatever they want to do and, and doctors know best, right? Like that is not the message here at all. They need to be aligned, they need to be bought in. They need to understand what the mission of organization is and help support that mission. But when we talk about autonomy and empowerment, it's within those guardrails that the organization has laid out so that the clinicians are aligned with that mission or the vision or the values of the organization. So there's I think three areas that clinicians really need a strong say in. One is obviously patient care. And overall, I think most health systems are really good at that. I mean, it's really the clinicians that drive the high quality care and making sure that your clinicians are engaged and, and empowered to do that and to show up to the bedside and do the work that needs to be done. And overall, I think, I think that's one area that in general health systems do a really good job of. I think other areas where we can look at how to empower and engage our clinicians is two other areas is, number one is the scheduling. Nobody knows better than the site and the clinicians at the site what the schedule looks like as well as, you know, how do we incentivize financially our clinicians, our clinicians know the things that need to get fixed and they are the best people to kind of design those financial incentives. I'm not saying that, you know, when it comes to autonomy over scheduling, the doctors get to say nobody works a night shift. I'm not saying when it comes to autonomy over pay, the doctors say pay us everything all the time, everywhere. What I am saying is that there are guardrails and there are boundaries that maybe the clinicians understand even better than anybody else. And if they're given the autonomy to have some say over what the night shift schedule looks like or what the ramp up looks like throughout the day as more volume shows up into your hospital and maybe if they're giving some say into what are the key quality initiatives that we really need to prioritize and incentivize, that leads to a lot more engagement and buy in from clinicians and it helps them stay really involved with the mission of the organization.
- [09:21]
A
Yeah, it sounds like there's a good bit of transparency there too in terms of helping them understand the why certain decisions are made too, right?
- [09:28]
B
Yeah. Oh, absolutely. I mean, you have to be very transparent about your motives, which are, you know, every single healthcare system has fantastic motives. Right. And every single healthcare clinician has fantastic motives. And making sure. That the system is really explicit about that. Like we're here to improve lives. Right. We're here to save lives, we're here to make lives better. I mean, that's our mission. That's the mission of every single administrator in healthcare and that's the mission of every single clinician. And so being explicit about that really helps create and drive that alignment. When clinicians see that you're on the same team and you see that clinicians are on the same team.
- [10:03]
A
Yeah, yeah. I want to dig in here now to sort of, I guess, team dynamics and how, how, you know, that shapes provider well being, you know, because it's, it's, you really gotta, you know, have positive feelings and interactions with the folks you come to work with every day. And a lot of that is informed by culture. So can you talk a little bit about how Vituity's culture has come to life in a way that has maybe positively impacted team dynamics or provider well being?
- [10:33]
B
Yeah, yeah. I wanted to highlight like one thing that we've done. So this takes investment, right. Like culture is really a measure of where you make your investments. And so we've really invested in wellness. We've created systems that focus on this. And one area that we've seen a really good return on that investment to really drive culture has been around a program that we have for our medical directors in particular. So these are highly trained clinicians, Right. Who are fantastic individuals. But what got them here is not going to get them there. And some of the habits that they've learned in medical school or in PA school or nursing school are not necessarily going to lead to success as leaders. Right. Like you kind of learn in medicine that there's a right way to do things and a wrong way to do things and that there's always a solution to a problem and that you just need to work harder to get to that solution. And those aren't always the healthiest behaviors for leaders to have. It leads to a lot of burnout when you don't recognize that there are just some challenges that can only be managed, like these quote unquote wicked problems that will never have a solution. And you're not a failure because you didn't solve for that. So we've invested a lot in wellness coaching for our medical directors. We've put dozens through a tailored 10 week program to build out these skills that they need as leaders. To be strong leaders, resilient leaders, and understand how to lead effectively, but really focus primarily on their own wellness. And as a result of that it's been really cool. So we train these dozens of medical directors through this program, but we've actually seen the burnout rates in their sites in the frontline clinicians who are on those medical directors teams. We've seen burnout and retention and culture improve in those frontline clinicians. So when you think about how do you build your culture, really focus on your leaders in the organization, give them the skills that they need to lead with wellness and mind, and then you'll see a real payoff in culture throughout the entire organization.
- [12:35]
A
And you think about how many just folks those directors touch. You know, it's really high impact what you could be doing by supporting them and spread out through the organization. Want to zoom in here on sort of the next generation of physicians, of course, and I think some of this is in keeping with your, the focus on wellness and trying to spread that throughout the organization. But we hear all the time about, you know, new physicians coming in. They want more flexibility, they have different expectations around autonomy, which we've touched on and sort of the sense of purpose there. But how is, how is vituity? Can you share any details about how you're potentially adapting to meet the shifting needs of new physicians while also clearly keeping clinical excellence as the North Star here?
- [13:21]
B
Yeah, yeah, great point. You know, first, let me just say, Brian, you know, you do hear that a lot. Like this new generation of physicians is different. You know, they're, they're more idealistic, they want more free time. And I don't, you know, that just sounds to me like old people talking about young people in general. You know what I mean?
- [13:38]
A
You might be onto something there.
- [13:40]
B
Like when I was, I entered as like Gen X, I was a slacker generation. These guys just want free time. They don't want to work. You know, like, you just kind of hear this message over and over. But what the younger generation has that us older cynical leaders don't have is that sense of idealism that drove us all into medicine and all of us into healthcare. And they've still got it. And so making sure we've been very intentional about talking about our culture to these new clinicians as they join vituity. We spend a lot of time talking about what we call our just cause, our mission, our just causes to improve lives. And so we try to really drive that sense throughout all of the onboarding, throughout all the orientation, all the meetings we have, the awards that we do, the recognitions that we have, the speeches that we give, the trainings that we do, the clinical bedside work that we do. We really try to drive that sense of mission that just cause. And I think that really resonates with a lot of younger clinicians who went into this just like all of us, for all the right reasons. We all just want to do a great job of taking care of patients and making their lives better. So, you know, making sure that you're a very explicit about that mission is really important. I will say though, you know, there is one key difference between this younger generation and prior generations of clinicians and that is student loan debt. I mean, that is a huge issue. The average resident who's entering practice is caring about a quarter of a million dollars worth of loans. That's on average. So half of your new physicians have more than a quarter million dollars worth of loans. So that is a huge issue that is really important. And thinking about how do you support them financially? We've had to change some of our models. We're offering more sign on bon businesses where we've got more infrastructure in place in our systems to support student loan repayments and get people hooked up and more education around consolidation, et cetera. And then we're also kind of changing our financial models in certain situations where we're providing, you know, we're kind of front loading the paycheck as opposed to end of the year or multi year bonuses. I'm thinking about those recent grads need money right now to start paying off these huge loan debts that they have. So that's, that's one difference to think about with this new generation. But ultimately, you know, the, the real issue here is making sure not just for our, our youngest generation, but for everybody. Making sure that they're bringing their whole person to work and that we are meeting their needs and giving them, you know, the, the tools and the opportunity to do what they want to do, which is to improve lives and making sure that they feel valued and appreciated for that work. So building out programs to recognize that, building out messaging to recognize the mission that we all have to improve lives. I think that's really important, not just for young clinicians, but for all of us.
- [16:25]
A
So much there. Dr. Miller. Really appreciate it. As an elder millennial, I can also appreciate what I've heard. You know, we're not, my generation isn't as in the ringer, I guess, as Gen Z would be right now. But I remember hearing things about how, how I was going to go all wrong because I like expensive lattes. So.
- [16:43]
B
Yeah, your avocado toast, Brian.
- [16:46]
A
Yeah, exactly. What's wrong with these Kids. But moving to a more serious note to finish up here, I guess I would love to. We're about a time I would love for you to just close out with, I guess, sharing a few practical actions folks can take to support their medical staff better and build a culture that really sustains success of physicians. Because as you pointed out too this, because the stakes here are, as you can read into this, the stakes here are really high. Like when you think about the future, the upcoming physician shortage, we always hear about the changing demographics in the population. The stakes are it's not just about the individual physicians. Like the whole country needs a thriving healthcare workforce. Right. So what action steps do you have for folks?
- [17:36]
B
Yeah, I think first really focus on autonomy and empowerment. And I think that's a little scary sometimes because we worry that if you give, you know, the workforce too much autonomy or too much empowerment, they're going to go in a completely different direction than the direction that the organization is going. So the key thing first is to really get alignment around your mission, around your just cause, which for all of us is we're here to improve lives. We're here to make healthcare better for our patients. Once you've got that alignment, which you get through very strategic messaging through really looking at your onboarding programs, to get that message across through looking at your ongoing events, you know, staff meetings, department meetings, medical staff, executive committees, making sure that you've got that messaging in there, then allow for that empowerment and the autonomy around making sure that clinicians have the freedom to do what needs to be done for their patients still within those guardrails. So, so that's number one. Second, I think is investing in your leadership, creating explicit, intentional leadership development programs to take these outstanding nurses and doctors and PAs who are clinicians, but really don't have the training they need around leadership and especially don't have the training they need around staying well and whole as a leader and investing in leadership development programs to give them that skill set, the skill set to create change, to lead with mission in mind and especially the skill set to be well, to recognize that, you know, you're not a failure, you're not an imposter, you're a talented individual. And we're dealing with these huge system level issues that no one person can solve. And so just to summarize, again, you know, creating that alignment with your clinical workforce and then allowing for empowerment and autonomy within that alignment and then investing in your leaders, especially investing in skill building courses around leading with wellness in mind are some key systemic changes that all of us can can start working.
- [19:41]
A
On on Dr. Miller. I think that's a perfect place to leave things. Thank you so much for coming on the podcast.
- [19:47]
B
It was great being here. Thanks for having me, Brian.
- [19:49]
A
We also want to thank our podcast sponsor, Vituity. You can tune to more podcasts from Becker's Healthcare by visiting our podcast page@beckershospitalreview.com.