My LinkedIn feed is full of posts about toxic bosses, toxic workplaces, and employee burnout.  There are endless articles and lists telling you how to be a better leader.  What I don’t see much of, especially from rural health leaders, is an honest conversation about leadership burnout.

Why?  Probably because it feels like a career-limiting conversation.  I get it. Even now, as a consultant who isn’t reporting to a board, I feel the need to choose my words carefully.  It’s a vulnerable topic and we live in an age of cancel culture.

Several years ago, while recruiting for a c-suite position, we kept dismissing candidates who had only one or two years in their last leadership role.  We labeled them “position hoppers.”  The recruiting firm told us we couldn’t expect more than two or three years from most c-suite candidates.  I was stunned.  At two years, you’ve just barely come to understand your organization.  And yet, the data backs it up.  The average tenure for hospital CEOs is around five years and for CFOs it’s even shorter.  

In private conversations with other healthcare leaders, I often hear things like:

“I can’t wait to retire.”

or

“I wonder what else I could do besides healthcare.”

I’ve watched leaders take massive pay cuts or move across the country just to get out of the field.  

But we rarely say these things out loud.  

It’s much safer to maintain the image of the steady, smiling leader who has it all under control.  

And let’s face it, in rural health we tend to have a cowboy mentality: go it alone, grit your teeth, get through it.  And oh, do I feel that.  I worked through maternity leave with both of my kids.  When I hear myself say that, I think, “What was I thinking?!”  But at the time, it felt absolutely necessary and I didn’t see another reasonable option. 

I don’t doubt that it’s always been lonely at the top.  That said, we’re now contending with cancel culture, the social media soapbox, politics meddling in healthcare to an extreme, and even violence directed at healthcare leaders (and if you think that’s just in urban health systems, you’re wrong).

Meanwhile, leaders are juggling expectations that feel impossible:

• Support staff well-being (they say your boss has more impact on your health than your primary care physician, but no pressure).
• Keep AR down and days cash on hand up (while planning for the OBBB).
• Be present and engaged in the community and at the office (but don’t micromanage).
• Build a new strategic plan (while also managing a renovation of your extremely aged facilities and launching a new service line because a renovation alone just doesn’t feel like progress to the public).
• And by the way, there’s a CMS inspector in the lobby and the toilet in the admin hallway is overflowing.

We’ve even put the burden for not burning out on our healthcare leaders.  

I’m not saying we shouldn’t focus on staff well-being or that we shouldn’t give the CMS inspector a smiling tour of the facility.  These are important things.  But I do think we’re reaching a breaking point where we’re burning out our leaders faster than we’re building them.

Where do we go from here?

I’ve spent a good deal of time reading up on managing burnout, shifting organizational culture, and being a better leader.  These are important topics and there are some good resources out there, but there’s also a lot of generic and unrealistic advice.  As a field, we need to make this more doable. 

I would love to hear ideas from leaders in the field.  In the meantime, here are a few thoughts:

• Normalize conversations about leadership wellbeing.  We won’t make progress if we don’t discuss the issue.
• Encourage peer networks.  Leaders need a place where they can have candid, supportive discussions with other leaders.
• Equip boards to support their leaders.  In rural health, most board members volunteer with the best of intentions.  They often bring deep expertise from other sectors, but few have been healthcare leaders themselves.  Education and resources can help boards understand the unique pressures their executives face.
• Explore new leadership models.  Co-leadership, fractional roles, or interim support may feel unconventional, but they could help keep leaders (and organizations) afloat.  Yes, it’s an added expense, but replacing your c-suite is costly too.
• Pause.  As board members, leaders, and community members, pause and ask whether your expectations are reasonable.  We live in a world that wants everything perfect and immediate, and social media hands out swift “justice” when it’s not.  Healthcare is different: it’s humans caring for humans.  Yes, we should insist on high-quality, consistent care and safe, welcoming facilities.  But remember, most people in healthcare chose this work to help, not harm.  Extend some grace.

If we want to keep our healthcare leaders in the field, we need to rethink how we support them.