Regulatory and administrative burdens associated with various health reform initiatives are taking their toll on physicians. Physicians are more frequently reporting they are burnt out and dissatisfied at work. To address the problem, practices are looking at ways to spread the burden and create more cooperative healthcare teams.
Burnout poses a problem for the future of healthcare. "This is a public health crisis," Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association and lead author of a recent study on burnout published in the Annals of Internal Medicine, told Healthcare Dive.
In her research, Sinsky has found burnout to be concerningly prevalent among U.S. physicians. While burnout affects many American workers (28% of the total population, Sinsky shared), 54% of American physicians are feeling overworked. Startlingly, Sinsky added the rate of burnout has grown dramatically in the last three years by almost 10 percentage points and – in the medical field – a higher level of education is associated with a higher level of burnout.
"Burnout is tricky because the initial phases are often indistinguishable from employee engagement," Dr. Jim Lebret, medical director of clinical analytics at CloudMedx and assistant professor of medicine at NYU Langone Medical Center, told Healthcare Dive. "Physicians may take on a higher workload than they can manage because of the obsessive need to prove themselves, which can mimic enthusiasm. But this leads to neglect of their personal needs and, later, burnout."
There are three widely-accepted symptoms of physician burnout, Dr. Oana Tomescu, associate professor of clinical medicine at the University of Pennsylvania Health System, shared:
Dr. Lisa Ellis, interim vice president of ambulatory operations at VCU Medical Center, noted these symptoms can present themselves in a variety of manners including a downward trend in patient satisfaction survey scores, poor physician retention, shorter fuses, an upward trend of medical errors and individuals simply not showing up for work.
Tomescu added the higher prevalence of medical errors can lead to malpractice suits, making burnout costly to the health delivery system.
In a Medscape report published earlier this year, physicians attributed the cause of burnout to too many bureaucratic tasks, too many hours at work and increasing computerization of practice. This echoes Sinsky's recent study where she and colleagues found physicians were spending approximately one-half of their time on EHR and administrative tasks compared to just around one-quarter of their time on clinical time with patients.
Physicians are less able to treat their patients because they are dealing with “more paperwork and more regulatory work than they have ever had to deal with in the past,” Dr. Lawrence Braud, a vice president on the Physicians Foundation Board of Directors who runs a private ear, nose, and throat practice in Baton Rouge, Louisiana, told Healthcare Dive.
Having the highest-training clincians in the healthcare delivery system do routine, administrative tasks that can be done by someone without such an education is potentially a wasteful use of resources.
One way to combat burnout and low morale is to build a cohesive team. “You can accomplish a lot more in terms of key objectives if there is a sense of teamwork,” Dr. Nick Wolter, CEO of the Billings Clinic in Montana told Healthcare Dive.
Sinsky and colleagues suggest implementing team documentation so the burden of EHR and administrative tasks are shared. They also suggested expanding roles for nurses and physician assistants to strategically distribute tasks.
At the seven-physician private practice where Braud works, additional staff have been added to reduce administrative burden while allowing physicians to see the same number of patients. The practice has added clerical and clinical staff members. While such an effort does require an organization sees more patients in a day to cover the cost of adding staff, Sinsky said the efficiency gains are much greater when an organization takes into account retention and avoids future turnover costs. Also, an organization could find itself with a less-stressed staff.
When building out a team equipped to tackle a growing number of administrative burdens, it's important to consider intangibles such as emotional intelligence and self-awareness after taking medical training and skills into account, according to Wolter. “It is a lot more fun to go to work when you have people that have those relational skills. Even a tough day with tough problems is more enjoyable when you have people that can cooperate.”
VCU recently paired with the AMA and the American College of Physicians to survey provider resiliency and burnout, Ellis told Healthcare Dive. The results will help VCU delve into tools and initiatives for moving the needle on burnout. "One of these may include differences in scheduling such as seven-days-on/seven-days-off. We will also be looking at a variety of job sharing, telemedicine methods to support providers with floater pools of physicians," she said.
As for other changes that practices can make to reduce physician burnout and improve moral, Wolter pointed to resources like American Medical Association's STEPS Forward, which offers strategies for achieving the quadruple aim. Some of these are relatively simple to implement. For instance, reconfiguring an exam room so that physicians can look at patients while working with an EHR is one way to turn the focus back to patient care and away from administrative tasks.
Growing levels of dissatisfaction and burnout among physicians could have a detrimental effect on patient access. According to a recent Physicians Foundation survey of 17,000 physicians, 48% of respondents reported they plan to cut back on hours, retire or take other steps that further limit patient access. Another 46% said they were planning on accelerating retirement plans.
Lebret, a digital health consultant, shares that some of his colleagues are looking for an out. "When I tell [some colleagues] of my consulting work they ask ‘How can I do that? I need something else.’ I haven’t yet heard anyone say ‘Why don’t you practice more than 50% time?’" Lebret said. Such potential exits are concerning as the physician shortage, especially among primary care physicians, is looming as more baby boomers are entering Medicare age and millennials are beginning to enter the health system.