Creating an environment for happy physicians
Staggering physician burnout rates call for a portfolio of solutions
As the health care industry has been shifting away from “fee-for-service” models, there has been a conscious and deliberate movement to place patients at the center of care, to increase patient engagement, while improving care outcomes and reducing costs.
If patients are at the “heart” of health care, it could be said that care providers must be the lifeblood that keeps the heart going. More and more demands have been placed on physicians, however, and it has taken a toll.
In 2018, WebMD took a pulse on the well-being of physicians themselves when it reported that suicide rates among physicians are the highest of any U.S. profession, and that this may largely be a result of untreated or under-treated depression. Other negative consequences of depression and burnout can cause doctors to leave employers or reduce their clinical work hours to a part-time basis. Aside from stress that begins in medical school and continues through residence, more studies are being conducted to better understand all of the circumstances which might be making physicians more vulnerable to depression, particularly once they are in the workforce.
The human aspect, and organizational casualties of, physician depression and burnout are certainly very real — and costly. Some estimates put the cost to recruit and replace doctors at these organizations ranging from $500,000 to over $1 million dollars per doctor.
Studies have confirmed that physician burnout also significantly affects patient care, the costs of which become more staggering, when you take into account medical errors, higher malpractice risk, damage to an organization’s reputation, along with decreased patient satisfaction and loyalty, etc. In fact, burned out physicians are twice as likely to provide unsafe care, three times as likely to receive low patient satisfaction ratings, and have also been linked to poorer quality of care due to low professionalism.
When you factor in this more global view of how much physician burnout costs, it’s a whopping $4.6 billion a year in the U.S., according to the latest study from the Annals of Internal Medicine. That’s $7,600 per employed physician, per year, at the organizational level.
Consider the prevalence — around two-thirds of U.S. doctors who experience physician burnout, depression, or both — and the projected shortage of doctors relevant to our aging population, and you get a clearer picture of the importance and timeliness of this issue.
Who is the most burned out, and why?
Those in critical care and neurology, family physicians, OB/GYNs and internists round out the top three groupings, according to a Medscape study. Female physicians are slightly more burned out than their male counterparts, and physicians between 45 and 54 years of age are the most burned out age group, at a rate as high as 50 percent.
According to the American Medical Association (AMA), burnout affects all sorts of caregivers but tends to affect physicians the most, and it can also occur across all specialties and care settings.
Similar to the movement to more holistically address patients’ overall health by incorporating social determinants of health (SDoH), there are many contributing factors affecting physicians’ overall well-being and job satisfaction as well. This can make it challenging to identify causes, institute tools to make improvements at the organizational level, and measure the tools’ effectiveness.
Despite these challenges, recent studies identify methods to improve physician burnout. We’ve compiled a sampling of eight of the most varied and promising ideas that have the power to create happier work environments and happier physicians:
1. Overhauling Medical School Curriculums
Did you know that burnout starts in medical school? Learning institutions are changing their curriculum in an attempt to give their medical students better tools to combat burnout early on. Some of those changes include an introduction to clinical experiences sooner in the process, more “applied learning” opportunities, and better incorporating SDoH for more comprehensive understanding of patients’ journeys. On example of this is at Geisinger Commonwealth School of Medicine, where students complete 100 hours of community service as part of their graduation requirements, to gain a better understanding of their patients’ needs across different socio-economic backgrounds.
2. EHR Adoption
Yes, there have been claims that physician EHR data entry has become so excessive that family doctors spend up to “86 minutes of pajama time with the EHR,” nightly, finishing their administrative work after-hours or at their homes. But there is also research that says hospitals with higher adoption rates of EHRs have happier physicians, more customized EHRs, and better teamwork among clinicians and their IT counterparts. The study concedes that “EHR success is largely driven by change management (i.e., people and processes),” and that physicians at these health care organizations with high EHR adoption rates also benefit from strong training, which may contribute to their job satisfaction.
3. Conducting Surveys
The Agency for Healthcare Research and Quality (AHRQ) produced funding that led to a new measure of burnout and the identification of several interventions that can potentially mitigate it. The Mini Z Burnout Survey was created so practices can take a “quick temperature of how much stress and burnout they are experiencing and what might be causing it.” With this sort of data at their fingertips, practices can create more proactive policies, at the institutional level, to reduce physicians’ stressful working conditions and burnout at their root causes.
4. Chief Wellness Officers
Just as the Chief Information Officer role has become more common in hospital systems to manage data requirements on behalf of the organization, the Chief Wellness Officer role has emerged “to successfully develop and lead a robust program designed to improve the well-being of clinicians.” This person has the budget, staff and authority to implement “evidence-based interventions that enable clinicians to effectively practice in a culture that prioritizes and promotes their well-being.” This, as part of creating a wellness “infrastructure,” would also include designing and instituting employee engagement practices to foster community amongst physicians and others in the organization, and would establish some resources or policies to help physicians achieve more work–life balance.
5. Addressing SDoH
A recent study indicates that “physicians with a high perception of their clinic’s ability to meet patients’ social needs were less likely to report burnout.” Physicians believe, ideally, that someone other than themselves, such as a social worker, is best equipped to address these needs, but given the advances toward addressing SDoH to improve patient outcomes, this marks another promising avenue that could ultimately reduce physician burnout.
6. Analytic Technologies
Employing newer analytic technologies such as advanced speech recognition, to more accurately transcribe doctor-patient interactions, and even digital phenotyping, which most consumers already use (and if HIPAA concerns could be properly addressed), have the potential to eliminate repetitive tasks, which physicians consistently cite as a major drain on their time and emotional well-being. Digital phenotyping examines a user’s interactions to reveal patterns. An example of this already being used is the Facebook algorithm that can scan users’ posts for signs of suicidal thoughts, which can alert a member of their review team for intervention.
7. Nurses as Teammates
Research suggests that when doctors and nurses work well as a team, that it not only yields better patient outcomes, but can improve job satisfaction for both parties as well. Added bonus: when doctors and nurses agree on their patient assessments, they can also land more accurate prognoses for the patient as well.
Exciting advances have been made with telehealth in recent years, and it serves as a promising solution to reduce physician burnout as well. Only about one in five physicians currently use telehealth options, which are, essentially, video visits that can be conducted on mobile phones, tablets or other devices. But physician “willingness” to use telehealth is up to 69 percent in 2019, for its abilities to achieve a more flexible work-life balance. Telehealth can also grant more access to patients, and makes it easier to retain new ones. Sixty-one percent of physicians indicated they were likely to be using, or to start using telehealth by year 2022, making this an explosive area for growth.
Too much ‘red tape’
While there have been many specialized studies in just the last couple of years — the above categories are just a sampling — the pervasive theme contributing to physician burnout has been “too many bureaucratic tasks, such as charting and paperwork” — paperwork, some of which could be inferred as EHR “data entry” in today’s digital landscape, since over 96 percent of hospitals and over 78 percent of clinics now use digital patient records.
The AMA further suggests in its “Steps Forward” module that “the predominant drivers of burnout are systems-level factors rather than individual physician-level factors” including high workloads and “workflow inefficiencies.”
Similarly, AHRQ’s Healthy Work Place Study had physicians choose from a list of interventions that they believed would improve burnout, one category of which was “changing workflow.” Two of the proposed solutions listed therein were “reducing required activities” and “providing time in the workday and workflow to complete required documentation tasks and enter data into the electronic health record.”
There is a solution that accomplishes both of these functions in one fail swoop: Bridge Connector’s no-code data integrations, which reign in organizational efficiencies for health care organizations. Depending on the client’s needs, these gains have ranged from reducing dual, manual data entry between disparate EHR and other platforms, to saving caregivers time to better focus on patients, not to mention the data transparency which better informs business decisions, bolstering productivity and profitability.
According to Joy Huss, a former nurse informaticist with nearly 30 years of experience who now helps develop Bridge Connector solutions, “It’s really important to note that, sure, it’s all great that it’s on the computer — but it also has to have a good workflow. You have to address the patient’s needs while you’re interacting with the EHR,” she said. “You don’t want to lose that patient focus, as you’re refining your processes to go from paper to electronic.” Huss is part of our team who keeps our integrations solutions focused on creating more efficient “workflows,” as well as keeping the user and patient experience “top of mind.”
Here’s to continuing to track innovative ideas which can create environments that are conducive to happier physicians. And here’s to leveraging the power of EHRs, which are here to stay, with data integrations — while improving physician workflows to help us reach those goals.