It’s individual physicians who feel the weight of the country’s burnout crisis, but experts say solving the problem requires pulling back and instituting efforts on a larger scale.
With growing awareness of the plethora of negative repercussions of physician burnout, comes an increased focus by physician leaders and health systems on tackling it, said Bryan Batson, MD, CEO of the physician-led Hattiesburg Clinic in Mississippi, during an education session at the AMA Annual Meeting.
Hattiesburg Clinic is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“In our organization, this was not a conversation you were having six to nine years ago,” Dr. Batson said. “And it's become a really important conversation in our organization and one that we've enjoyed the partnership with the AMA to help us learn about ourselves so that we can start addressing the issues that we have through the Joy in Medicine™ Health System Recognition Program and the Organizational Biopsy®.”
As the leader in physician well-being, the AMA is reducing physician burnout by removing administrative burdens and providing real-world solutions to help doctors rediscover the Joy in Medicine.
The scope of the problem is clear, and alarming, said Jill Jin, MD, MPH, an internist in Chicago and a senior physician adviser for the AMA.
The share of burnout among doctors “is 40% higher than the general population when controlled for hours worked, educational level, age, gender and relationship status,” she said. “This is a problem that disproportionately affects our profession.”
But physician burnout is a affects more than just individual doctors. The health care system, patients, even the financial health of organizations that employ physicians all are negatively affected by burnout, Dr. Jin said, noting “the cost of burnout is significant.”
With that in mind, Drs. Jin and Batson offered system-level strategies to prevent physician burnout.
Stop the unnecessary work
There are multiple opportunities to take work off physicians’ plates, said Dr. Jin. The EHR and the patient portal inbox, where increased time demands are known to drive burnout among physicians, are a great place to begin.
“There is so much work we're doing on a day-to-day basis that is unnecessary, that has little or no clinical value, no evidence for benefit,” Dr. Jin said. “It's always easier to take away than to implement, than to add.”
Health systems can simplify login processes and order entry, reduce note bloat and minimize unnecessary hard stops. Asking physicians to give examples of unnecessary parts of their workflow, some of which are simply “mistakes” in the EHR, is important. She gave the example of requiring physicians to answer questions about umbilical cord care for adolescents as extra clicks as an alert that was never turned off, that add up to a significant portion of time that could be saved by asking front-line physicians for their input.
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Divide the necessary work
Teamwork has also been shown to be protective against physician burnout and underpins sharing the necessary work of medicine, Dr. Jin said.
“Every part of the patient care workflow has to be a team-based workflow,” she said. “Starting from pre-visit planning and pre-visit lab testing, to standing orders, prescription renewals, team-based management of the EHR in-basket, team documentation” should rely on a network that includes not just clinicians but also nurses, medical assistants, pharmacists, social workers, nonphysician providers and administrative staff.
“There are many potential members of the team,” Dr. Jin said. “But the idea is that the physician cannot be acting alone.”
Support individual physicians
Health systems can make a meaningful impact on physicians’ well-being by offering them more autonomy and flexibility.
“Even if it's just something such as choosing their template times. … Something simple really goes a long way,” she said. It “also includes, for example, the option to work from home by telehealth, or the option to decrease their FTE if needed. And when doing that, importantly, reducing patient panel size accordingly.”
Peer support can also be helpful, Dr. Jin said, as can coaching, mentoring and professional development opportunities, time and money for continuing education, and creating communication channels between physicians and their administrators. She further said systems must consider PTO and vacation time too.
“A key part of feeling valued is vacation and PTO policies that include clinical coverage, in particular EHR inbox coverage without burdening their colleagues,” Dr. Jin said.
Supporting individual physicians also includes offering a robust employee-assistance program and access to mental health care for those doctors with anxiety, depression, PTSD or substance-use disorders—all of which should not be mistaken for burnout. Sadly, too many “physicians do not like to admit that they’re vulnerable” to such mental health challenges, Dr. Jin said.
Share what you’ve learned
Communication among health systems and physicians about their efforts to tackle burnout will also help move the needle on such a complex problem, noted Dr. Batson.
“We are all tackling similar problems and we're learning from each other,” he said. “And in your unique approaches, we can learn from you and hopefully people will share their successes and even failures so that we don't repeat those as we tackle these very, very important issues.”
