As a multispecialty practice that is physician-owned and governed, Hattiesburg Clinic gets the best of both worlds—the benefits of a large health system and private practice. This has likely contributed to the organization’s outstanding performance on measures of physician burnout, job satisfaction and stress. Yet Hattiesburg Clinic has still more to accomplish on its well-being journey.
After completing the AMA Organizational Biopsy® (PDF), 84.6% of Hattiesburg Clinic physicians reported feeling satisfied with their job, which is 15.6 percentage points higher than the national benchmark of 69%. On top of that, 48.2% of physicians have reported job-related stress, compared with 55% nationwide.
Hattiesburg Clinic has more than 450 physicians and non-physician providers located in 17 counties in South Mississippi. For the Organizational Biopsy, there were 110 respondents with most coming from family medicine. The AMA benchmarking report—which is exclusive data to the AMA that is not published anywhere else—reflects 2022 trends in six key performance indicators—job satisfaction, job stress, burnout, intent to leave an organization, feeling valued by an organization and total hours spent per week on work-related activities (known as “time spend”).
The purpose of the aggregated data is to provide a national summary of organizational well-being and to serve as a comparison for other health care organizations. The results may be limited by the health systems that chose to participate.
Meanwhile, just 36.4% of physicians at Hattiesburg Clinic reported feeling some level of burnout, far below the 53% benchmark rate of doctor burnout across the nation. And 21.9% reported plans to leave the organization within two years, which is 15.1 percentage points lower than the national benchmark on “intent to leave.”
Those impressive figures cannot be attributed to Hattiesburg Clinic physicians’ taking on lower workloads, said internist Rebecca Lauderdale, MD.
In terms of workload and relative value units (RVUs), “we’re high volume across our organization. It’s not that there’s not as much work to do or that the workload is lower. It’s that physicians get to participate in designing their work and in organizing their work the way that they want it to be within constraints,” said Dr. Lauderdale, who is the physician well-being champion at Hattiesburg Clinic, which is a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
In a physician-owned and governed organization such as Hattiesburg Clinic, it may be harder for doctors “to admit to having any sort of stress or difficulty because they know they’re talking to somebody else who does similar work,” Dr. Lauderdale said.
Nevertheless, Hattiesburg Clinic physicians “are talking about these things more frankly and explicitly than we ever did before over the past few years,” she added. “I hope that that’s made a difference. I know that I feel like people are more likely to spontaneously talk about the difficulties that they have or just the everyday stresses and support each other.”
Drawing on insights gathered from the AMA Organizational Biopsy, read on to learn how Hattiesburg Clinic is working to further improve the well-being of its physicians.
Reducing physician burnout is a critical component of the AMA Recovery Plan for America’s Physicians.
Far too many American physicians experience burnout. That's why the AMA develops resources that prioritize well-being and highlight workflow changes so physicians can focus on what matters—patient care.
Support from the AMA
“Being involved with the team that we worked with at the AMA was great because they’ve been so supportive to us,” Dr. Lauderdale said. “The AMA helped us with understanding our data when we sat down and talked about the data after we gathered it,” Dr. Lauderdale said. “From those insights that we got, we recognized that our early career physicians needed help and we wouldn’t have known that in any other way.”
“We also wouldn’t have known that physicians really want to spend time with each other. They want opportunities for that, so we invested in that,” she said, noting a fun group outing to the zoo that drew nearly 3,000 physicians, staff and family members. “We want to do more things like that and also do some things that are just physician-focused. ... But we wouldn’t have jumped on those things had we not had that confirmation that that’s really what’s important for everybody,” she added, noting “it may end up having a ripple effect throughout the whole organization in a really positive way.”
The AMA team also met with Dr. Lauderdale to answer questions about the AMA Joy in Medicine™ Health System Recognition Program and confirm Hattiesburg Clinic’s eligibility to apply. Hattiesburg Clinic is planning to apply for the Joy in Medicine Health System Recognition Program for 2024.
Guidance for younger physicians
“With our Organizational Biopsy that we did … one of the things that we found was that our early career physicians had the highest rates of burnout in the organization,” Dr. Lauderdale said, noting “they were 10 percentage points higher than the average and we really set out to understand that better.”
For physicians who were one to five years out of residency or fellowship training, 48% reported symptoms of burnout compared with 23% of those with 16–20 years in practice. On top of that, 72% of younger physicians reported feeling satisfied with their current job. All the other physician cohorts had higher levels of job satisfaction that even exceeded the overall rate among Hattiesburg Clinic doctors.
But 52% of these early career physicians did feel valued by their organization, which is higher than the overall rate at Hattiesburg Clinic and much higher than those 11–15 years out of training, of whom only 29% reported feeling valued.
“One of the things that we could do better—and that we are actively tackling—is making sure that as we have new physicians join, that they understand that they do have autonomy,” Dr. Lauderdale said. “I don’t know anyone who was trained in a residency environment that taught them to take charge and design their own work.
“So many people enter from the standpoint of being a student, being a trainee and then they come to us and are likely to do whatever the people around them are doing,” Dr. Lauderdale added. “Knowing that they have options, that they can innovate and helping them with their imagination is the biggest thing that we can do. And getting them more information.”
Onboarding academy
To help younger physicians, Hattiesburg Clinic launched an onboarding academy in 2021. A cohort of physicians who are new to the practice attend meetings once a month for a year on a rolling basis. Each meeting focuses on a different topic, ranging from resilience and burnout to the operational structure of the organization and finances.
“That has made a big difference in their ability to understand the organization from the beginning instead of feeling later on like they’re not really sure who to talk to about certain questions or things that they need help with,” Dr. Lauderdale explained, “We’re getting better and better at that.”
More social opportunities
One area of well-being that could use further improvement, though, is physicians’ reported sense of feeling valued. At Hattiesburg Clinic, 45.5% of physician respondents reported feeling valued by their organization—about the same as the national benchmark level of 45%.
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“Our early career physicians actually said they felt valued even though they were the ones with the most burnout,” Dr. Lauderdale said, speculating that onboarding academy and other efforts have positively affected this metric among younger doctors. “As we go forward,” she said, the plan is to incorporate similar activities with other physician cohorts.
“When we asked them about what the top three things that we can do to improve your well-being are, the very top answer was more social activities with other physicians. And then under that was they wanted a place to exercise, which—that one surprised me,” Dr. Lauderdale said. “We did a series of physician-engagement groups back before the pandemic. We did a couple rounds where we had physicians sign up and join a group that met for a few months together once a month at a restaurant and the organization paid for the meal.”
“They had a topic to discuss that had to do with well-being in some way. And those were really well received, but the pandemic shut that down. We tried to do it virtually, but everybody was so Zoomed out that our attendance and interest in that went away,” she said, noting they are thinking about how to have dinners again where everyone is invited to “talk with each other about how they can be better partners to each other.”
EHR coaching
When it comes to time spent in the EHR, 39.1% reported spending more than four outside of work on such clerical duties. Meanwhile, 60.9% reported spending four hours or less on the EHR outside of their normal scheduled work time.
To reduce time spent in the EHR outside of work, “every month, every physician manager gets a report from Epic on your utilization, your efficiency, compared to your organization and then compared to nationwide to other organizations,” Dr. Lauderdale said. “And it has to do with how many hours you are spending outside of scheduled time with patients.”
Hattiesburg Clinic CEO Bryan Batson, MD, “is our real Epic expert,” Dr. Lauderdale noted, and the organization’s assistant chief medical information officer also “is available to help anyone who has a report that is not what they want it to be.” Both are “available to coach” physicians to streamline their time in the EHR.
“Our whole Epic team does that,” she said.
Unfortunately, even when physicians feel as though they have the hang of efficiently using the EHR, big updates come along that seem to change its whole look and feel.
Prior to such updates, Hattiesburg Clinic hosts an “Epic Happy Hour.” In one big room, they set up lots of workstations and the organization’s entire Epic team was on hand.
“We had wine, cheese, hors d'oeuvres and invited physicians to come and play with it before it actually goes live,” Dr. Lauderdale said, noting “we had a checklist for them to go through. We had door prizes. We did everything we could to attract them to actually show up.”
“Both times we have done this we have had really good attendance,” she said. Future events tied to help physicians master specific EHR skills such as templating are in the works.
“We’re going to look at the people who have the best utilization and see if we can’t spread that knowledge around.”
Focus on physician leadership
“One of the funny characteristics of being a physician-owned and governed organization that has grown dramatically over the past 20 years is that we felt like this small family, but we’ve grown to being really big and we sometimes don’t realize how big we really are,” Dr. Lauderdale said.
“And there has not been a big focus on developing leaders to help serve this large number of physicians that we have,” she added.
“Our next frontier is: How do we develop that in a way that’s meaningful for our physicians, given that we’re structured a little bit differently? And what’s that going to look like for us?” Dr. Lauderdale said.
“It’s exciting.”
