Almost everyone appreciates having autonomy at work. But when physicians spend more than a decade in high-stakes and grueling medical training, only to enter practice with virtually no control over their work environment, schedule or day, it can lead to the kind of spiraling frustration that often turns into burnout or leaving the profession entirely.
“It’s one of those things where the more you try to micromanage a physician’s schedule, the more a feeling of distrust you give to the physicians. It'll backfire, if you as a physician sense that your organization doesn't trust you,” said Jill Jin, MD, MPH, an internist and senior physician adviser for the AMA, one of the authors of the AMA STEPS Forward® “Value of Feeling Valued Playbook.”
Physician burnout remains a pernicious issue in the U.S. Though the percentages of those experiencing burnout have declined from the peak during the COVID-19 public health emergency, 43.2% of physicians still say they have at least one symptom of burnout.
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™.
When physicians feel valued—not just as providers of patient care or as deliverers of services for their employers, but as competent professionals who have devoted immense time and energy to becoming experts at their jobs—it is proven to be positively associated with lower levels of burnout.
The feeling valued playbook makes the case for showing physicians they’re valued and then lays out five strategies for doing just that. The first strategy covers how to provide physicians with the kind of autonomy and flexibility that helps them thrive in demanding roles.
Start with autonomy
Some of the areas in which physician input is valuable include the schedule template design, flexibility in daily or weekly work hours, an ability to work from home when doing telehealth, and panel size optimization, among other issues. It’s also crucial to compensate physicians for the time they spend doing administrative tasks and panel management.
That’s not to say that achieving work/life balance in schedule optimization is an easy task.
“One of the challenges is that, of course, individual physicians will want as much autonomy and flexibility as possible, and from a practical standpoint, that's not realistic. The clinic needs to stay open a certain number of hours. The hospital needs to be open 24/7,” Dr. Jin said. “So, we can't give complete autonomy to the physician, but at the same time, giving little bits of choice when it makes sense to do so makes a huge difference.”
Through it all, communication is key. Practicing physicians, practice managers and operations staff, said Dr. Jin, should all be involved in template design or changes.
“Having them talk to each other can make a huge difference,” she said. “There is usually a solution that can be found that will work for everyone.”
Clear strategies are needed
Physicians need some input on their schedule—whether by letting them choose how to incorporate telehealth or by giving them the ability to put holds on appointment slots without an approval process—and to collaborate on discussions about clinic start and end times, and choose their appointment length templates.
There should also be a way to provide same-day access for urgent appointments, with reserved slots based on objective metrics such as no-show rates, fill rates and the number of urgent visits per week.
As for vacation and paid time off (PTO), schedules should be opened at least 13 to 18 months in advance, and vacation time should be proactively blocked off with the option of later changes. These are strategies that encourage both schedule flexibility and physicians taking the full amount of PTO to which they’re entitled.
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Make panel size work for physicians
It’s also important to “right-size” the patient panel. Though it may be tempting for practices to take on as many patients as possible, over-paneling can contribute to physician burnout and dissatisfaction. Not only does it affect the quality of patient care, but physicians will be frustrated when they’re not able to see their established patients when an urgent issue arises. Ultimately, the practice’s overall environment is threatened, as well.
“In many ways those same goals of continuity and seeing their own patients and having enough access for their own patients, which is accomplished by having physicians having their own control over the schedule, are also shared by the practice,” Dr. Jin said. “The practice also wants to see their own patients, and the practice also wants continuity of care.”
Factors that influence a practice’s panel size capacity include:
- Composition of the extended care team.
- How many nurses or medical assistants are on the team.
- Skill level of the other team members.
- Whether the team is working together as a core unit each day.
- Local regulations for team-based care.
- Degree of local practice autonomy.
All should be weighed before determining the appropriate patient panel size for a physician and practice.
It’s also important to allow physicians who are new to the organization time to ramp up—ideally at least three to six months—before giving them a full patient schedule. Physicians newly out of training should be given even more time to shadow colleagues, get training on the EHR and familiarize themselves with the rest of the team.
“That is how organizations can show physicians that they are valued even before their first day seeing patients. Building that trust from the beginning is very important,” Dr. Jin said.
AMA STEPS Forward® open-access toolkits and playbooks offer innovative strategies that allow physicians and their staff to thrive in the new health care environment. These resources can help you prevent burnout, create the organizational foundation for joy in medicine and improve practice efficiency.
