When a physician asks about a mysterious, onerous or downright nonsensical task and is told that it’s due to “a regulatory requirement,” experts say that should be the beginning—not the end—of the conversation.
Even compliance officials can be surprised at the results of digging into such cases, Kevin Hopkins, MD, a family physician and senior physician adviser at the AMA, said during an AMA Insight Network meeting with Suja Mathew, MD, executive vice president and chief clinical officer of the Atlantic Health System in New Jersey, about reducing regulatory burdens.
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“It really is a good idea to take a step back and take a long, hard look at what we do each and every day due to regulatory compliance requirements,” he said, noting that one study found “an estimated 78% of the things that patients and physicians identified as low-value work were within the full control of health care executives to change and weren't actually regulatory requirements.”
Upon examination of some of these tasks, it may become clear that they’re unnecessary, said Dr. Hopkins. “Policies and procedures that our organizations develop, usually in order to keep us compliant with some actual regulatory requirement, oftentimes they're actually overinterpreting those regulatory requirements, or our own internal policies and procedures end up being more restrictive than necessary.”
Dr. Hopkins went on to note that health care is one of the most regulated industries in the U.S., with oversight from bodies including the federal government at the macro level to each individual physician’s health system at the micro level. Inefficiency and overwork can easily result from such a complex network of ever-changing rules.
“We continue to see a lot of physicians and other health care workers on that continuum of fatigue to exhaustion to burnout, and a big part of that really has to do with … the untenable workload,” he said, adding that “regulatory burden is a piece of that puzzle.”
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™.
Make the business case for change
The first step, Dr. Hopkins said, is to explain to decision-makers how inefficiency and overwork impact not only the well-being of physicians and other health professionals but also the bottom line. Physician turnover, directly related to burnout—which in turn is related to overwork—is expensive.
“For every physician who gets to that point and leaves their job, the cost to the organization is between a half a million and $2 million, depending on the specialty,” he said, adding that research from 2019 shows that “burnout costs $4.6 billion per year to health care organizations—and that only accounts for the cost of the actual turnover and decreased clinical hours.”
But it’s not just turnover that’s at issue, said Dr. Hopkins, who is also vice chief of the Cleveland Clinic Primary Care Institute.
He said that at the Cleveland Clinic physicians have long been required to use dual-factor authentication for ambulatory orders on even noncontrolled medications in the EHR, which affected 11 million orders annually. When they questioned the practice, they were told it was a regulatory requirement. After some digging, however, they discovered that the rule had sunset in 2021.
“Even though it doesn't take very long to retype in your password, it added up to 12,376 physician hours over the course of a year, which has an indirect cost of $2.25 million for that amount of time,” he said. “You think, ‘Every second I'm spending doing this, I can't do something else.’ And so that time has real cost associated with it.”
The AMA STEPS Forward® “Reducing Regulatory Burden Playbook” gives physicians the knowledge and resources to help alleviate these burdens and advocate changes in their health systems. The playbook also clarifies often misunderstood and overinterpreted regulations and offers strategies to cut administrative burdens that lead to additional work, excessive documentation, an increased cognitive burden and dysfunction within the health care team.
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Keep communication flowing
Once it’s understood that regulatory burden is on the table, the process should continue with the organization asking itself, “What can we stop doing?”
He acknowledged, however, that it’s “something that we are not very good at in medicine. We just add on to a plate that's already overflowing.”
And Dr. Mathew said that too often, hearing that a task is due to a regulatory requirement ends the conversation.
“Usually that response, ‘It's a regulation’—whether it's meant to or not—what it does is silence the person who's asked the question and absolutely we don't go further. We just assume that, in fact, that's true,” she said.
Dr. Hopkins agreed that the next step should be investigation. He said one good follow-up is, “‘Well, can you please show me that regulatory requirement and where it comes from?’ And to ask it in a way that's not confrontational, as if you're doubting someone's integrity ... But oftentimes we find out that there actually isn't a regulatory requirement when we dig into it.”
He said there’s also a balance to be struck between following a regulation and applying an overly strict interpretation.
“I think of it like putting a governor on an engine. We don't want to go so fast in our work that we cause harm to patients or significant patient safety issues because we're not taking the time to do it properly. And yet we can set the governor too low and so move so slowly that it impairs our efficiency to get anything done and deliver the care that our patients need, want and deserve,” he said.
Ultimately, he said, health care systems must tackle regulations if they are to deal with the problem of physician burnout. The cost of inefficiency and overwork is too great to ignore.
“It literally sometimes feels like death by a thousand paper cuts, right?” he said. “So, the one way to stop that process is to stop the paper cuts.”
Learn more with the “AMA Debunking Medical Practice Regulatory Myths Learning Series,” which is available on AMA Ed Hub™ and provides regulatory clarification to physicians and their care teams. For each topic completed, a physician can receive CME for a maximum of 0.25 AMA PRA Category 1 Credit™.
Physicians are encouraged to submit questions or ideas they have about potential regulatory myths. The AMA’s experts will research the matter. If the concern turns out to be a bona fide regulation that unnecessarily burdens physicians and their teams, the AMA can advocate for regulatory change.
