Physician burnout — the long-term, cumulative stress and depersonalization that doctors experience amid growing burdens in the practice of medicine — continues to pose a major threat to a healthcare industry that remains in dire need of clinical leaders.
Even before the COVID-19 pandemic, the awareness and study of burnout grew so rapidly that it spurred new descriptions. In 2018, the National Academy of Medicine (NAM) proclaimed that it was an “epidemic.”
The most common alternative, perhaps, is “moral injury” — a phrase that many suggest accurately reframes the issue to not be about a problem with an individual. Rather, moral injury “describes the challenge of simultaneously knowing what care patients need but being unable to provide it due to constraints” beyond a doctor’s control — systemic issues that can impact all doctors.
Whatever you choose to call it, successive studies and surveys all point to these factors prompting more physicians to leave their jobs and, in some cases, the profession entirely before their planned retirement. Earlier this year, a study published in Mayo Clinic Proceedings estimated that primary care physician turnover, fueled partially by burnout, leads to nearly $1 billion in excess healthcare spending each year.
An Aug. 23, 2022, MGMA Stat poll found that 40% of medical groups reported that a physician had retired early or left the organization due to burnout this year, while 57% did not and another 3% were unsure. The poll had 602 applicable responses.
These results come almost a year after a similar MGMA Stat poll found that one in three (33%) of medical practices had physicians retire early or leave due to burnout in 2021 — a rate that grew from 28% in a March 2, 2021, MGMA Stat poll that asked about physicians retiring unexpectedly from the organization.
Despite the pervasive awareness of physician burnout and the business imperative to mitigate its contributing factors, efforts across the industry vary. In a May 11, 2021, MGMA Stat poll, nearly nine in 10 (86%) healthcare leaders reported that they did not have a formal plan or strategy to reduce physician burnout.
However, the latest poll shows that more organizations are starting to formalize their efforts as opposed to simply “planning to have a plan.” Among medical group leaders responding to the Aug. 23 poll, more than one in three (34%) said they have a formal plan or program to address physician burnout, compared to 66% who did not. Some of the top efforts that practice leaders shared with MGMA were:
- Addition of scribes to aid with documentation
- Ongoing recruitment of new physicians to address panel sizes and improve call coverage
- Efforts to address disruptive or violent patient behavior
- Regular check-ins with physicians and ensuring they get adequate leave time or formal sabbatical periods
- New wellness initiatives, EAP availability, malpractice carrier-provided resources, and app-based programs to help improve work-life balance
- Increased flexibility in employment packages
- Improvements to EHR workflows to minimize administrative burdens for physicians.
One particular resource touted by one medical practice leader is the Well-Being Toolkit and Happiness Strategies from the Duke Center for Healthcare Safety and Quality, which is designed to help healthcare leaders to develop champions for well-being in their organizations.
How much is the EHR to blame?
At the time, that poll noted that many healthcare leaders had informal efforts and discussions to monitor and address burnout among physician and staff, while others looked specifically at the issue of their organizations’ EHRs and investing in adding functionalities specific to their specialties to make them more intuitive and less cumbersome for physicians and other clinicians to use.
Studies prior to COVID-19 also link higher levels of clinician burnout to dissatisfaction with the EHRs they use: A 2019 study published in Mayo Clinic Proceedings showed a strong relationship between the odds of burnout and EHR usability — and the usability of EHR systems at the time received an “F” grade from physician users.
A recent American Medical Association (AMA) playbook for saving time within a physician practice highlights the ongoing need to eliminate “stupid stuff” from the workflows of physicians and others, based on a program from Hawaii Pacific Health that highlighted more than 300 time-wasting EHR activities that could be removed.
Strategies for acknowledging and mitigating burnout
The May 2022 MGMA Executive Session podcast provided insights into properly framing the burnout issue from two physician experts:
- Michael Nochomovitz, MD, chief clinical partnerships officer, Devoted Health, and previously senior vice president and chief clinical integration and network development officer, New York-Presbyterian
- Jessica Dudley, MD, chief clinical officer, Press Ganey, and former chief medical officer at Brigham and Women’s Hospital in Boston, where she was responsible for teaching development and oversight of physician-led efforts to improve the quality and efficiency of healthcare.
“Although it’s hard to see it as a silver lining of the pandemic, there’s now a real awareness of the challenges facing recruiting and retaining physicians and creating the opportunities for them to be professionally fulfilled and live up to their own expectations of why they chose a career in medicine,” Dudley said.
Dudley framed the issue of physician burnout with three main contributing factors:
- The doability of the job: “Administrative burdens or regulatory requirements being piled on doctors ultimately gets in the way of them … taking care of patients.”
- Embracing team-based care: “Medicine initially was a very individual type of practice,” but that has evolved in recent decades, and organizations that have not invested or developed the support and infrastructure for physicians are struggling. “You really run better as a team.”
- The burdens of perfectionism: Physicians are “wired” to strive for perfection, “which ultimately means sacrificing our own well-being to take care of those around us,” Dudley said.
Nochomovitz agreed with these key components of the growing burdens of stress and burnout, adding that the emergence of physicians’ duties with EHRs being “one of the biggest dissatisfiers” for the profession. EHRs added a lot of “pajama time” documenting in patient records after regular work hours, which diminished physicians’ sense of professionalism due to a loss of independence and added complications to doctor-patient relationships as physicians spent more time in the EHR compared to patient-facing clinical time. All these issues were then compounded by the stresses of the pandemic, Nochomovitz said.
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