Daily Grind

Physician Burnout – The Good, the Bad, and the Hope

This is a guest post by Dr Kathleen Rokavec.

I started my medical practice in 1997 in a small town in rural Pennsylvania. In the fall, the Friday night football games were a big event and if I wasn’t on the sidelines as the team doctor, I was in the stands rooting for the home team. There were no smart phones, or even cell phones back then. If the hospital or a patient needed to contact me, the answering service sent an alert to my pager, I had to walk across the parking lot to the only pay phone within 3 miles and hope that no one else was using it. I had no access to patient information so I had to quickly gather as much information as I could in order to make decisions about patients I may have never seen before. While the walk to the payphone took time and was not ideal, the pager and the payphone were the tools of the day. They were simple tools, easy to use and understand, but not very convenient.

The smartphone, with instant access to patient information wherever we go, has given us some freedom. But the access to massive amounts of information at our fingertips can be overwhelming. At the same time technology has introduced a barrier between the physician and the patient. The promise of a system that would improve my efficiency and quality of care has instead become a burden and is a significant contributing factor in physician burnout. Burnout has been defined as a combination of emotional exhaustion, depersonalization, and a low sense of accomplishment. I know it well.

My first encounter with burnout was at that rural Pennsylvania hospital where I had a busy family practice caring for my patients in the office and the hospital. I also delivered babies and cared for newborns in the nursery. I took care of my elderly and chronically ill patients in the 2 local nursing homes. I helped out in surgery because there was a shortage of doctors to assist. I was on call every 3 nights, answering patient phone calls, admitting patients from the Emergency Department, and covering all of those patients in the hospital. I loved my work, but it was the emotional exhaustion that finally made me walk into the CEO’s office one day and beg him to find coverage for me. I needed to get away. Three days later I was on a sailboat in the Penobscot Bay with no electricity, no internet, and no phone.

According to a recent study, physicians spend 16 minutes per encounter doing EHR work. Imagine having that extra 16 minutes to spend with each patient! A Mayo Clinic study found that the “strongest predictor of physician burnout was how much time an individual spent tied up doing computer work.” With the increasing administrative burden, regulatory requirements, and loss of control, physicians are at a greater risk of burnout than ever before, leading to doctors leaving the practice of medicine and higher suicide rates than any other profession.

Not only does physician burnout take a toll on the health and well-being of the individual, there is a financial cost as well. A 2019 article in the Annals of Internal Medicine (Shasha Han, et al., 2019) reported that the “annual economic cost associated with burnout related to turnover and reduced clinical hours is approximately $7600 per employed physician each year.” That adds up to approximately $4.6 billion annually in costs related to physician burnout.

To make matters worse the profession now has to deal with an unprecedented (in our lifetime) global pandemic. COVID is fanning the flames of provider burnout. While many providers saw a dramatic drop in patient volume, they also are dealing with a drop in revenue and a dramatic shift in how care is provided. Hospital-based providers are facing increased volumes, sicker patients, unknown treatment guidelines, and risks to their own health and that of their families. The social isolation only makes the situation worse.

Earlier this year the ONC unveiled its new plan to combat clinician burnout[1]. The report identified four problem areas:

  • Clinical documentation
  • Health IT usability
  • Federal health IT and EHR reporting requirements
  • Public health reporting, including coordination with prescription drug reporting requirements and electronic prescribing of controlled substances.

The 72-page plan describes the challenges of the current healthcare IT environment and presents recommendations for the best next steps that address the growing problem of clinician burnout. Despite the ongoing frustrations and burdens physicians face, there is hope in the ability of advancing technology to improve the physician-patient experience and athena is uniquely positioned to lead the industry in this effort.

In addition to working with regulatory and governmental agencies, we need to work with the clinical specialty societies, medical professional boards, and the clinicians themselves to make sure the EHR serves as a tool to help in patient care and compliance with clinical guidelines instead of just for billing and reporting purposes.

In an age when I can quickly and effortlessly ask a device on the kitchen counter to play my favorite song while I am making dinner, shouldn’t I be able to ask my computer to tell me the results of the patient’s last stress test while I am evaluating and treating his chest pain?

Dr Rokavec also blogs at tastefullyunrefined.com

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