The pressures on physicians today are different than they were even a decade ago. Physician burnout is a serious problem with potentially catastrophic results. New Hampshire Public Radio spotlighted this problem last month. Here are some of the takeaways from that program:
What is Burnout?
Burnout is more than having a tough day or week and needing to recover over the weekend. It’s a feeling of being totally emotionally exhausted and depleted, feeling cynical about your work and feeling like your job has no meaning. It’s usually a result of chronic, long-term stress. For many doctors, burnout comes with the job.
According to the Mayo Clinic Proceedings, more than half of physicians expressed feeling burned out – and that number continues to rise.
The Mayo Clinic reports that, “The organizational impact of physician burnout can include lower productivity, staff turnover, decreased quality of care and malpractice suits. For the individual physician, burnout can lead to broken relationships, alcoholism and suicide.”
Physician Burnout Culprits
Clearly, this is a serious issue affecting far too many physicians. But what is to blame?
Tanja Vanderlinde, an internist at Concord Hospital, said there are a couple factors at play. First, it’s the volume of work physicians are expected to do. They are pressured to see more patients in less time, and still make sure the patients feel valued. And second, it’s the work doctors are expected to do after they leave the office.
Surprisingly, the Electronic Health Record (EHR) movement is a component of this after-hours work. Electronic medical records were supposed to make physicians’ lives easier, and make patients’ information more accessible. But what has resulted is an ever-growing series of questions that could easily be marked down incorrectly.
Steve Del Giudice, a retired dermatologist and stress reduction trainer for medical professionals, called this extra work “pajama time,” meaning a doctor gets home, eats dinner with the family, puts on pajamas, and spends another few hours in front of the computer, inputting information.
Not all doctors have to fill out these records themselves. Nurses or nursing assistants may also click the boxes. But with dozens of boxes to click, making a mistake is very easy to do. Ultimately, the physician is usually held responsible for those medical record mistakes.
As Del Giudice says, “The medical record was not designed by physicians. It was designed as a billing instrument. So it’s not really friendly toward practicing medical providers.”
Finding Solutions – Systemic
Surveys have proven that physician burnout is a real and rampant issue. What’s being done about it?
There are two fronts to fight: systemic, and individual.
Here are some of the systemic solutions:
–A focus on team-based care. This would include taking some of the work off the doctor’s desk, like using a scribe to do documentation. According to Vanderlinde, one doctor who tried this method reported enjoying his work more and having more time to assist medical assistants.
The downfall to a team-based approach is that it costs money to bring on more personnel, and in order to hit those numbers, doctors may need to see more patients. It is a vicious circle.
-Another approach comes from the insurance companies, who tend to be the ones requiring that more and more boxes get checked on the EHR. Some are cutting down their required fields to just 22, which is a huge decrease from the 120 or so fields that doctors are dealing with.
-Some doctors are trying out different pay models. For example, family medicine doctor Eric Kropp established a direct-care practice where patients pay a flat monthly fee for his services. He says this model allows doctors to take care of fewer patients, which allows for a better quality of care.
-Using a functional dictation program, to allow doctors to speak the health record answers while still working with the patient.
Finding Solutions – Individual
Burnout has to be addressed at an individual level, too. Those solutions include:
–Stress reduction techniques to boost resilience under pressure.
–Personal care, like getting enough exercise, quality sleep, eating well, spending time with family, etc.
–Getting extra help by delegating. From a financial standpoint, many financial advisors are beginning to charge monthly rates like I do. Managing your finances takes time, so working with an advisor on an ongoing basis means your money is being consistently attended to.
Changes have to happen at both levels to see true results, so it’s important that organizations do what they can to combat this burnout.
“Healthcare is a giving industry,” Del Giudice said. “When you’re giving all day, you become depleted. A patient can never have a positive experience unless the physician is also having a positive experience.”