Why include articles about clinician burnout in the Patient Deterioration & Sepsis category of our web site? Clinicians we've interviewed learn to trust the "gestalt" or "spidey sense" of their personal intuition. The combined intensity and heightened awareness required to detect sepsis-related indicators may suffer in the onset of burnout. It's worth exploring.
It’s common knowledge that doctors work long hours. From late nights studying in medical school to the 28-hour shifts many young doctors experience during residency, physicians are conditioned to push their bodies and minds to the extreme in pursuit of a noble goal – making patients better. What if, however, those very patients are adversely affecting their doctor’s well-being?
The U.S. is facing what has been called a severe and growing epidemic of physician burnout, with nearly half of all clinicians reporting feelings of exhaustion, depression, depersonalization and failure. The epidemic threatens to affect not only the health of physicians but that of patients as well, since tired and overworked doctors are inherently less engaged and more prone to mistakes. In fact, a recent Stanford study found that burnout influences quality of care, patient safety and patient satisfaction – and that medical errors double among physicians suffering from the syndrome. With over 1.1 million physicians in the U.S. and a rapidly growing pool of patients, physician burnout is everyone’s issue.
How did we get here and what can be done to reduce the burden placed on physicians?
What’s Causing The Physician Burnout Epidemic?
While “physician burnout” is the term most commonly used to describe the epidemic, it’s important to note that it’s not just doctors who are affected. Nurses, physician assistants and even office staff also report feeling burned out at above-average rates. When asked to identify the causes, more than half of healthcare professionals cite mounting bureaucratic or administrative tasks, followed by long hours at work, lack of respect, increased computerization at their practice and insufficient compensation.
While the reasons for physician burnout are complex and nuanced, the burden of menial tasks and increased documentation plays a big role, cutting into physicians’ quality time with patients – not to mention their nights and weekends. In fact, one study found that for every hour spent with patients, physicians spend an average of two hours on paperwork in electronic health record (EHR) systems – and this is even longer in specialties like general surgery, urology, and cardiology.
“Before switching to our current EHR system, it wasn’t uncommon for me to spend three or four hours charting at home after a long day at the office,” says Dr. Renee Walker, D.O., FAOCO, of Joplin Ear, Nose & Throat. “I always felt like I was close to burning out.”
The documentation clinicians must complete is far more than just clinical notes – it includes medical necessity clauses, quality measures for Merit-Based Incentive Programs (MIPS) and billing codes for services delivered. According to Modern Healthcare, the Centers for Medicare and Medicaid Services (CMS) release around 11,000 pages – or 58 new rules – each year containing new reporting requirements and billing codes. These regulations are in pursuit of value-based care initiatives — the transformation of healthcare from traditional fee-for-service payment models to fee for quality. For physicians, this means that reporting on care quality is directly tied to salary — and accurate, comprehensive documentation can mean the difference between full or partial reimbursement for physicians from insurers. With many doctors today living paycheck-to-paycheck, getting it right is not only a medical necessity, it’s a financial one as well.
Imagine trying to stay up-to-date on new clinical best practices and therapies for your patients, while also deciphering thousands of pages of legalese to get paid for your hard work. It’s a daunting task for anyone and nearly impossible for someone who is already overworked and burned out.
The Solution Everyone Loves to Hate
Over the past decade, the majority of healthcare practices have digitized their patient medical records to comply with the Obama administration’s Health Information Technology for Economic and Clinical Health (HITECH) act. Since that time, a refrain not uncommon in the medical world is that doctors “hate computers and technology.”
This couldn’t be farther from the truth. Physicians don’t hate technology – they have smartphones, fitness trackers and tablets just like everyone else – what they hate is bad technology.
The digital revolution has spurred dramatic increases in productivity and efficiency across countless industries, but the healthcare space remains oddly separate from much of this positive change. There’s no doubt, however, electronic health records have the potential to offer many advantages – they provide a centralized location for patient information, enable electronic prescriptions, increase patient access to their own health information and much more. The benefits are simply too numerous to cite them all. However, if EHRs are making a physician’s job harder instead of easier, they haven’t been designed to realize their full potential.
Many EHRs today face two major issues: lack of understanding of the varying needs of different healthcare practices and an inability to share patient data across systems.
According to the Electronic Health Record Association (EHRA), “While EHRs are often mentioned as a prime culprit in news reports of physician burnout, it is our experience that clinicians’ frustrations with EHRs are often less about the technology and more about using it not simply for patient care but to fulfill regulation-driven documentation requirements.”
Think about the last time you visited your primary care physician (PCP). You likely checked in at the front desk, completed a form documenting any changes in your medical history, had your vitals taken by a nurse and then saw your primary care doctor. Now, consider what happens if you were to visit Dr. Walker’s practice for an ear, nose and throat (ENT) appointment. Dr. Walker will ask very different questions than your PCP, record different medical information, and the billing codes and quality measures she’ll report on are completely different as well. If these questions, input fields and billing codes aren’t readily available on her EHR, physicians like Dr. Walker spend hours completing medical records post patient visit. Think about it this way: With physicians seeing an average of about 93 patients each week, if it takes just five extra minutes to complete a medical record, that’s nearly eight hours of extra work.
An ENT doctor using an EHR designed for a primary care physician would be akin to a server at a restaurant attempting to place a food order on a system meant for retail applications. Screens and questions might be out of order and fields for documenting patient responses may be missing or require shorthand when a symptom or billing code isn’t available from a pre-created list.
When we attempt to create a “one-size-fits-all” solution and shoe-horn it into all aspects of healthcare, the result is an EHR system that puts “paperwork” first and foremost, not the needs of the physician and patient. However, if we think beyond the confines of an 8.5×11” piece of paper, we can unlock true technological innovation that not only does no harm, but actually improves healthcare for patients and physicians alike.
Do No Harm: Putting The Patient – And Physician – First
The electronic health record market is expected to reach $38.3 billion by 2025, and a single implementation in a hospital setting can cost a billion dollars. However, despite these high costs, physicians still face a severe digital downgrade when they step into the office. In our personal lives, we benefit from the digital revolution every day with solutions ranging from Amazon’s new grocery shopping experience to ride hailing services like Uber and Lyft, yet the medtech industry remains behind. By focusing on the clinician experience and leveraging modern-day innovations like cloud technology and machine learning, we can create solutions that provide physicians with the tools they need to provide exceptional care — without burning out.
We’re all patients at some point in our lives, so understanding the challenges our physicians face (aside from practicing medicine) may give you a different perspective on your next visit.
Cloud-based and user-friendly EHRs that are cost-effective and designed specifically for the physician’s specialty are the path forward, as opposed to complex, expensive one-size fits all systems. These solutions should be self service, allowing physicians to make updates and changes themselves without the need to involve IT support. Adding in straightforward innovations like the ability to electronically message colleagues and patients and 24/7 access to patient records can go a long way toward improving the physician experience — and ultimately improving patient care.
When we get the basics like this right, there’s room for true innovation in technology to make doctors more efficient and improve patient care. The future of healthcare technology is a secure, interconnected, user-friendly and easily accessible record of each patient’s health data that can be shared across hospitals and state lines – and with patients themselves. Using intelligent algorithms, physicians will be able to tap into a vast pool of data and use precision medicine to prescribe treatment plans based on what’s worked for patients with similar symptoms and medical conditions – and even similar genes. Health records will be linked to a patient’s insurance so physicians can inform patients about anticipated costs at the point of care. Researchers will be able to use deidentified patient data to identify best practices for care delivery and discover new uses for medications.
This bright future isn’t so far away. In fact, for some physicians and their patients, we’re already able to do much of this. EHR records can be so much more than just paper on a screen. If implemented correctly, they can not only reduce physician burnout but provide previously unavailable insights into treatment options and care for the entire population.