SAN FRANCISCO (Calif.) – How do you take care of those whose life’s work is to take care of others? “Physician, heal thyself” is an increasingly challenging objective to achieve for the more than 50% of American clinicians who report symptoms of burnout. Emotional exhaustion, depersonalization, depression and feelings of helplessness burden the care providers staffing primary and specialty clinics nationwide.
To uncover key factors comprising physician burnout in the U.S., researchers at Sutter’s Center for Health Systems Research (CHSR) analyzed electronic health record (EHR)-related work performed by clinicians in a Northern California-based multispecialty practice. Results of the observational study were published in the July issue of Health Affairs.
Ellis Dillon, PhD
“Given the correlation between physician workload and desktop medicine, and the rising number of physicians who report burnout, it is important to carefully examine the relationship between pivotal aspects of desktop medicine and physicians’ well-being,” says Ellis Dillon, PhD, assistant scientist at CHSR’s West Campus (Palo Alto Medical Foundation Research Institute). Dr. Dillon collaborated with other CHSR investigators and lead study author Ming Tai-Seale, PhD, MPH, a professor in the Department of Family Medicine and Public Health at the University of California, San Diego.
While various causes of burnout have been examined in prior research, including workload, efficiency, meaning in work, culture and values, control and flexibility, social support and community at work, and work-life integration, few studies have examined the role played by EHR workload.
In the present study, the researchers analyzed survey, administrative and EHR data from Sutter’s Palo Alto Medical Foundation. Of the 1,292 physicians who were invited to complete the confidential 2016 survey, 934 (72%) responded.
Thirty-six percent of the physicians reported burnout symptoms, and 29% intended to reduce their clinical work time in the upcoming year. Receiving more than the average number of system-generated in-basket messages was associated with 40% higher probability of burnout and 38% higher probability of intending to reduce clinical work time.
Analyses of EHR work found that in-basket messages generated by the EHR system accounted for almost half (114) of the 243 weekly in-basket messages received per physician, on average—far exceeding the numbers received from their colleagues (53) and patients (30).
Dr. Dillon and Dominick Frosch, PhD, co-director of CHSR and director of the Palo Alto Medical Foundation Research Institute have engaged in efforts to promote physician wellbeing since 2016.
Dominick Frosch, PhD
“This research project grew out of our relationship with Palo Alto Foundation Medical Group leaders committed to improving physician wellbeing, and the recognition that the first step toward improvement is measuring burnout and wellbeing,” says Dr. Frosch. “In addition, we wanted to identify key factors related to burnout to provide a foundation for discussions about what to do next.”
Informed by these results, Sutter Health is working on several initiatives to improve the “Joy of Work” for frontline physicians. These include reconfiguring primary care teams away from physician-medical assistant pairs to larger teams that can better support each other; providing multi-disciplinary inbasket support leveraging medical assistants, nurses and pharmacists to reduce the burden on physicians, and; providing dedicated training programs for physician leaders.
Additionally, Sutter is exploring various innovative technology and tools to support how they care for patients and input information into EHRs. For example, approximately 100 Sutter network doctors have access to a service via Augmedix that frees them from extra time charting inside patients’ health records thanks to real-time, quality controlled, and customized remote scribes, accessed through Glass. The results include reduced physician burnout, as many doctors remark how the service helps them save time charting, so they can spend more of their focus on immediate patient needs. It also enhances productivity—saving doctors an average of two hours a day—giving them additional time to attend other patient care matters.
“Health care organizations may benefit from engaging with their physicians in creating optimal policies on email work, in addition to helping them with such work. Limiting desktop medicine work during evenings, weekends, and holidays, unless the physician is on call, could reduce burnout,” says Dr. Tai-Seale, who notes that changes in communication with physicians, staffing and scheduling may help address burnout and EHR workload burden.
Long work hours and increasing pressure to care for greater numbers of patients with limited resources have contributed to a national epidemic of physician burnout. Longtime PAMF Community Board Trustee and donor, Jeannie Ritchie, gave $1 million to fund a series of leadership summits to explore innovative options to support physician wellness.
• Physicians are burning out at a rate that’s twice as high as the average American worker.
• It’s a problem that’s costing the U.S. $4.6 billion each year, according to a new study released last month in the Annals of Internal Medicine. The costs of burnout are related to doctors leaving health systems and working reduced hours, according to the study.
• Last month, the World Health Organization added burnout to its list of medical conditions, characterizing it as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.”
About the Center for Health Systems Research (CHSR)
Sutter Health’s CHSR improves the care, experience, and health of all patients, clinicians, and communities through innovative research, development, and analytics that have an immediate impact on the delivery of care. CHSR accelerates the continuous transformation and evolution of health systems.