Doctors have become collateral damage in healthcare reform.
By most measures, the last decade of healthcare transformation—with its focus on evidence-based guidelines, electronic health records and value-based payment models—has driven improvement in the quality of care individuals can expect from their healthcare providers. The frequency of hospital-acquired conditions is declining, hospitals are starting to realize cost-savings through bundled payment models, and 30-day readmission rates are declining nationwide.
Meanwhile, physicians are leaving the profession in droves. The problem has gotten so severe that the Association of American Medical Colleges now projects a U.S. shortage of 42,600 to 121,300 physicians by 2030. In many places globally, the physician shortage is even more staggering.
Increasingly, the evidence points to physician burnout as the driver of this phenomenon. A new study published recently in JAMA finds that nearly half of new residents experience symptoms of burnout at least once a week. This comes on top of a 2016 study authored by doctors from the Mayo Clinic and American Medical Association that found that the prevalence of physician burnout has increased from 45.5 percent to 54.4 percent over the last three years.
Similarly, a survey of clinicians, clinical leaders, and healthcare executives conducted by NEJM Catalyst found that 83 percent of respondents characterized physician burnout as a serious or moderate problem in their organizations.
Citing a range of reasons, ranging from frustration with cumbersome electronic health record software to challenges wrangling payments from insurance companies, doctors are simply getting beaten up by the very system that was designed to enable them to improve healthcare. It’s affecting both their physical and mental health as well as work-life balance.
It doesn’t have to be that way.
While it is true that healthcare reform has introduced a number of new processes and protocols that doctors need to follow, along with a firehose of data that they cannot possibly hope to digest, it has also ushered in a revolution in analytics capabilities and administrative best practices that have the power to reduce burnout. The key is to address the root causes of burnout, rather than the symptoms.
Burnout is commonly an indication of underlying organizational dysfunction. Effectively addressing that requires a comprehensive strategy that operates at the enterprise, departmental, and individual levels.
It is not something that can be dealt with by counseling physicians to become more resilient. As with any strategic initiative, leaders must start by understanding the current state through measuring key indicators, in this case the manifestations, drivers and impacts of burnout.
Remarkably, the authoritative research in this space suggests that the burnout phenomenon (in many professions, not just medicine) is driven by just six factors. They include the following.
- Work overload (and, more recently, information overload)
- Lack of control
- Insufficient reward
- Breakdown of community
- Absence of fairness
- Conflicting values
While there is a lack of consensus on how to define burnout, understanding the drivers serves as the basis for designing a burnout mitigation plan that includes support for physician wellness, changes to the management system and culture, and efficiency improvement at the point of care to allow physicians to focus on their patients rather than on screens and keyboards.
Ironically, the solution that enables physicians to spend more time with patients and less with technology is made possible by technology. But it’s probably not what you think.
While so much of healthcare has become flooded with unstructured, disparate data sets that can often create more confusion than answers, the data and analytics used to address physician burnout are decidedly pragmatic.
For example, in a recent project with an independent radiology practice in San Luis Obispo, Calif., an analysis of patient volume patterns revealed that demand for radiologist reading time was highest between 10 a.m. and 2 p.m. However, the practice was not staffed optimally during those hours. As a result, the practice was operating in a perpetual state of playing catch-up, routinely requiring doctors to work after hours to make up for the time lost during the peak.
This echoed my own experience as head of a 300-physician medical foundation that was running at an $ 11 million annual budget deficit while experiencing a significant physician staffing shortage. Analysis of the system’s data revealed that the real root causes of those problems were systemic—things like constant repetition of basic data entry tasks that could have been automated, inefficient use of existing staff and clunky electronic health records that were not optimized for the specific practice. Taken together, these seemingly minor annoyances add up to a crippling amount of administrative inertia that keeps doctors from experiencing the joy of why they got into medicine in the first place.
Fortunately, getting to the data and analytics that let physicians and their practices pinpoint these inefficiencies in their workflows can be relatively easy. The healthcare IT boom of the past several years has produced all manner of analytics that can surface actionable insights, and the growth of artificial intelligence in the space is starting to make things better, changing our data management approach from one offering systems of record to one providing systems of insight. The challenge for health system leaders is to commit to find and treat that problem at its foundation.
The solutions are there; we’ve got to do more to support physicians in applying the same analytical, scientific rigor they do to their practice of medicine to the operation of their practices. For far too long now, physicians have been asked to roll with the constant influx of new regulatory requirements, to jump through just one more hoop, to suck it up and soldier on.
That’s not the solution. We need to take the epidemic of physician burnout seriously. There is a great opportunity for C-level executives to engage and collaborate with physicians to make sure doctors have the data, tools, guidance, and support they need to transform their practices.
This is bigger than simply improving work-life balance; it has become a critical business imperative for the leaders of medical practices, and will increasingly become a strategic advantage for those who get the formula right. Crucially, doing so will also allow doctors to reconnect with their patients and realize their professional fulfillment as healers.
Paul DeChant, MD
Paul DeChant, MD, is a deputy chief health officer with Simpler Healthcare, a division of IBM Watson Health.