The increasing attention paid to Physician burnout, its causes, and possible remedies is the subject of numerous studies and articles. As a physician working in the Healthcare IT Consulting field for over 12 years, I have witnessed firsthand the growing epidemic of Physician burnout.
It is important to understand how burnout is defined and/or recognized. The accepted standard for burnout diagnosis is the Maslach Burnout Inventory, developed by Christina Maslach and her colleagues at the University of San Francisco in the 1970s. The three main symptoms are:
Exhaustion
Depersonalization
Lack of efficacy
Physicians as a group are particularly susceptible to this triad. Dike Drummond, MD in his article on this topic, has eloquently summarized this as follows:
The stresses of caring for patients and working in a particular job situation can contribute to burnout.
Life outside of medicine should recharge your energy levels, but that isn’t always the case.
Traits encouraged in physician training and responsible for our success (e.g., perfectionism) may make us more susceptible to burnout.
Burnout ultimately leads to Physician turnover. When a healthcare professional leaves, an organization must account for:
Continuity of care
Training costs
Staff workloads and Medical staff dissatisfaction
Accident rates
As staff tenure decreases and institutional knowledge bleeds away, other negative impacts may be to organizational efficiency and professional development.
Then there is the financial impact. Some reports estimate that replacing a physician is at least $200,000 but can reach as high as $1 million per exiting doctor.
Multiple factors have been identified as contributing to Physician burnout. It can generally be agreed that the EHR, and the goal of meaningful use of the EHR, are two of the leading contributors to physician burnout and decreased productivity. Despite significant investments in capital, resources and time, an organization’s hoped-for positive impacts on patient safety, efficiency, and financial health have not been realized but have had unintended negative effects on the practice of medicine, a provider’s specific role, and the disruption of work-life balance.
Some authors have suggested that the Meaningful Use program be suspended until the EHR has been redesigned to support interoperability and more closely align with the Physician’s needs to provide care for their patients while building a truly useful medical record. While it is recognized that this is a noble goal, given the considerable investment to date in EHRs, and the financial constraints most organizations are laboring under, this is unrealistic. The disruption to patient care and the general operations might be catastrophic.
But this does speak to one of the central tensions during the implementation of the EHR. How much training is necessary to prepare a Physician to incorporate the specific system into their practice? There is a delicate balance between what is needed to develop competence and what is needed to drive real proficiency. I would suggest that most organizations have the resources and time for the former and hope that through experience their providers attain the latter. Our experience suggests that only a subset will achieve this and that most are just competent, and this adds to their overall stress level and demands on their time.
In the absence of a wholesale redesign of the EHR, our experience is to work with what you have and make it better. We know that the initial training is important to get things up and running. We also know that, until you turn the system on and use it, your providers never really understand how to incorporate it into their daily workflow.
In our experience, one of the critical steps to provider success, and lowering of stress levels, that many organizations fail to follow up on is ongoing focused training. Understanding what is working and what providers continue to struggle with is key to helping them become more effective and efficient in their work. Ongoing training that develops greater proficiency and efficiency in their practice can have significant positive impacts such as increased patient satisfaction due to better interactions, better time management, and working to return to a better work-life balance.
At Optimum Healthcare IT, we have had the opportunity to work with multiple organizations and their providers on precisely this. There is no “one size fits all” solution; each organization is unique. But our approach is centered on assessing where your providers are succeeding and where they are challenged. Our team can also identify potential opportunities for ongoing training opportunities. We focus on their success and by doing so, help successfully drive the organization’s goals of patient care, safety, and organizational health.
