The problem:

In one study of musculoskeletal radiologists, the physician burnout rate was reported at 80%!

The rate of physician suicide is twice that of the public at large, and it’s worse for women physicians. 400 physicians commit suicide each year, and experts believe that’s likely an underestimate. Hence stunningly, roughly a million patients a year lose their physician to suicide.

What is physician burnout?

When physicians devote excessive time and effort to useless tasks required by an inefficient system, overactive payers and burdensome regulators, emotional exhaustion sets in.

With depersonalization, physicians lose the ability to be empathetic and often become emotionally distant to patients and families. This can be perceived as callousness or even cynical behavior by patients and their families. This may manifest as an inability to express grief for patients’ or families’ losses. Naturally this negatively affects the patient experience and the patient’s confidence in the physician’s recommendations. These patients are less likely to follow their physician’s advice, resulting in poorer patient outcomes.

Over time, as the physician continues to jump through what they consider meaningless hoops, they begin to experience feelings of low achievement and decreased effectiveness. They begin to feel not only that the bureaucratic button pushing required of them is meaningless, but the actual task of healing begins to lose value for the physician. As physicians begin to view their work as meaningless, the quality of their work suffers.

Physician burnout affects us all: lower quality, higher costs, reduced access

A healthy, high functioning physician is the foundation of a high functioning healthcare system.  Yet reports indicate physician burnout rates are worsening nation wide.

Chronic fatigue, alcoholism and drug addiction are all associated with physician burnout.

Burnt-out physicians deliver a lower quality of care, receive lower patient satisfaction scores, have a lower capacity to effectively engage and lead the healthcare team, and their suffering results in lower team morale.  Patient safety is compromised. Unnecessary consultations or lab tests are ordered. They are more likely to make medical errors and, suffer medical malpractice suits. The culmination of all this activity drives up healthcare costs, reduces quality and limits access to care.

Why today? Healthcare’s triple threat: Electronic Health Records (EHRs) insurance requirements and government regulations

Physicians have always worked long hours, but now physicians tell me that time wasted jumping through what they consider meaningless hoops is driving them to distraction.

Burnout is related to loss over control of work, disrespectful leadership, increased performance measurement (some of our physician organizations and hospitals are responsible for monitoring and improving over 600 quality metrics!) increasing complexity of medical care, implementation of EHRs  and profound inefficiencies in the practice environment. Many (one might venture to say most) EHRs are not optimized to facilitate efficient physician practice.

One physician leader recently told me that his EHR allows monitoring of how many hours each day a physician is logged on to the EHR, entering data. He told me he was shocked at the results: Physicians in his practice are often logged on, writing notes and answering emails for up to 18 hours a day. He can’t believe they can survive with this lack of sleep.

Also contributing to worsening physician stress is a poor balance between effort and reward, lack of community, lack of fairness and values conflict.

How does physician burnout drive up healthcare costs?

Early retirement, reduced physician hours and physician turnover costs directly affect physician employers and practices. The reduced quality of care delivered by burnt-out physicians, the increased medical error rate associated with physician burnout, unnecessary testing and referrals generated by burnt-out physicians and increased medical malpractice risk and malpractice premiums all indirectly contribute negatively to healthcare costs in America.

Path to the future:

A recent Health Affairs blog authored by 11 health system CEOs including Massachusetts’ own  Dr. David Torchiana,  President and CEO of Partners HealthCare and Dr. Steven Strongwater, President and CEO of Atrius Health offered the following first steps towards a solution;

Health systems need to:

•    Recognize that physician well-being is critical
•    View physician well-being as a core priority
•    Regularly measure physician well-being/burnout
•    Include these measures in institutional performance dashboards
•    Allocate the resources necessary
•    Hold management accountable for improving physician well-being/burnout
•    Evaluate and track the institutional costs of physician turnover, early retirement, and reductions in clinical effort.
•    Emphasize leadership skill development
•    Understand and address more fully the clerical burden
•    Encourage government/regulators to address the increasing regulatory burden
•    Reduce the burden of the EHR on all users
•    Compile and share best practices
•    Educate their fellow CEOs about the importance of this work

MMS and MHA jointly forming a Physician Burnout Task Force

The Massachusetts Health and Hospital Association (MHA) is partnering with the Massachusetts Medical Society (MMS) and is currently in the process of creating the MMS-MHA Physician Burnout Task Force. This will be composed of physicians and physician group leaders from within both hospital and physician practice environments. The task force work is expected to begin in January 2018 and conclude its work by year end. If you have any information which may be germane to understanding, addressing and successfully combating physician burnout, would you please send it along to:

Steve@defosays.com

Thanks in advance!