This article first appeared in the August 2018 issue of Cardiology magazine from the American College of Cardiology.
In early 2018, Medscape released a report on physician burnout. The takeaways, unsurprisingly, are not good. The number of physicians who report feeling ‘burned out’, or otherwise depressed, continues to climb. All the while, we’re seeing even more demands on their time.
Areas that we think of as core to population health — critical care, ob-gyn, and family medicine to name a few — are also the areas that have the highest incidents of burnout. We’re well past the point where we should be considering innovation as a solution to physician burnout, and instead we should focus on innovating requirements and how we expect physicians to deal with them.
The Root of the Problem
A recent article in The Atlantic points to one overwhelming problem — electronic medical records (EMRs). Regulations that governed the use of EMRs appeared in 2009, and have only gotten more demanding since then. The patient population continues to get older, chronic illnesses climb, and more people are covered by insurance. Yet the EMR is ever-more demanding of a physician’s time.
A Health Affairs study in April of 2017 showed that time spent on documentation had edged out time spent with patients. As any physician will tell you, they go to school (and into significant debt) to help patients. Any time spent doing administrative work is not only stealing away from the patient, it’s taking away a piece of the physician as well.
We’re all well aware of the potential benefits of EMRs, but their designs are often rules-focused instead of being provider-focused. While the EMR is not the only problem, it sits at an intersectional point where many smaller problems collide.
A Focus on Wellness
Mentioning the word “wellness” often conjures up images of yoga mats and step monitors. But the American Medical Association wants us to take a different look at the term. As part of a larger initiative to prevent burnout, the AMA posits that physician wellness should be a quality indicator for a practice.
Tying physician wellness to quality indicators seems good in theory, but what does it look like in practice? For that answer, we can go back to the Medscape report and physicians’ own solutions to reduce their stress.
Looking at broad categories, surveyed physicians break down their causes of burnout to two areas:
1 – Financial stress
2 – Time constraints
The average medical school graduate walks away with a degree…and over $200,000 in debt. Most students take at least 10 years to pay off their loans, and many reach the 20-year threshold. The healthcare field on the whole struggles to find enough physicians to keep up with demand, and burnout is higher among the younger population. They are often making the least amount of money while still trying to repay their college loans.
What level of wellness are we offering young physicians? What hope are we giving them that “things will get better”? All the while, we’re piling on more regulations, and more responsibilities.
The answer seems simple — pay them more money so that they have less financial stress. Sadly, the mixture of for-profit healthcare, lower insurance repayment, and expanded quality metrics leaves little room for increased salaries.
Clinicians are often given no choice but to work with the tools provided to them. As such, exploring innovation isn’t high on their to-do list. But today’s landscape requires that every person in the physician’s circle take an active role in helping ease the causes of burnout.
One area where innovation can have significant impact is in offering physicians more time with patients. Medical scribes ease the pain of EMR duties for the physician, but their use is often seen as a bandage to a broken-arm problem. What we need are companies that work toward providing information to the physician when it’s needed, and integrating with existing workflows without making them more complex.
At HIMSS18, one big innovation that can help to ease the pain of EMRs came from integrating them with artificial intelligence. athenahealth, AllScripts, Cerner, and more all unveiled or gave more details on their plans to ease the physician workload by using artificial intelligence to help complete EMR mandates.
Another example of a company taking the plunge is EvidenceCare. Evidence-based medicine has been long-held as an ideal approach to healthcare, but time constraints make it impractical. Instead of requiring hundreds of hours of reading, EvidenceCare provides a delivery platform that can help providers make decisions in mere seconds. This can lead to more time spent with the patient, improved insurance reimbursement, and it integrates with existing workflows.
The unfortunate truth of many innovations is that top-down approval is required to see them implemented. This challenge is not unknown to the world of innovators, so companies like EvidenceCare are offering their products to individuals as well as institutions. This brings us back to the importance of the AMA’s point toward wellness.
Institutions and individuals alike must work together to ensure physician wellness that prevents burnout. This is an ongoing process, requiring surveys, interventions, and champions for the initiatives within the institution. But even beyond that, it’s a personal process that every physician needs to examine, to make sure that their needs are being met.
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