In a 2014 survey, 54% of physician respondents reported experiencing at least 1 sign of burnout, up from 45.5% in 2011, according to a study published in Mayo Clinic Proceedings (2015;90:1600-1613). Satisfaction with work-life balance declined during the same period (48.5% vs 40.9%).
Electronic medical records (EMRs) may be a contributing factor, as Susan T. Hingle, MD, Chair of the Board of Regents at the American College of Physician (ACP), related. “When I would handwrite or dictate [notes], I would put them together in the context of a patient as a person, and how it is all interrelated,” said Dr Hingle, a professor in the Department of Internal Medicine at Southern Illinois University School of Medicine in Springfield. “This is missing in the current structure of most EMRs.”
EMRs have also reduced the amount of time physicians can focus on the patient. Instead, many doctors end up staring at a computer screen during a visit. “Opportunities to connect and find meaning in our work is not happening because of the distractions of the task at hand,” Dr Hingle said.
To address the problem, the ACP developed the Patients Before Paperwork initiative “to reinvigorate the patient-physician relationship by challenging unnecessary practice burdens.” (https://www.acponline.org/advocacy/where-we-stand/patients-before-paperwork).
If doctors opt to document outside of the visit, they often end up doing work at home, which eats into their personal time. In fact, Dr Hingle said physicians spend an average of 2 hours every night on documentation.
The EMR inbox
The EMR inbox is another drain on physician time. When Dr Hingle used paper charts in her practice, the charts stayed at the office. Now, physicians log into email at night and see a list of prescriptions that need filling or patient questions to be answered. “I see there are 20 other things that have popped up in my inbox and I should deal with now … and if I don’t, tomorrow there will be even more,” she said.
Debra Phairas, president of Practice and Liability Consultants LLC, based in San Francisco, said she highly recommends considering the use of scribes to deal with this burnout contributor. Having someone transcribe and enter information in EMRs while a physician treats the patient reduces the nighttime workload and allows more physician/patient contact. Some of her clients are pain management specialists and ophthalmologists, who, because they need to have direct patient contact during visits, have used scribes for years.
“I have even proven its cost-effectiveness with a family practice … so specialists can definitely afford a scribe,” she said.
Increased paperwork associated with a trend toward the implementation of value-based payment systems also may contribute to physician burnout. Physicians may be spending more time with such tasks as medication reconciliation and other preventive care practices required to demonstrate value-based care.
“Our ‘work intensity’ has gone up significantly,” Dr Hingle said. “Most doctors got into health care to help people, but they don’t have time to see they are doing that or reflect on the meaning of their work.”
Phairas said doctors need to delegate some of their administrative tasks. One way to do so is by using a product like the Microsoft Outlook task function. The task feature allows doctors to create a task, assign it to someone, and set target dates and priorities. The task will stay on the task bar. Upon completion, the person assigned to the task notifies the physicians that the task has been completed.
“If you don’t use these kinds of tools, you never know if something is being done or where it stands,” she said. “If doctors used more organizational tools, they wouldn’t be so stressed out.”
Putting policies and procedures in place for administrative tasks will help reduce the clerical work a physician does, freeing up much-needed time, she said.
Medication reconciliation, for instance, should be done ahead of time so a doctor can review the medications, make changes during a patient visit, and then give it to a medical assistant to update in an EMR. Lab tests and X-ray results can also be streamlined, Dr Hingle said. Doctors should be able to review them and either send a note for the nurse to order additional tests or sign off on them. When they do that, someone can be responsible for sending a “normal” lab letter to the patient. Someone can also be trained to fill out disability paperwork so a physician just has to sign off on it when completed.
Making time for others
It is easy to gobble down a quick lunch every day, or work in the evening after the kids go to bed, and think time is being spent wisely. Dr Hingle stresses the importance of purposefully scheduling time to connect with friends and coworkers. “I went to lunch with a colleague last week, and it was so nice to connect on that personal level,” she said. “I can’t remember the last time I did that.”
During grand rounds, her hospital once planned a “story slam” where people shared lessons they had learned from patients. They were able to spend some time reflecting on their work and connecting as a group.
One way to make more time for these kinds of things is to avoid overcommitting to things doctors feel like they have to do, but do not want to. Phairas recommends pulling back on multiple responsibilities like hospital committees when possible. “Sometimes it’s just a matter of saying no that can take pressure off,” she said.