“Ain’t Nobody Happy”

The concept of physician burnout is not a new one, having been studied and discussed for decades.  However, the noticeable increase in the rate of physician burnout has been documented and debated with renewed urgency over the past several years. With doctors now carrying the highest rate of suicide of any profession, the growing wave of physician burnout is being widely described as a “national epidemic” and a “public health crisis.”

Clearly, the effects of burnout have a significant impact on how healthcare is administered to patients.  One healthcare executive put a spin on an old axiom: “if the doctor ain’t happy, ain’t nobody happy.” When pressed for more information, the executive shared that disengaged doctors can rub the staff the wrong way, which ultimately can lead to the patient not receiving the best experience from both physicians and caregivers. If the doctor ain’t happy, the staff ain’t happy and the patient ain’t happy, either – that’s a lot of unhappiness!

Defining Physician Burnout

Psychologists define “burnout” as decreased enthusiasm for work, growing cynicism and a low sense of personal accomplishment.  Specific to the physician,  burnout is linked to emotional exhaustion, depersonalization and feeling ineffective at work.  Taking this definition a step further, the elements contributing to burnout can lead to unexpected discoveries. For instance, the feeling of depersonalization is heightened by patients changing jobs (and health plans) and employers changing plans to keep up with market demands.  In addition, physicians are spending more time in front of their computers, dedicating almost twice as much time in the EHR as they are with the patient. An unintended consequence of more time spent in the EHR is less time spent collaborating with peers. Strip away the camaraderie of the job, and it’s easy to see how burnout is on the rise.  While important, these elements simply scratch the surface of many contributing factors.

Calculating the Cost of Physician Burnout

The cost of physician burnout is high.  In the clinical realm, studies point to physician burnout impacting quality of care, patient safety, patient satisfaction and even link it to an increase in patient mortality among hospitalized patients.  These are risk factors that simply can’t be ignored.

In addition, there are ways to calculate the financial costs of burnout.  A colleague introduced me to a burnout calculator to see what physician turnover is costing an organization. The cost to replace a doctor typically runs between $500K and $1M per doctor.  Physician turnover rates range from seven to ten percent, with about 30 percent of turnover related to burnout. Knowing this, an organization can take their turnover rate, multiply by their total providers, take one-third of that number and multiply by $500K  in order to calculate a conservative estimate of the cost of burnout at their organization. The figures can be staggering. One hospital executive calculated their cost of turnover attributed to physician burnout at $30 million annually!

EHR as Part of the Problem

There is a general consensus that a major contributor to physician burnout is the EHR. Ironically, a system that was deisgned to simplify a physician’s workflow has, in many situations, done the exact opposite.  It is easy to point a finger in this direction, and for good reason. Taylor Davis, VP at KLAS Enterprises, in his research at KLAS and the Arch Collaborative has pinpointed three negative emotions associated with the EHR:  doctors suffer feelings of stupidity, discomfort and hopelessness.  The feeling of “stupidity” come with a failure to be adept at navigating the system; “uncomfortable” because the system is not configured to them, their preferences and their work styles; and “hopeless” because they don’t see an immediate fix to their problem, certainly not without taking time away from the part of their jobs they appreciate the most –  their patients.

Imagine that! Some of the world’s smartest and most talented professionals feel disabled inside a system that is supposed to help them excel. An increase in the amount of time writing notes has led to an increase in the amount of time reading notes to draw a conclusion for the time of care and support a patient requires.  The list of EHR grievances is long in the eyes of the caregiver.

EHR as Part of the Solution

Hold on!  There’s a light emerging at the end of the tunnel, thanks to the camaraderie and collaboration in healthcare.  Smart people have recognized the challenges the EHR were contributing to physician burnout, and started working to reduce and eliminate them. Here is a sum of the discoveries out there, thanks again to the data amassed by the Arch Collaborative:

Keys to EMR Success:

(Addressing stupidity, discomfort and hopelessness)

  • Mastery (Training and usage):  Physicians and clinicians are masters of their craft, but not of their technology.  Successful organizations know:
    • Training matters: New doctors need six hours of initial training and four hours annually of ongoing training in the EHR.
    • Quality instruction matters: They need strong teachers, knowledge of clinical workflows and tailored to the audience (i.e. role, specialty area) they are teaching.
    • Peer influence: Peer-to-peer training is very effective as it helps create culture change while providing topical content to the individual.
    • Show me the data: Train users how to get data out of the EHR. It matters more than how to get data into it.
  • Comfort (Personalization): The level of EHR personalization is the best predictor of EHR satisfaction, with personalization that helps users get the data out of their EHR helping most.
  • Hope (structured governance or shared ownership): Successful organizations have structured their governance so that small/critical optimizations can move fast.

The end goal is to eliminate the negative connotations associated with the EHR, and – through mastery, comfort and hope –  turn the EHR into a catalyst for organizational change.

Moving Past Burnout

Physician burnout is a complex problem and one that needs to be addressed immediately in your organization.  One study indicates three recommendations to address physician burnout:

  1. Support proactive mental health treatment for physicians experiencing burnout.
  2. Improve EHR standards with strong focus on usability and open application programming interfaces.
  3. Appoint executive-level chief wellness officers at healthcare organizations.

Outside of these steps, organizations should refer back to the data from Arch Collaborative, and  spend some time training and personalizing the EHR. Teams can experience quick and immediate wins, all while demonstrating a commitment to resolving the toxic feelings associated with physician burnout.  Resources and outcomes tied to to this area of focus are promising. Examples include Hawaii Pacific Health’s belief in “Getting Rid of Stupid Stuff” and Stanford Medicine’s Home 4 Dinner or Epic Concierge programs. There are many other great ideas and programs out there working to address the issue, and as more teams work together to find solutions, the healthcare industry can move towards resolving the complicated crisis of physician burnout.

About the Author:  Eric Born is a Director at Alidade Group.  When not writing, he can be seen around his hometown cheering on his three kids with his wife Sara, or working in the yard with their dog Cookie.