Physician burnout: an “area of continued vigilance”

Physician BurnoutEditor’s note: According to a 2017 survey by the website Medscape, more than half the nation’s physicians are burned out, defined as “having feelings of cynicism, a low sense of personal accomplishment and a loss of enthusiasm for work.” On Feb. 8, approximately 100 medical providers, administrators and students attended an Iowa Medical Society (IMS) conference on provider burnout and professional resiliency. Among them were Dr. Steven Herwig, who shares his perspectives below on the topic.

Although I am retired three years, the issue of physician burnout has been a concern from my days as the board chair at the Iowa Clinic and now as a member of the UnityPoint Health Board of Directors. Several factors contribute to physician stress.

1. Physicians are, by nature, perfectionists. While one should not ignore the gravity of decisions involving the health of our patients, it is a reality that we do not always make the right or best decisions, despite our good intentions.

2. The electronic health record (EHR) has been a technological marvel in capturing health data, making this information available for sharing and eliminating paper charts and chart file rooms. That said, health professionals did not spend years in medical training to become transcribers. The EHR takes a significant amount of time for chart completion, reducing the time a physician spends in clinical activities. This is
a waste of professional time and diminishes time spent in leisure, family time, recreation and other pursuits. 

Some providers are using medical scribes or remote transmission of information to be formatted by a trained transcriber and reviewed by the clinician later to assess for completeness and accuracy. At the IMS conference, Paul DeChant, M.D., M.B.A., discussed methods that use radio-frequency identification (RFID) devices to eliminate entering passwords when entering information in the EHR. He also promoted having printers in each exam room to eliminate time and steps to retrieve printed materials.

3. The margins in health care are very slim, which makes increased productivity an economic reality. Many means of assessing productivity exist – by collections, billings, relative value units, patient volumes, etc. Physicians have an intrinsic knowledge of their productivity. Many resist the temptation to see more patients in order to spend more time with each patient. There remains the matter of overhead and expenses that are balanced with payment for medical services.

4. Time pressure. Over the course of my 34 years in medicine, I witnessed a loss of collegiality due to time/productivity pressures. The physician’s lounge has become a virtual “ghost town.” When local medical centers stopped having specialty sections meet quarterly for morbidity and mortality reviews and discussion of patient care issues, there was a loss of gathering with other professionals in one’s specialty area. 

Regarding solutions for dealing with this endemic issue, I commend the medical societies for addressing it. Whatever methods are implemented, the issue will not be resolved, only improved upon, so this needs to be an area of continued vigilance.

1. Continue to find ways to make the EHR less intrusive to the physician/patient experience. Anything to get the physician away from the keyboard will be an improvement, whether using scribes or remote telecommunications for data capture and entry.

2. Use others, such as medical assistants and nurses, to enhance the amount of information entered before the physician interacts with the patient. Can one imagine seeing an attorney and, during the entire visit, the attorney is typing information into a computer?

3. For medical groups, have physician wellness committees monitor well-being. Encourage leisure and recreational pursuits (work-life balance) and take regular vacations.

4. Have physician mentors for new physicians who meet regularly and share more than just clinical issues.

5. Look for warning signs that may be indicators of early stress and burnout, including anxiety and depression, anger issues, lack of empathy, lower productivity and quality of performance. Intervene or provide avenues for assistance, such as life coaching and wellness counselors, or just be a good listener.

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