physicians

Combating Physician Burnout in the Digital Era

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Physicians are burning out at alarming rates, and we should all be paying close attention.

According to the Agency for Healthcare Research & Quality (AHRQ), provider burnout now exceeds 50%.

For physicians, the negative health effects have serious consequences. Physicians now have the highest suicide rate of any profession In real terms, one physician is lost in the U.S. every day to suicide. This is an epidemic affecting all service lines, women and men, across rural and urban settings. Stories of depression, lack of desire to perform at a high level, and chronic fatigue abound.

Obviously this is impacting patient care. This makes conceptual sense—a burnt out provider will be less effective, resulting in declining outcomes, reduced patient engagement, frustration in the ‘system’ and poorer population health. And while the human costs are highest and most important, there are also financial costs for health systems and practices. Discussed at a panel at this year’s Becker’s Hospital Review Health IT + Clinical Leadership 2018 Conference, Dr. Tim Lineberry of Aurora Health made an important statement about physician burnout: “Burnout is a business issue. If you lose one physician … that's an immediate issue from a revenue standpoint.” This makes a troubling human issue a troubling business issue for health systems and hospitals.

One industry-wide, measurable effect of physician burnout is a physician shortage. Recent research by the Association of American Medical Colleges (AAMC) predicts a physician shortage of 100,000 by 2030. This shortage will be partially caused by physician burnout while simultaneously driving physician burnout, as efficiency and productivity expectations continue to increase for physicians. The result is an accelerating and deepening crisis.

How can we address physician burnout?

Many experts have pointed to the EMR as a primary culprit for physician burnout. This is because physicians spend roughly 50% of their day interfacing with an EMR. One solution to the EMR issue is to increase the usage of scribes. Currently underutilized, scribes are proven to improve physician satisfaction and reduce burnout by cutting the time a physician spends on documentation in half.

Scribes are certainly not the only group that can help address physician burnout. To more directly address the current physician shortage, policy and regulatory changes should be made to place more investment in Nurse Practitioners. A growing base of skilled providers, Nurse Practitioners are crucial to filling care gaps and to meet patient needs that do not require a physician. Given limited time and resources, physicians need to focus on the most urgent and crucial medical needs of the population, and leave pap smears and other procedures to other providers who are trained and able to give quality care.

The Keys to Any Physician Burnout Improvement Strategy

Most importantly, addressing physician burnout requires a clear strategy that takes into account the following components. According to Karen Weiner, CEO of Oregon Medical Group, “Best practice is to identify the sources of stress for the physicians of that particular setting, identify relevant interventions, create metrics with baselines and goals, then watch closely for improvements over time, and tweak the interventions as needed.” Following this expertise, there is no silver bullet or one-size-fits all solution to address physician burnout. The daily sources of stress for an orthopaedic surgeon will differ from the sources of stress that an urgent care provider has.

Technology: Friend or Foe?

What role can technology play in addressing physician burnout? Is technology only a hindrance? If utilized for peak performance, technology can alleviate some daily stressors for physicians:

  1. Patient intake and workflow management - for physicians who view decreasing control over their schedules as a daily source of stress, there are solutions that address patient intake and workflow management. The goal of these solutions is to replicate nuances, like intake protocols and custom workflows, within the provider’s schedule. This ensures the right patient sees the right provider at the right time.

  2. Algorithm-driven patient navigation - allows the patient to be ‘steered’ to the optimal provider. This could be closest/soonest, a member of the care team, or a Nurse Practitioner or Physician Assistant, all designed to alleviate the schedule stresses of the physician and her or his practice management system.

  3. Telehealth - a key component of the physician shortage issue, and by extension physician burnout, is location. There are not enough providers in certain localities. Telehealth solutions exist that take location out of the equation, allowing greater access to care for otherwise underserved communities. For these localities, greater access to telehealth translates to decreased burden on local providers.

  4. Healthcare IT compliance automation - in a highly regulated environment, physicians need automation to remain in compliance with all regulations. Solutions that automate compliance lessen the burden on physicians and support staff when it comes to compliance.

In summary, there are a multitude of methods to address the physician burnout crisis including manpower and technology. Prior to implementing any solution, however, the first and most crucial step is to listen to providers, determine their top sources of stress, implement solutions and refine them on an ongoing basis. This strategic thinking and listening should guide any and all investments in alleviating physician burnout. The human issue of physician burnout will only be solved by listening to physicians and addressing their specific needs.

Trust: The Key Component to Finding a Doctor

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How can I trust a stranger, whom I have never met, with the most precious asset—my health?

In the past, when selecting a provider, trust was established primarily through word of mouth referrals in addition to baseline qualifications such as education, licenses, and experience. This information allowed people to make judgments on both a provider’s character as well as their competence.

While these mechanisms still apply, the increasingly digital, fast-paced and less personal 21st-century world has largely replaced word of mouth with modern technologies. These technologies include 5-star rating systems for doctors, and more recently, advertising platforms that require providers to pay money to show up on a provider search function. However, these technologies fail to match patients with the right provider - and thus do both patients and providers a disservice.

Doctors dislike 5-star rating systems because they are:

1. Skewed to negative ratings - one or two poor ratings based on a misunderstanding can ruin a provider’s patient flow.

2. Patients want “the best” - only providers with the highest ratings will take a majority of the patients when in reality there are many more competent doctors with better availability than those with highest ratings.

3. Higher star ratings do not reflect fit - care providers with five stars are often not the best fit for the patient’s specific needs. Star ratings inherently cause sub-optimal patient traffic to each doctor, creating a poor experience for both parties.

In a similar vein, sponsored provider search ads have appeared recently in an attempt to mimic the paid search engine experience available on leading search engines.

However, sponsored provider search ads create a pay-to-play system that:

1. Rewards providers who spend on advertising instead of the physicians that are the best fit for each patient

2. Profits off the patient’s lack of knowledge, and lack of trust, about who their best provider should be

3. Treats providers and patients as commodities and not as humans looking to provide and receive care

Additionally, these technologies do not align with a provider’s or health system’s objectives. In a world where health systems need to drive triple aim to be successful, and volume-based care has been replaced with value-based care, quality, accuracy, and humanity need to be prioritized over volume, inaccuracy, and commodification.

DocASAP: Using Technology to Restore Trust in the Physician-Patient Relationship

Fortunately, there are technologies today that guide patients to the correct provider while aligning to the needs of providers and health systems. The most notable of these technologies is intelligent online appointment scheduling. Intelligent online appointment scheduling has many facets, all of which are central to its ability to meet the needs of patients, providers, and health systems.

The components of intelligent online appointment scheduling include:

1. Matches patients with the right providers in the right setting at the right time

2. Increases patient access to care through omni-channel pathways

3. Replicates the health system’s workflows, rules and protocols

4. Gives the provider 100% control over their schedules
 

The best care can be provided by matching patients to the optimal provider based on the patient’s needs. More importantly, in this model, providers and patients are treated as humans instead of commodities. Accurate clinical protocols ensures that patient needs are awarded the consideration they deserve, while accurate operational protocols drive patients to the right provider. Lastly, because DocASAP focuses on retaining patients within a health system, increased retention leads to longer-lasting relationships between the providers and patients.

To summarize, the physician-patient relationship can still be built on trust, even in today’s digital world. To achieve this, however, healthcare technologies must meet the needs of all parties and treat them as humans, not commodities.

Interpersonal Challenges are Common Among Highly Successful People: Here's the Easiest Way to Stop Them

Posting by Tami Berry, M.D.

Posting by Tami Berry, M.D.

Interpersonal challenges become more common and equally important the higher up we go within an organization. Therefore, identifying the interpersonal challenges of successful people is a very important topic that many do not think about regularly. As a physician and general surgeon, I know from firsthand experience the importance of making an active effort to manage interpersonal relationships. In learning about this mostly during my many years as a senior surgical resident, I know the detrimental impact unhealthy interpersonal relationships can have on the workplace, patient care, and one’s overall well being. Any effort we take to improve our interpersonal relationships is a boon to the entire ecosystem within which we live and work.

Clearly, the higher you go in any organization, the more technically skilled the employees are. This holds true in residency training and the healthcare system in general (ideally). As you are climbing your way up the rungs of the ladder, it becomes clear to you that interpersonal skills, or the lack thereof, become more pronounced. In fact, having good people skills often determine how high you rise within an organization or profession, how far you will ultimately go and how high your patient satisfaction scores are. Even if you aren't interested in rising to the highest of ranks, it is obvious that healthy interpersonal relationships are key to the well being of teams, groups and the overall health of the organizations within which we find ourselves involved.

By changing our interpersonal relationships, we are changing our behaviors. In order to do this, we must change our thoughts. While this sounds simple enough, this is no easy task. Change is hard. The reason why change management principles and departments exist is because change is difficult for the majority of the population. Whenever we are seeking to improve anything, I always simply look for the low-hanging fruit first. What are the slightest changes I can make that will have the greatest positive impact? Choosing to be nice to everyone you work with for the day is a great goal to start with. Realistically, it may take an unreasonable amount of energy and effort in terms of the mental and behavioral toll it takes to achieve. A quick way to make a positive change in this category of improving interpersonal relationships would be if we just stopped being jerks and treat people like humans. It is way easier to improve a negative attitude than it is to be nice all the time. Besides, being nice can mean a lot of different things to different people (am I now holding doors for everyone, am I now forced to ask him about his weekend plans, do I have to compliment a certain amount of people a certain number of times, etc.). To be frank, I can't figure out how to be nice all the time. But I can refrain from being a jerk which is something everyone can do all day every day.

To simplify this process, below is a list of behaviors you can stop doing right now to ensure you don't land on the "I'm a jerk list" which is a great list for at work and even at home. If you catch yourself doing any of these top 10 jerky behaviors, make the choice today that you will stop them. Trust me, your colleagues will notice and feel the difference; you may even come off as nice by simply not being mean.

TOP 10 LIST: WHAT TO STOP DOING SO YOU'RE NOT A JERK AT WORK

  • Making Destructive Comments: These are often needless sarcasms and cutting remarks that we think make us look smart or witty, but they only serve to undermine and demean others
  • Not Listening Respectfully to Others: The inability to demonstrate respect for all team players and their contributions. This is a passive-aggressive form of disrespect for others.
  • Passing Judgment or Viewing Others as Beneath You: The need to rate others and categorize or file them in a hierarchical order based on our narrow and sometimes self-serving standards.
  • Negativity that Shuts Down the Input or Opinion of Others: This often shows up as a need to express or show our negative thoughts even when we weren't asked.
  • Failing to Give Proper Recognition and Failing to Express Gratitude: The inability to praise, reward or honor the work of others around you.
  • Claiming Credit We Don't Deserve: This is the most annoying way to overestimate our contribution to any success that happens. It's a quick way to gain resentment from others.
  • Blaming Others Rather Than Taking Responsibility: The selfish need to deflect blame away from ourselves and onto events and other people. "It couldn't be my fault."
  • Refusing to Apologize: The inability to understand consequences and take responsibility for our actions or admit when we were wrong or when we have wronged others.
  • Failing to Recognize How Our Actions Affect Others: The inability to empathize or have compassion for others. This shows a lack of self-awareness and emotional intelligence.
  • Playing Favorites: The inability to see that we are treating others unfairly and not choosing to fix this behavior. This threatens team effectiveness in profound ways.

I know that being nice can be a real challenge. Sometimes just not being a jerk is often easier than trying to figure out how to be nice. When you catch yourself in the act of one of these jerk-like behaviors, then stop. And then ask yourself what other action can you take instead that will have a more positive outcome? Virtually any other option is better than the one you’re about to follow through on. A good strategy is to keep an eye out for how these behaviors show up in your life in overt or even subtle ways. Once you recognize the patterns, you will be more equipped to prepare for them in a non-jerky way. By doing so, you will make life a whole lot better for yourself and all who work with you.

Here's to your well being and the well being of all who meet you, know you, work with you and love you.

Tami Berry, M.D.

P.S. I hope you've enjoyed my Top 10 List: How Not To Be A Jerk. I would love to hear your thoughts and ideas, especially if you've had success not being a jerk today!

Honorable Mention: This blog was inspired by the work of Marshall Goldsmith, specifically his book titled What Got You Here Won't Get You There. A great read from a world-renowned leadership guru. I highly encourage you to pick it up if you have the time. One of my favorite ideas that I took from this book is to decide to stop doing what harms you or others. Instead of making a to-do list today, I made a stop-it list. At the top of my 'stop-it' list was stop procrastinating and write this post! I hope it helps you.