It’s a progression of symptoms all too commonly witnessed. Clinical burnout for professionals can begin with increasing feelings of stress, followed by slow detachment from their work and their lives. The continuous pressure begins to affect the physiological system as well; headaches and muscle aches arrive and the body feels tired, even if the physician has adequately rested for a night.¹
These health professionals are working endlessly to take care of patients, but who’s taking care of them?
As a company focused on the Quadruple Aim, we believe the overall well being of health professionals must continue to be prioritized when developing value-based care models.
In the context of the COVID-19 pandemic, the crisis has become even more dire and taxing. In a study cited by this TIME magazine article, 62 percent of doctors said that worry or stress related to COVID-19 had a negative impact on their mental health and 55 percent said they felt burnt out when going to work.² These numbers, for obvious reasons, are not very shocking. However, that is not to say, substantial efforts can’t still be made.
In fact, future efforts are imperative. A new American Medical Association (AMA) study suggests that one in five physicians and two in five nurses intend to leave their posts within the next two years.³ In an industry already grappling with workforce shortages, this “Great Resignation,” as FierceHealthcare deems it, could have serious consequences for the care environment. The total cost of burnout in the U.S. due to turnover and reduced hours is an estimated $4.6 billion annually.³ These predictions shouldn’t be taken lightly. According to other studies the AMA has performed, numbers reveal that approximately one-third of physicians who indicate moderate or high likelihood to quit their jobs within the next two years actually do.³
“1 in 5 physicians and 2 in 5 nurses intend to leave their posts within the next two years.”
The time to act is now. Clinical leaders could begin by recognizing symptoms of burnout among their fellow health professionals and then work to identify the drivers of it.
Outside of the COVID-19 pandemic, some other top causes of burnout can include⁴:
- Demanding administrative tasks/paperwork
- EHR fatigue
- Discrepancies with insurance companies over prior authorization and other payer requirements
- Loss of work-life balance, from high volume or staffing shortages
- Worries about revenue loss or reimbursement rates not keeping pace with costs of care delivery
- Loss of alignment with the organization’s mission or vision following an acquisition by a competitor hospital or other entity
The following are various solutions to help organizations build a more efficient care environment so we can all help retain and appreciate the health professionals that make quality care possible for our patients.
Solution 1: Realigning Work Environments to Organizational Values
As noted in the last section, an organization’s internalized values can have a great impact on a health professional’s sense of ease. Implementing Quadruple Aim principles allows the health professional to realize that the future of health care includes building a better future for them.
In the context of COVID-19, health professionals have been severely overworked. Nonetheless, many still felt good about what they gave back to their communities in the past two years.²
“Even though nearly 30% of all physicians experienced high stress related to COVID-19 and 29% had substantial levels of work overload, 46% of doctors had an enhanced sense of meaning and purpose during the pandemic,” says the TIME article. “In fact, more than half felt valued by their organization.”²
The AMA reported in one survey that odds of burnout were 40 percent lower in those who felt valued by their organizations.⁵ Part of feeling valued, the AMA says, can include giving clinicians more control over their schedules and time commitments.⁵
“For example, if a physician’s workplace is causing burnout, she will experience lack of autonomy and control,” Sara Berg for the AMA says in another article. “In other words, the doctor may often feel like she doesn’t have a say in her work. And, while telling them to practice yoga may help on an individual level, it does not fix the system—it is just a Band-Aid.”⁶
The simple act of considering health professionals in workflow changes, and asking for their input, could be monument for shifting their burdens.
Solution 2: Give Physicians More Control
In one study focused on physician burnout, published in the Journal of the American Society of Plastic Surgeons, researchers suggest that physician happiness is not correlated with the workload, but the perceived ability to manage it.⁷ As stated above, a health professional’s sense of power can impact how burnt-out they feel. Work-life balance has a different definition for everyone, and is always determined by the individual, rather than the organization. However, remedies to physician burnout should come from the organization, which has the power to change the circumstances, rather than from the individual who is already tackling this internal crisis.
“Although individual-based interventions can help to promote positive attitudes, bolster confidence, and decrease depersonalization, they do not necessarily result in decreased levels of burnout,” says the aforementioned study. “As such, these efforts have been criticized as misguided and even victim-blaming, as research has demonstrated that burnout is a response to the environment, necessitating greater focus on organization-directed interventions to reduce burnout.”⁷
Part of giving physicians more control could include allowing them flexibility to reduce work effort, and modify work hour distribution and start times.⁷ If a clinician is permitted to do work they’re passionate about, they’re also less likely to experience the same rates of burnout. Mayo Clinic found that when academic physicians have less than 10 to 20 percent of their work time to do what they care most about, their burnout rates rise to above 50 percent.⁸ The same can probably be said for other genres of clinicians. Consider asking clinicians what they enjoy doing the most and where they see themselves investing their talents. Nurturing these passions could also mean allowing paid time for continued education. This not only means more valuable time gained by the clinician, but could also translate into higher quality care for the organization as well.
Solution 3: Invest in Partnerships to Reduce Tasks to the Essentials
A health professional’s top priority should also be providing quality medical care. However, too often we see them riddled with administrative and technological tasks that take more time than the actual care work. This can leave health professionals feeling overwhelmed and uninspired.
The AMA says that even a small drop in task load can greatly reduce physician burnout; for every 10 percent drop in task load, there are 33 percent lower odds of a physician experiencing burnout.⁹
“Medicine is a mentally and physically taxing career. Some features of the environment, such as poorly implemented technology and low-value administrative tasks, add greatly to the cognitive workload,” said Dr. Christine Sinky for the AMA.⁹
The first step to reducing some of these burdens could include partnering with technology companies that automate some processes for you. For example, choosing EHRs with high patient and clinical usability can reduce the burden of time spent learning and explaining how to use it. Clinical leaders might also consider having an EHR that triages messages and alerts to only the health professionals who need to act on them. This stops irrelevant messages from flooding other health professional’s inboxes, which can often be an overwhelming sight.
A partner like Certintell could be a seamless solution for your physician burnout needs. As a Managed Care Organization (MCO), we can help streamline certain clinical services in partnership with your health system. Annual Wellness Visits (AWVs) and health risk assessments fall under our scope of care with our highly trained medical team. Remote Patient Monitoring is our specialty for high-risk patients, including Care Management services like Chronic Care Management, Behavioral Health Integration and more. We also handle billing and eligibility checks for your telehealth needs, reducing the amount of hiccups you have when trying to implement more efficient procedures. Moreover, our certified health coaches can work with your patients outside of your office hours to drive behavior change. This ensures that each time you see your patient, they will be better than the last time, allowing you to see promising results, rather than frustrating and stagnant metrics.
Several studies exploring physician burnout also encourage the use of medical assistants (MAs) alongside clinicians. In a family medicine program at Colorado University, medical assistants were involved in a startup program in which they performed the initial workup including history taking, reconciling medications, scheduling visits, administering vaccinations, and providing information regarding health education and preventive care. In turn, this helped physicians concentrate on physical examination and medical decisions. Although the medical assistants had to go through extensive training to be effectively work semi-independently, they were an overall cost-neutral expense for management. In the end, burnout rates for these clinicians decreased from 53 percent to 13 percent in six months.⁸
Forming partnerships can help alleviate health professionals from their excessive hours, while also addressing staffing shortages. Medical staff, such as health coaches and medical assistants, provide a fresh opportunity for collaboration that affords everyone the ability to flourish in a balanced working environment.
Solution 4: Invest Leadership and Stakeholders in the Effort to Reduce Burnout
Again, the most effective drivers of change come from the top. Clinical leaders can take certain measures to ensure the needs of their health professionals are being listened to and acted upon. These steps can include:⁷
- Recognizing the burnout problem, the role leadership can play in its prevention and be open and willing to change the care environment
- Developing a team of invested stakeholders and physicians whose purpose is to perform needs assessments of the organization and identify major drivers of burnout at that specific organization
- Developing and implementing specific and targeted solutions for those identified drivers of burnout
- Measuring outcomes and impact on burnout so that modifications for improvement can be made
The TIME piece cited earlier in this article continued to highlight the benefit of peer connection and the impact of a lent ear.
“What’s really great about peer support, or just the whole idea of working toward providing emotional support for clinicians, is you get almost no pushback,” says Dr. Jo Shapiro in the TIME article. “I think people want to talk to someone who’s been there and knows what it feels like.”²
Take for example, Mount Sinai who developed a smartphone app to provide support for health professionals when in-person conversations couldn’t always be had. The app offered feedback on the staff’s levels of anxiety, depression, PTSD and overall wellness. It also provided resilience training and other educational resources. In all, the app only took a month to build.² Small efforts like this can have a big impact in showing staff that the leadership cares and is invested in their health as much as they are in the patients’.
Next Steps: Take Action Against Clinical Burnout Today
There are many steps that can be the right first steps to take when it comes to addressing burnout for your organization. If you want to talk more about the Quadruple Aim and what it could look like at your organization, contact us today to see what innovative care models other organizations are implementing to simplify and streamline their workflows.
SOURCES:
¹ TeamHealth. “Avoiding Physician Burnout: Symptoms and How to Address It.” TeamHealth, 9 Apr. 2020, www.teamhealth.com/news-and-resources/white-paper/avoiding-physician-burnout.
² Howley, Elaine. “Caring for the Caregivers Post-Pandemic.” Time, 21 Sept. 2021, time.com/6099936/doctor-burnout-pandemic.
³ Kreimer, Susan. “‘Great Resignation’ Could Be Coming for Healthcare as Clinicians Face Mounting Burnout and Stress, Study Finds.” FierceHealthcare, 22 Dec. 2021, www.fiercehealthcare.com/practices/burnout-workload-and-fear-infection-compel-physicians-and-nurses-to-reduce-hours-or-leave.
⁴ “Even as COVID-19 Pandemic Eases, a Physician Burnout Epidemic Continues.” MGMA, 27 Oct. 2021, www.mgma.com/data/data-stories/even-as-covid-19-pandemic-eases,-a-physician-burno.
⁵ Berg, Sara. “5 Solutions to Help Ease Physicians’ COVID-19 Burnout.” American Medical Association, 1 June 2021, www.ama-assn.org/practice-management/physician-health/5-solutions-help-ease-physicians-covid-19-burnout.
⁶ Berg, Sara. “COVID-19 Put New Emphasis on Need for Physician Burnout Solutions.” American Medical Association, 16 Nov. 2021, www.ama-assn.org/practice-management/physician-health/covid-19-put-new-emphasis-need-physician-burnout-solutions.
⁷ Carrau, Diana, and Jeffrey E. Janis. “Physician Burnout: Solutions for Individuals and Organizations.” Plastic and Reconstructive Surgery – Global Open, vol. 9, no. 2, 2021, p. e3418. Crossref, https://doi.org/10.1097/gox.0000000000003418.
⁸ Patel, Rikinkumar S., et al. “A Review on Strategies to Manage Physician Burnout.” Cureus, 2019. Crossref, https://doi.org/10.7759/cureus.4805.
⁹ Berg, Sara. “Even Small Drop in Task Load Can Cut Odds of Physician Burnout.” American Medical Association, 5 Nov. 2020, www.ama-assn.org/practice-management/physician-health/even-small-drop-task-load-can-cut-odds-physician-burnout.
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