Earlier this year, researchers with the Massachusetts Medical Society (MMS), the Massachusetts Health and Hospital Association (MHA), the Harvard T. H. Chan School of Public Health, and the Harvard Global Health Institute collaborated to issue a report on physician burnout, aiming to inform and enable physicians and healthcare leaders to assess the magnitude of the challenge presented by burnout in their work and organizations, and to take appropriate measures to address that challenge.
The findings from the report unsurprisingly revealed that inefficient electronic health records (EHRs) are one of several leading causes of burnout among healthcare providers.
“The growth in poorly designed digital health records and quality metrics has required that physicians spend more and more time on tasks that don’t directly benefit patients, contributing to a growing epidemic of physician burnout,” report author Ashish K. Jha, M.D., the K.T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health, and director of the Harvard Global Health Institute, a VA physician and Harvard faculty member, said in a press release statement accompanying the report. “There is simply no way to achieve the goal of improving healthcare while those on the front lines—our physicians—are experiencing an epidemic of burnout due to the conflicting demands of their work. We need to identify and share innovative best practices to support doctors in fulfilling their mission to care for patients.”
The idea that physician burnout has become an epidemic in healthcare is not just a recent trend, but it might have a long-lasting impact. By 2025, the U.S. Department of Health and Human Services (HHS) predicts that there will be a nationwide shortage of nearly 90,000 physicians, many driven away from medicine or out of practice because of the effects of burnout. Further complicating matters is the cost an employer must incur to recruit and replace a physician, estimated at between $500,000-$1,000.000.
As such, industry groups have come together on efforts such as the MMS-MHA Joint Task Force on Physician Burnout to offer recommendations on how to improve. Indeed, this latest report represented a “call to action,” the researchers wrote, “to begin to turn the tide before the consequences grow still more severe.”
Recently, Healthcare Innovation Managing Editor Rajiv Leventhal spoke with key leaders who were involved in the report—along with a subsequent whitepaper on the issue—including: Alain Chaoui, M.D., immediate past president of the Massachusetts Medical Society; Steven Defossez, M.D., vice president, clinical integration at the Massachusetts Health & Hospital Association; and Larry Garber, M.D., a practicing internist and the medical director for informatics at the Massachusetts-based Reliant Medical Group.
The discussion centered around a few key areas: the group’s driving motivation that spurred these efforts; if the burnout crisis has worsened, how physician leaders can improve things going forward; what can be done to improve EHR standards with a strong focus on usability and open application programming interfaces (APIs); what role the federal government could play; and more. Below are part-one excerpts of that conversation, with part two being published in the coming days.
How did all this work around striving to reduce physician burnout begin?
Dr. Defossez: I am a practicing neuroradiologist and also the vice president of clinical integration at the Massachusetts Health & Hospital Association. So I meet with leaders from across the state—physician organizations, ACOs, IPAs, hospital leaders, and others. I also [attended] a [recent] CIO Forum at the Massachusetts Health Data Consortium, and saw Dr. Garber give a presentation about innovations they have put together to optimize the EHR at Reliant Medical Group, including providing individualized training for their clinicians, [resulting] in a wonderful model of team-based care. So I asked Dr. Garber to share some of these innovations with our task force.
Dr. Chaoui: When Dr. Defossez and I sat down in the Massachusetts Medical Society, we compared notes about the importance of physicians’ health and where physician burnout is happening. Then, we saw that the data was showing that physician burnout is skyrocketing—and there has been a lot of research over the years that has shown it’s escalating—and is actually becoming a public health crisis.
So the purpose of the “call to action” paper was to first of all urgently demand action by everyone—the government, healthcare organizations, and others. So we asked for a call to action and we identified six key stakeholder engagements and their responsibilities here: health plans, insurers, and the National Committee for Quality Assurance (NCQA); state and federal agencies; medical schools and residency programs; EHR vendors; provider organizations; and boards of registration of medicine.
We asked health plans and the NCQA to work on important issues such as prior authorizations and referrals. We talked with state and federal agencies to try to eliminate the excessive documentation that really has nothing to do with patient care. We worked with the medical schools and residency programs to help with supporting self-care and counseling services for their trainees. We worked with the EHR vendors, which became the purpose of our second paper. And we worked with hospital and healthcare systems to try and focus on physician health and create roles such as the chief wellness officer.
Your first report made note of health system CEOs who declared physician burnout a public health crisis, while also attesting that the situation has worsened. What key factors do you attribute to that?
Dr. Defossez: The numbers are all over the place, but the situation was clearly worsening from 2011 through the time we wrote this paper. Increasingly over the last two to three years, many have been recognizing physician burnout as an occupational hazard—a workplace condition that needs to be addressed. There are lots of efforts at the grassroots level, as well as our own task force, that are addressing this. The analogy we use at our task force is that lots of seeds have been planted and we’re watering them, and some green shoots are beginning to come up, but it’s still very early and we don’t have a forest yet. However, the workers on the front lines may not yet feel the effects of the improvements that have come in. Dr. Garber and Reliant have been ahead of the curve, trying to use technology innovation to achieve the Quadruple Aim, which is inclusive of clinician satisfaction improvement.
The Mayo Clinic, for example, has [conducted] clinician satisfaction surveys over time showing some improvement and that it’s possible to get better. Some members of MHA have demonstrated the same. It’s a matter of first recognizing the condition, recognizing its underlying root causes, and then identifying best practices to rectify those causes. We have been very active on our joint causes in doing this for the last year-and-a-half.
The goal this year is to get those green shoots tall enough so that the people on the front lines feel them. So we have a few things in the works for this year, including compiling a playbook of best practices from the literature. Googling “physician burnout” will give you 9 million hits; there are plenty of papers out there and we need to compile what is known and what the best practices are, and then help disseminate it.
Part two of this discussion will more specifically focus on the work Dr. Garber and Reliant Medical Group are doing in this area, and how these healthcare leaders see the future.
