Documentation burdens, misaligned values challenge female providers
Clinical inequalities between the sexes point to needed changes in healthcare IT and service models, or burnout is inevitable.
Workloads for clinicians are undeniably heavy, but an under-appreciated fact is that many female physicians are carrying a larger burden in patient care, increasing the propensity for burnout and disillusionment.
Studies have found that female physicians are more likely than male physicians to receive patient messages on portals and from internal staff, said Eve Bloomgarden, MD, COO and co-founder of Women in Medicine. She noted that female physicians are also more likely to be asked questions about patients’ psychological issues, and they’re also more likely to ask patients questions during appointments.
In a presentation from the HDM KLASroom, Bloomgarden, Subha Lakshmi Airan-Javia, MD, CEO of CareAlign, and Shane Danaher, chief operating officer at Divurgent, examined clinical inequalities for women and how these issues exemplify overarching problems in healthcare.
The presenters noted three specific and cumulative disparities between male and female clinicians. Women spend more time on documentation tasks, find it harder to decompress after work and disagree more often with their organization leaders’ values, they contend.
“And it’s not just about doing documentation—it's also about reading documentation,” Airan-Javia adds. “The average patient chart has over 15,000 words. To give you a comparison, Shakespeare’s longest work, which is Hamlet, has 30,000 words.”
As a result, female physicians end up with more information to process and remember, more data to document, and less time available during clinician hours in which to document, she added. Many physicians complete documentation at home, and because women are more likely to carry family and household duties, taking work home leads to the other problems for females in healthcare.
“We know that women physicians, compared to men, report a much harder time unwinding and decompressing,” Bloomgarden said. “And bringing work home leads to more insomnia. All of these things are contributors to burnout and ultimately stem from the challenges of an overwhelming system of notifications and documentation.”
Dr Eve Bloomgarden, CEO, Women in Medicine: women's challenges with workday decompression.
Conflicting vales are an issue
Danaher expanded on the challenges female physicians face when experiencing discontent with organizational values.
“A 2018-2020 Press Ganey physician engagement survey identified that female physicians are more likely to be out of alignment with the shared values of organizational leadership. That is a key contributor to burnout,” Danaher says. “The system is set up in a way that is causing more volume to be a necessity, and that volume is falling inequitably on the different genders.”
COVID-19 has exacerbated all three of these issues and is causing an exodus of physicians from medicine, particularly female physicians.
Dr Subha Lakshmi Airan-Javia, CEO, CareAlign: misreporting of gender inequities in technology and process capabilities
“I think the last two years have really widened all of the gaps, disparities and inequities that were pre-existing in healthcare,” Bloomgarden said. “Things have been magnified, and the outcome is that women are leaving medicine. We're seeing an enormous shrinking of the of the workforce, and it's really not a sustainable situation.”
Airan-Javia, Bloomgarden and Danaher also discussed actions that could and should be taken to improve healthcare systems and alleviate female clinicians’ burdens.
“I think we need a bit of a revolution in healthcare IT,” said Airan-Javia. “We have this incredible foundation put into place of our data being digitized. What we need now is to take it to the next level and figure out how to make this information useful so that clinicians can deliver better care.”
“The state of healthcare is in crisis,” added Bloomgarden. “We need to adopt crisis standards for documentation and alleviate that burden. We also need to ask who is doing something the best and take their model instead of asking everybody at each individual institution to build things from scratch. The trial-and-error process is being paid for in patient lives.”
Airan-Javia also argued for abandoning fee-for-service models. “I think making improvements really takes questioning assumptions, questioning existing policies, and thinking about why we're doing what we're doing,” she explained. “I'm hopeful for a shift to value-based care and that we can start thinking about care quality instead of just volumes.”
Watch the full discussion: Addressing clinical inequity yo improve equity for all
View highlights of the HDM KLASroom: Improving the care team experience