EHR modifications, data analysis become tools to fight doc burnout

Physician burnout continues to plague healthcare organizations, and at Privia Health, the financial hit can be an estimated $1 million for each physician that leaves and has to be replaced.

That can be a huge hit for the company, a national physician organization that provides services through high-performance physician groups, accountable care organizations and population health management programs, says Joseph DeVeau, MD, who is the virtual health medical director for Privia Medical Group.

DeVeau, who has survived his own case of burnout as a family doctor, knows many of the causes. Electronic health records systems are often cited as one of the causes of physician workloads, serving as a possible prelude to exhaustion and lack of desire to continue in the profession.

But the problem is multi-faceted, and with awareness of the causes and analytics of data intended to keep a careful eye on physicians’ work-life balance.

In a presentation at this week's annual conference of the Medical Group Management Association, DeVeau highlighted the widespread nature of burnout. Nearly 44 percent of American physicians—including 54 percent of family doctors—exhibit at least one symptom of burnout, which includes emotional fatigue, cynicism, depersonalization and a loss of meaning in work.

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“Without intervention, we will see decreased quality of care provided, decreased access to care and increased costs,” he said. Other data indicates that physicians in large health systems are more likely to exhibit characteristics of burnout, although doctors in all health settings are at risk.

That’s because pressure is rising in many aspects of clinicians’ jobs, and technology has added to the problem instead of relieving it. Surveys of clinicians suggest that records systems take up at least 33 percent of their time, and 49 percent of their time is spent doing what they perceive to be clerical work.

Surging information access is not only causing overload for physicians, but they’re encountering patients who often come armed with Internet-accessed medical information, some of it of dubious quality.

Meeting regulatory requirements—often involving data collection and payer demands for transparency—also adds to the crushing load.

The litany of results of burnout include decreased patient satisfaction, the increased likelihood of medical errors and then litigation, and patients’ belief that overworked physicians are not interacting with them at a high level. And physicians who are burned out often end of impacting the work of other members of the medical team.

“For our organization, we estimate that there’s a total cost of $1 million for each physician lost,” DeVeau said, although other organizations suggest replacement costs of $500,000 to $1.3 million per physician. “So if we lost 25 physicians, that was a hit of $25 million.”

To combat the trend, Privia has taken steps to rebuild its physician community, fostering physician engagement and helping them with adjunct services to increase their effectiveness as clinicians, rather than remaining hyper-focused on organizational efficiency.

That trend is growing nationwide, as the country wrestles with the physician burnout problem. A study recently published in Medscape estimates that 45 percent of healthcare organizations now are offering programs for physicians to reduce stress and burnout.

Privia has started a physician wellness strategy, an effort that is physician-led and physician-driven.

Part of the effort involves taming the EHR burden by optimizing the use of the systems in place. Reducing the workload involves using macros to aid in documentation or smart sets for frequently used treatment protocols. “We try to reframe how they view the EHR, seeing it as a tool and not an adversary,” he said. He also suggested that organizations consider using virtual scribes to help ameliorate the documentation burden.

Telehealth also is lessening the burden for physicians at Privia. It’s now doing 1,000 visits a month with the technology, and it’s embedded within its EHR, DeVeau adds.

The organization also is using data collection and analysis to keep an eye on physician work and well being. It surveys doctors twice a year, and then regularly talks to physicians about their profiles. “We tell them that we need to hear from them about what we can do to help them out,” he said. “The best way to prevent physician burnout is to change the organizational structure and processes that lead to burnout.”

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