The new healthcare crisis? Doctor burnout, thanks to paperwork.
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A little over two years ago, I wrote a column for The Hill about how frustrated physicians were turning to alternative direct payment models of care to save the "soul" of medicine by alleviating the twin problems of too much paperwork and too little time with patients.

Although Direct Primary Care (DPC) remains controversial among physicians and health policy experts, it nevertheless has gained traction in many local communities and supporters are anxiously awaiting the fate of a national bill that further empowers the model.

Today's column picks up where my DPC column left off, again looking at some of the problems physicians are facing in the current landscape of healthcare delivery. This time, I focus on a larger and more prevalent problem: the alarming rate of burnout and dissatisfaction among physicians.

Physician burnout has increased by 25 percent in just four years. A recently released survey by Medscape asked over 14,000 physicians from over 30 specialties about "burnout," a condition defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment. In the 2017 Medscape report, 51 percent of all physicians reported experiencing burnout, up from 40 percent in 2013.

The main causes reported were "too many bureaucratic tasks" and "spending too many hours at work." These two factors ranked highest among both male and female physicians and were consistent with the findings in the preceding two surveys from Medscape.

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To be sure, the additional documentation required by the growing number of productivity and quality measures directed at physicians from public and private payers has taken its toll. A study last year in the journal Health Affairs found that physicians and their staff spent over 15 hours per week complying with quality reporting requirements at an annual cost of over $15 billion. Another recent study funded by the American Medical Association (AMA) and reported in the Annals of Internal Medicine found that for every hour a physician spends with patients, an additional two hours are consumed completing administrative tasks related to the visit.

 

All this time away from direct patient care has a human price, as alluded to in an article in the Journal of Family Medicine in which the authors purported that the increasingly burdensome regulatory requirements of electronic data entry were "playing a role in dehumanizing our profession."

While these kinds of ever-increasing duties may be necessary to demonstrate improved processes and outcomes with regard to screening for cancer, diabetes, and other conditions, it nonetheless translates into high personal and economic costs for physicians.

Why should we care about unhappy doctors? It turns out that physicians' reduced well-being and satisfaction may lead to diminished physician concentration, effort, empathy and professionalism. Such behavior, in turn, could foster misdiagnoses and other medical errors and suboptimal care.

Studies suggest, and it just makes good sense, that when patients feel connected to their physicians in a shared decision-making relationship, they are more likely to follow their physician's recommendations and have higher levels of satisfaction.

Yet, despite the growing knowledge of the discontent among physicians, there is little belief among those in the trenches that the problem is being taken seriously or that anything is being done to address the problem.

When asked recently in a New England Journal of Medicine Catalyst survey about how their organization is addressing the issue of physician burnout, many of the respondents replied "nothing," "not enough," "paying lip service" or "talking about the problem in committees but no action plan yet." This perceived lack of attention to the problem only fuels the feelings of exhaustion and hopelessness among physicians experiencing stress and often drives them to reduce work hours.

Burnout is a serious threat to physician well-being and patient care. Of the physicians in the Medscape 2017 survey who did not report burnout, 59 percent stated they had great satisfaction with their work compared to only 7 percent of their despairing colleagues, a disturbing finding.

What creates job satisfaction for physicians? An AMA study conducted with RAND Corp. concluded that some of the key drivers of physician satisfaction include having greater control over the pace and content of clinical work and working in an environment that fosters fairness and respect.

Trying to restore these attributes within clinical practice and healthcare organizations would be a good place to begin to heal doctors in distress.

We cannot solve the problem of physician burnout by simply reducing quality improvement reporting requirements or by getting rid of the demands of the electronic health record (EHR). Instead, a good first step would be to adopt a defined set of core quality metrics like the ones that that the National Academy of Medicine recently recommended. This would reduce the burden of complying with competing sets of quality measures and free up more time for face-to-face interactions between doctors and their patients.

Refocusing attention on physician well-being alongside improvements in high quality healthcare is good medicine for everyone.

Carolyn Long Engelhard is the director of the Health Policy Program at the University of Virginia School of Medicine's Department of Public Health Sciences.


The views of contributors are their own and not the views of The Hill.