A patient with diabetes frets because their out-of-pocket cost for insulin is $250. The doctor empathizes with her, but realizes there’s little they can do to help.
Physicians on average spend more time on their EMR than on patient contact, and one or two more hours of data input at home every night, studies show. How do physicians – who only want to connect with their patients – deal with that?
COVID-19 strikes, staff are laid off, and those remaining worry about contracting the virus or carrying it home. Meanwhile, physician-owners worry about keeping their practices and livelihoods alive.
Now, you’re the sales rep, calling on that office. How do you maintain a productive relationship with them?
‘Moral injury’
In 2019, for the first time since 2011, the physician burnout rate dropped below 50% among doctors in the United States, according to a triennial study conducted by researchers from the American Medical Association, the Mayo Clinic and Stanford University School of Medicine.
“Growing national efforts to address physician burnout are on the right track, but more work is needed to achieve meaningful change,” said then-AMA President Barbara L. McAneny, M.D. “Addressing the crisis requires continued investment from the health system in a comprehensive strategy that targets barriers to efficiently providing patients with high-quality care as the primary driver of physician burnout.”
Jeff Panzer, M.D., MS, vice president for care transformation at Heartland Health Centers, a network of federally qualified health centers in Chicago, prefers the term “moral injury” to “burnout.” “The term ‘burnout’ could imply there’s something inherently wrong with the individual provider or care team member,” he said. “Moral injury,” on the other hand, points to the systems factors that are the reason for burnout. “It’s the idea that you know what you need to do to help people, but you’re not able to.”
Many people point to electronic medical records systems as a contributor to burnout. “EMRs have made things more complicated,” said Panzer. With a master’s degree in quality, he believes in the value of measurement and quality, neither of which can be accomplished without smart technology. But too often, administrators and regulators have settled on surrogate measures for quality, and applied them in a rapid – and sometimes lazy – way, he said. “We went from no measurement or poor measurement, to this. We measure things that aren’t reliable indicators of quality, just because they’re measurable.”
Fix the workplace, not the workers
Christine Sinsky, M.D., vice president of professional satisfaction for the American Medical Association, said burnout is nothing new. But in the past 10 years, it has been more widely studied, understood and talked about, she said. The AMA has aggressively addressed the issue through initiatives such as its Practice Transformation program, Steps Forward™ and the Joy in Medicine™ recognition program.
Studies show that physicians are highly resilient, that is, they adapt well to stress, she said. “The problem is the workplace and chaotic work environments, not individuals. The interventions that are most effective are those that work to improve leadership, address values alignment between leadership and the front line, institute a sense of fairness in the organization, increase teamwork, and decrease clinical burden.”
An important driver of professional fulfillment and better patient outcomes is a sense of autonomy, she continued. In large, health-system-owned practices as well as smaller ones, that can be reinforced by pushing decision-making authority to those who are closest to the patients. It also calls for strong leaders, who can strategically delegate work and eliminate unnecessary tasks.
Part of a team?
Administrators, consultants and others have tried to address burnout in predictable – but not always effective – ways, said Andy Swanson, vice president of industry insights, Medical Group Management Association. For example, they have tried rewarding physicians financially for meeting certain goals. “This has led to some positive financial results, but it also has led to problems insofar as longevity, engagement and clinical issues are concerned.”
Another approach is emphasizing exercise, wellness and nutrition. “None of these things are bad,” he said. “But I would argue that they miss one of the most important facets of work, which is, ‘Do you feel part of a team?’” Physicians may not think to ask themselves that question. Traditionally, they have been captains of the ship. But in doing so, they end up being an island.
The fee-for-service approach to medicine, which leads to wall-to-wall patients throughout the day, exacerbates the problem, said Swanson. “Production makes good business sense, but the work processes are skewed.” Electronic health records can contribute to stress when they are used more as financial tools than as clinical tools.
Said Hari Prasad, CEO, Yosi Inc., “Any medical practice that accepts insurance and uses electronic medical record software requires a tremendous amount of administrative bandwidth to ensure documentation is completed in order to get reimbursed. So, in a way, most medical practices experience significant burnout due to a high need for managing documentation and insurance needs.” A solutions partner of Henry Schein, New York-based Yosi is a developer of patient intake and registration systems.
Sales reps: ‘Tread lightly’
Sales reps who walk into a practice that is showing signs of burnout should tread lightly, advised Kevin Barefoot, territory manager for MTMC, an outsourced sales organization. “End-users and clinicians tell me the shorter the emails and the shorter the sales pitches, the more success the sales rep will have.”
Clinicians are looking for solutions for their problems, such as how to prevent infection issues or deal with long lead times on essential products, said Barefoot. “Bring supportive clinical evidence for products and solutions, and let them know about nearby health systems that are using them. Help them find products you may not even carry. Ask them how they are handling things right now in their practice. This will help you to connect on a personal level.”
Said Swanson, physicians may not openly admit they feel burned out, but they will talk about the things that irk them, such as their EMR, paperwork, or simply being unable to spend quality time with patients. “Sales reps are experts on products and services that can improve customers’ clinical situations,” he said. “I would advise they tell their customer, ‘I understand you’re frustrated; is there some way we can help you with that today?’ Even if it’s an incremental solution, that physician knows there’s one more person helping the practice.”
Sidebar:
Resources
- “Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being,” National Academies Press, 2019.
- American Medical Association: Joy in Medicine™ recognition program. Designed to guide organizations interested, engaged, and committed to improving physician satisfaction and reducing burnout.
- American Medical Association: Steps Forward™, https://edhub.ama-assn.org/steps-forward. More than 50 modules on topics including: practice transformation, burnout and well-being, EHR and technology, organizational culture, patient-physician experience, team-based care and workflow.
- American Medical Association, “Caring for our caregivers during COVID-19,” March 2020. Practical strategies for health system leadership to consider in support of their physicians and care teams during COVID-19.