From Bob Rauner, MD, MPH, FAAFP
Physician burnout is an issue I’ve been interested in for a long time. In part because I’ve been there myself and want to avoid it again. There are a lot of misconceptions out there, including some folks who treat it as if it’s a psychiatric malady suffered by physicians as opposed to a predictable response to a crappy work environment. Several of my favorite physician bloggers, Drs. Roy Poses and Bob Centor, have a great article on the likely causes of physician burnout this month at Medscape.com, if you don’t want to sign on to Medscape, Roy Poses’ version is on his own blog as well as Bob Centor’s on his blog. I strongly encourage you to read their posts!
My opinion is that the main causes are:
- A flawed payment system that encourages a short visit/hamster wheel style of practice that produces a conflict between what physicians know is best for one-on-one continuous care and the productivity demands necessary to maintain your margin.
- A move from an independent to an employed practice that often puts physicians under leaders who do not strike a good balance between margin and mission.
- A toxic legal and political environment for healthcare.
The most encouraging thing for me lately is the enthusiasm I’ve seen from the physicians involved with the Nebraska Medicaid Patient-Centered Medical Home pilots in Lexington and Kearney. The last I talked with the lead physicians of these clinics, they said they were more enthusiastic about the practice of medicine now than they have been in the last 30 years! The pilot projects conclude next month and the preliminary results on quality and cost are very encouraging. This is now transitioning into a similar amount of enthusiasm for physician-led accountable care organizations which offer the potential for aligning several incentives we all value – more pleasant care for our patients, better margins for clinics without hamster wheel productivity pressures, a team-based approach and the potential to see measurable improvements in the health of our patients. Who doesn’t like to see objective evidence that they are doing a good job taking care of their patients?
But what about EHRs? Will they help or hurt? I honestly think it depends on the execution (Bo Pelini’s next most favorite word after “football” during his interviews :). If it’s an EHR selected by the finance guys that is not very user friendly and turns physicians into $10/hour data entry clerks, things will get much worse. If there is flexibility that frees physicians from data entry (combinations of good templates, voice recognition, selective continued use of dictation, effective use of clinic staff to document chart sections that don’t require physician data entry and the option of scribes) and the addition of tools that help physicians take care of their patients (disease summary screens, disease registries, better communication tools), then I think EHRs could make a big improvement. Unfortunately, I think it’s too early to tell which way things will shake out, but I am optimistic. Especially with the potential of Patient-Centered Medical Home and physician-led Accountable Care Organizations in Nebraska.