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Physician Burnout – A National Crisis

Tuesday, May 15, 2018   (0 Comments)
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Warren Johnson, MN, RN(ret.), CEO, Scribe-X Northwest and Med-X Joshua Hurwitz, MD Medical Director, Scribe-X Northwest and Med-X

 

Scribe-X is a Bronze Welcome Reception Sponsor and Wine Tour Sponsor for the 2018 Spring Primary Care Conference

 

Overview
Burnout among America's physicians is well documented. Doctors face increased pressure to see more patients, yet growing dissatisfaction with the type of duties medicine requires, and time it takes to complete the work, has become untenable for more and more physicians. As a result, many physicians are leaving clinical practice. Many strategies have been employed to address this issue, including changing compensation and benefits, outsourcing more clinical support and administrative services, as well as changing staffing matrixes. The intervention that has provided the most significant and measurable impact on physician satisfaction is the implementation of a medical scribe program. The Journal of Family Medicine, April 2017 article "Can scribes boost FP's efficiency and job satisfaction?" finds that medical scribes can achieve both without negative impact on the patient experience. Furthermore, this can be achieved while generating a positive return on investment.

 

Problem
Historically the term "physician" referred to a medical doctor, but in the modern healthcare landscape that term can be applied to doctors, physician assistants, nurse practitioners, and resident physicians. These highly trained care providers are seeing more patients than ever before. At the same time, nonclinical work, primarily in the form of interacting with the electronic medical record, takes up an increasing proportion of the physician's workday. This takes time away from their families, hobbies, professional development, volunteer and community involvement, and activities that keep them healthy and happy. The resulting decrease in quality of life has led to an epidemic of physician burnout. The Mayo Clinic reports that physician burnout now affects 54% of physicians, and those who self-reported burnout are more likely to quit.

 

Clinics and hospitals face greater economic pressure than ever before. In order to stay competitive, these organizations must ensure their providers see as many patients as possible. The Affordable Care Act in particular has led to a greater number of patients seeking care than in years past. At the same time, the number of physicians retiring exceeds the number of physicians, physician's assistants and nurse practitioners being entering the workforce. Meanwhile, each clinical encounter requires extensive administrative and clerical work by the physician. Such tasks are generally dissatisfying among physicians. The most onerous among these duties documenting in the medical record. Patient visits require increasingly nuanced documentation in order to meet compliance requirements generate payment for the visit. This increase in documentation time is perhaps the main contributor to physician job dissatisfaction and burnout.

 

Solutions
There are many ways to address physician burnout, but few have shown as much promise as the implementation of a well-designed medical scribe program. Recent articles in The Atlantic and Journal of Family Practice describe how medical scribe programs can positively impact the following areas:

 

  • Physician Satisfaction - reducing the amount of clerical work, reducing the time at the key board and restoring the focus to the patient
  • Efficiency - through a reduction in documentation time and a net increase in patient contact time, the ability to see more patients during equal amounts of patient contact time
  • Revenue - adding new revenue often adding twice the investment or more

Given all of the financial pressures, in some ways, it seems counter intuitive to add another member of the team. However, when that member can have such a direct impact on the workflow, charge and metrics capture while enabling the physician to see more patients...it doesn't make sense not to.

 

Evidence
The scientific and anecdotal evidence continues to grow as more and more specialties, academic institutions, small and large health systems implement various medical scribe solutions.

 

In the Journal of Family Medicine study excellent results were achieved through outsourcing the medical scribes. The articles listed below are a small sample of what is available in the literature:

 

Mayo Clinic Proc. 2015 Dec: 90(12):1600-13 Shanafelt TD et. Al Changes in Burnout and Satisfaction with Work-Life balance in physicians and the General U.S. Population between 2011 and 2014

 

The Atlantic: The Burnout Crisis in American Medicine "Are electronic medical records and demanding regulations contributing to historic doctor shortage?" May 11, 2018

 

Journal of Family Medicine, April 2017 "Can scribes boost FP's efficiency and job satisfaction?"

 

Recommendations
Patients deserve the best care possible. Addressing physician burnout requires thoughtful steps reduce as much clerical work as possible. Medical scribes are in the best position to provide this service.

 

We recommend partnering a medical scribe organization as a strategy to avoid common pitfalls of bringing the program in-house. Piloting a program with a partner that has proven quality in training, staffing and support. Partners who truly customize the service to each physician and clinic. Federally Qualified Health Centers have some unique needs and require an even higher level of customization and support.

 

We are available to answer any questions and to provide additional resources.

 

 Warren Johnson Joshua Hurwitz 
 Warren Johnson, MN, RN(ret.), CEO, Scribe-X Northwest and Med-X 

Joshua Hurwitz, MD Medical Director, Scribe-X Northwest and Med-X 

 

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NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.


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