Physician burnout is widely considered a pernicious epidemic that puts physician and patient health at risk. Frustratingly, it’s also often assumed that inescapable facts of physician life are to blame: increasing documentation demands; EHRs; and a physician culture that prizes self-reliance and endurance over self-care.
Individual practices may not be able to move the needle at all on these factors, but we don’t have to throw up our hands and give up on avoiding or ameliorating burnout. There are many small but significant changes that managers and owners can make that can have a positive impact on physicians’ work lives, reducing stress and boosting morale — and the great news is these changes often bring other benefits to the practice business.
Fairness and transparency: technology can help
I often write about technology that can help practices run better. It’s one of my favorite topics, partly because I feel that challenging EHR implementations have left many physicians and administrators feeling very skeptical and hesitant to adopt recent innovations — even ones that were developed in a more physician- and practice-focused way. Many newer tech tools can both increase practice efficiency and improve communication and transparency, changing physicians’ work lives for the better.
For example, for specialties with on-call responsibilities, scheduling is often a massive chore. When the process is regarded as a “black box,” it can be a source of stress and distrust. On-call scheduling usually involves a patchwork of requirements and assumptions. When the rules aren’t automated, crafting a compliant schedule is a tedious process usually handled by one or two experts (who had better not get hit by a bus, lest all that knowledge disappear). Even something as simple as two physicians swapping a call can throw a monkey wrench into the works.
Recent tech solutions for on-call scheduling address all these operational issues. They’re marketed mainly as a means to streamline scheduling and reduce errors and liability — worthy and profitable advantages to be sure. But there are happy byproducts of automating the schedule, such as making sure it is easily understood and accessible to all, ensuring the rules are followed fairly, and making changes more manageable. These “softer” advantages foster trust in the system and give physicians back a sense of control over their time. That, in turn, can help physicians plan more and better ways to recharge their batteries away from work.
Improving transparency and communication can also make a big difference in morale when physicians are compensated based on productivity. Often, productivity data is presented to physicians only when annual bonuses are paid — meaning that for most of the year, physicians have no idea whether they’re on pace to meet their financial goals. Using EHR and practice management tools to report progress more frequently — or, better yet, present it in a dashboard on demand — helps physicians feel more trust in the way their compensation is determined.
Staffing for physician satisfaction – and productivity
Most practice managers and physician owners are very focused on staffing expenses and their effect on profitability. It’s natural to look hard at those expenses, since staffing is often among the top two or three practice expenses. Looking at the cost side of staff alone can lead to the incorrect conclusion that minimizing staff boosts profitability, however that mistake can contribute to burnout as well.
As a recent NEJM article observed, as physicians take on more clerical duties, job satisfaction declines, and burnout risk increases. The ability to chart remotely using modern EHRs and mobile devices allows physicians to leave on time, but they often end up doing more work at home. This time-shifting provides an illusion of higher productivity — and may make it seem like physicians need fewer support staff. But it eats away at personal time, grinding away at physician morale, and accelerating burnout.
But what if, instead of reducing staff, practices increased the support for physicians – and asked medical assistants and nurses to do more? As the NEJM article pointed out, providing more staff, and empowering them to help their physicians and non-physician providers in more meaningful ways, is a way to increase productivity. It can even help practices be more profitable, despite higher staffing costs, while giving physicians back some of their personal time. And as a bonus, using MAs, LVNs, and other staff to the fullest of their scope makes their work more meaningful, and so encourages their engagement and morale — helping them avoid burnout, too.
Laurie Morgan is a partner and senior consultant for Capko & Morgan. Her consulting focuses on practice management effectiveness and practice profitability. She is also the author of the recent book People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice as well as the Management Rx series of e-books.