 is president of CompHealth, the nation’s largest provider of locum tenens physicians and founder of the traveling physician industry. She joined CompHealth in 2001 as a sales consultant and served in a variety of management roles prior to being named president in 2017. Lisa is passionate about building lasting relationships and helping her team members reach their highest potential.

Lisa Grabl 

One year into the COVID-19 pandemic, many healthcare workers have been pushed to their limits. Perhaps understandably, many are reevaluating their career decisions. We wanted to learn more about how the pandemic has affected providers’ career planning, work satisfaction, and burnout, so 

 more than 1,200 physicians, nurse practitioners, physician assistants, and registered nurses to find out.

The results revealed a workforce that’s burned out, overworked, and in need of greater work/life balance. While these facts are especially alarming in the face of an already existing provider shortage, the insights we received can also help employers better understand their employees and take steps to improve their experience.

Providers’ career satisfaction has declined over the past year, the survey showed, with 43% reporting that the pandemic has had a negative impact on how they feel about their jobs.

It’s also increased burnout, which already affected a substantial number of providers (80%) pre-pandemic. Nearly two-thirds (64%) of respondents reported that the pandemic has made their burnout worse, and that number was even higher for those working in frontline roles like emergency medicine.

Employer response to the pandemic was positive

Despite these grim numbers, the majority of providers (69%) felt their employers did a good job responding to the pandemic. Three-quarters (75%) felt they had sufficient PPE and 70% felt safety protocols were being followed.

That said, providers did find areas where they felt their employers were lacking, with many reporting insufficient staffing levels, inadequate compensation, and inefficient work processes. Nearly a quarter (22%) felt their concerns weren’t listened to, and 26% said they didn’t agree with the decisions their employers made.

We also asked providers what was most important to them in their careers. After a year of nonstop work for many and furloughs for others, it’s unsurprising that 83% reported work/life balance as the most important factor, followed by job stability (78%).

Workplace culture was also mentioned as an important factor, with 76% rating it as important, slightly ahead of compensation (75%). These numbers are telling, and employers should keep in mind that creating a positive work environment is equally important as a fair paycheck.

Despite the past year’s challenges, 95% of respondents said they plan to continue working in healthcare, and most (87%) plan to stay in their current role for the time being.

Yet when asked if they plan to continue in their current position past 2021, that number dropped to 76% -- meaning nearly a quarter of physicians may be looking to change employers soon.

Revenue Cycle Management: Benefits and best practices

With large numbers of providers considering changing employers, organizations that are savvy enough to listen to providers’ needs can benefit. The insights provided by this survey are a good starting point to figure out how to attract – and keep – talented providers.

While compensation is clearly important, we’ve seen that many providers rank other considerations higher when making career decisions. Finding ways to promote true work/life balance among staff can lead to greater career satisfaction, less burnout, and happier employees.

Strengthening your workplace culture is also worthwhile, as we’ve seen providers find this just as important as compensation. At CompHealth, our strong workplace culture is always top of mind, and it’s helped us retain highly-engaged and talented employees. We make time to celebrate our successes, but we also take feedback seriously in an effort to continuously improve our workplace culture. 

The pandemic has negatively impacted many aspects of healthcare, and it’s also highlighted struggles providers have dealt with for years. Yet bringing attention to these deficiencies also gives us an opportunity to ameliorate them. It’s now more important than ever to consider how we can improve our healthcare providers’ experiences at work so they can keep doing what they do best—caring for patients.

, the nation’s largest provider of locum tenens physicians and founder of the traveling physician industry. She joined CompHealth in 2001 as a sales consultant and served in a variety of management roles prior to being named president in 2017. Lisa is passionate about building lasting relationships and helping her team members reach their highest potential.

Articles

It’s now more important than ever to consider how we can improve our healthcare providers’ experiences at work so they can keep doing what they do best—caring for patients.

Healthcare providers career satisfaction is dropping 

Nurse practitioners and PAs are crucial parts of any healthcare system, but determining how they can best contribute to the success of your practice or organization takes research and planning. Advanced practice providers (APPs) combined with physicians can help lower costs, improve patient outcomes, and deliver quality and timely patient care.

There are a variety of models for APP practice around the country. Regardless of which model you are using it is important to ensure you are using the fullest extent the law allows. Some states allow APPs full autonomy, but some practices are tempted to still have a physician see every patient so they can receive full re-imbursement. Utilizing APPs may let those practices bring in more patients allowing physicians to focus on higher acuity patients. Providers may be getting a reduced rate, but it could increase the volume they’re seeing for their practice.

It is also important to periodically check the state regulations for any changes, especially if those changes expand what APPs can do.

7 Financial Reports Your Practice Needs to Run

How your APPs provide care and interact with patients will vary depending on your facility’s goals and state regulations. In some facilities, physicians and APPs share a patient panel, while others have APPs manage their own patients.

Some specialties lend themselves better to APPs working independently. For example, a family nurse practitioner may be able to easily take on their own case load without physician oversight. On the other hand, surgery specialties often require the oversight of a physician but can be utilized for pre-op and post-op rounding, and even act as first assistant during surgeries.

Some facilities have patients first see a physician for diagnosis then schedule follow up visits with an APP. In some cases, this allows the facility to still bill under the original provider and get 100% of the compensation in ‘incident-to’ billing.

Facilities where APPs operate independently may not be able to bill as much for these visits, but it doesn’t necessarily decrease profit margins. Paying your APPs commensurate to the reimbursement rate can help you balance your profit margins.

“There’s a lot of gray area in work for APPs,” says Ronna Smith, manager of APP clinical education at 

. “The first thing we do as a leadership team when we’re analyzing whether or not a team should add an APP is get to the nitty gritty of ‘what is the work?’ What do they envision the APP doing? Is it billable? Does it require medical decision making? Is it provider-level work?”

It’s important to include APPs in making these types of decisions. They have great perspective and can bring ideas for how to set up your model.

“It’s important for physicians to understand the strengths and weaknesses that APPs come to the table with,” Smith says. “APPs can rise to any challenge you put in front of them. But to make it as successful as possible, you need intentional training and a good care model plan.”

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After incorporating APPs into their organization, Smith says the change at Seattle Children’s Hospital has increased provider flexibility and allowed them to provide better care and education to families.

“Our model is very collaborative where nurse practitioners and physicians work together within various teams,” says Smith. “If a child is on the schedule to see if they need a tonsillectomy, the initial work is done by a nurse practitioner. If the NP feels that child should move forward with a surgical plan, they pull in a surgeon who is working with them in the same clinic. The surgeon would verify the exam findings and the plan, answer any questions the family might have, and then that child would go on that surgeon’s schedule. So, in that same visit, the family would see an NP who would do the bulk of the work, and the physician can spend more time in the operating room.”

During the 2020 pandemic, the model has also helped the hospital be flexible and adaptable. “We have an 

, and those learners are assigned to multiple areas of the hospital during their training year,” says Smith. “They’re credentialed to be in multiple places, they’re used to changing assignments frequently. We had a whole contingency staffing model in place, and the adaptability of our past and present APP fellows on our staff is what made that model possible.”

Whether you run a hospital system or a small practice, including APPs in your healthcare staffing model can help you reduce cost and generate revenue while still providing high quality care to patients.

Nurse practitioners and PAs are crucial parts of any healthcare system, but determining how they can best contribute to the success of your practice or organization takes research and planning. 

Making the most out of PAs and NPs

Physician burnout was a problem before COVID-19 appeared, and the pandemic has only increased the levels of burnout among all of our healthcare providers. During a recent webinar with Locumstory.com, Dike Drummond, 

, shared how to spot burnout as well as ways to combat it.

The primary symptom of burnout is exhaustion, both physical and emotional, says Drummond. He compares doctors to parents: both often put someone else’s interests ahead of their own, regardless of the circumstances.

The second symptom of burnout is cynical sarcastic venting, also known as compassion fatigue. “Venting can be dangerous. It's never healthy but I see a lot of doctors who are under stress, and who will get upset for righteous reasons,” says Drummond. “They'll go and vent on the table, get angry, and vent just enough steam that it gives them the ability to go back out into their practice and keep doing the very same thing.

The final symptom is asking “What's the use?” or a loss of hope and vision. Drummond says this is when you begin to doubt the purpose and meaning in what you do, and you start to fear that if something doesn’t change, it may negatively affect your patients. 

Taking those traditional burnout symptoms and throwing in a global pandemic is not a recipe for success. The pandemic has added a whole other level to what physicians face on a daily basis. You may be treating COVID-19 positive patients and dealing with the stress that comes from that; or, you may not be treating any patients due to the drop in elective procedures and patients who are fearful of COVID-19.

”Everybody who's been involved in the carnage is traumatized. There will be PTSD in the wake of this,” says Drummond. “Then there's the economic impacts on you and your finances, on the shellacking the healthcare industry has taken, especially in the second quarter of this year, the general economy, then there's an election, political polarization, shooting in the streets, a potential second wave that we may be in the middle of right now. It just never ends.”

This perfect storm of stressors makes life at work harder while also making it more difficult to recharge when you are at home. Drummond talks about how these added worries make it more important than ever to focus on taking good care of yourself and your family.

“You also need to take care of the people that are closest to you on your work teams, the people that help you see patients in your intimate work team and your call rotation,” says Drummond. “Take really good care of each other, have each other's back, check in early and often. These are extraordinary times, and we are nowhere near the end of it.”

So, you know you’re burned out and the pandemic is just making things worse—what now? Dr. Drummond outlines three ways to help you identify what you can change to feel less burned out.

 Write it down. What kind of patients do you want to see, what do you want to do, how much do you want to be paid, etc. Keep writing until you have documented everything you are looking for.

 Compare your ideal practice with your actual practice. Identify areas where they overlap.

Build a plan to match your current practice with your ideal plan.

 Figure out what needs to happen to align your current practice with your ideal practice. Start by taking one item on your list at a time and start making plans for how you can change.

He recommends not doing this alone, and getting your team involved to help you make the changes. The best way to start this is with daily team huddles. Drummond says:

“Here's the basic huddle. Very simple. Twice a day if you have morning and afternoon patients. If you’re on the OR, huddle in the OR. If you're in a hospice, huddle however many times you need to. You can call a timeout at any time of the day and huddle up again if things get hairy. Your whole team. Run your schedule, bring it back, look at all the patients, look at all the vacant slots, tell them how you want to book. Make sure the patients have everything they need before they get there and make sure you know who's sick out in the waiting room. You're preventing fires in the first place, and ideally—key points here —this is a stand-up meeting where you go to them. I've seen doctors who gather the people around them as they sit like kings and queens at their desk in their office. That does not work. So, please stand up and go to them.” 

For the physicians that Dr. Drummond works with, he finds that 70% are able to make enough changes to their existing practice to recover from burnout. The other 30% start the process of a new job search to find their ideal practice.

Whether you just need to make changes in your existing job or find a new one, addressing burnout is crucial to your long-term happiness and success as a physician. For more tips from Dr. Drummond, you can watch the full webinar on 

Addressing burnout is crucial to your long-term happiness and success as a physician.

Overcoming physician burnout in the midst of a global pandemic

The impacts of COVID-19 on healthcare have been far reaching with no immediate end in sight. The stresses this pandemic have put on medicine, however, haven’t changed the medical needs of millions of Americans. As elective care starts to return, we spoke with several organizations around the country to see how they’re meeting the needs of their patients and employees.

The rise of telehealth is an unexpected benefit from the crisis and many facilities have shifted from no virtual appointments to making it a regular part of their practice. One unique use of telehealth came from 

, CEO and president of Margaret Mary Health in Batesville, Indiana. They had an existing telehealth relationship with their school system so doctors could see students with the help of technology and school nurses. When schools shut down due to Covid-19, they were able to utilize that technology to create a temporary respiratory clinic.

“In a rural area it’s tough because internet capabilities are really poor in many of our areas. But we’re thinking right now about remote sites,” said Putnam. “So, if I’ve got a medical assistant and a great internet connection, can a patient visit there instead of going to their primary care physician? I mean, other than the physician not being physically there, my technician or my medical assistant’s there who can draw blood, get vital signs, position the camera appropriately to get an image of an ear or throat or something else. There’s a lot of stuff where we met flat resistance beforehand, now we know it works, so how do we optimize it?”

, DO, chief medical officer for the Michigan Hospital and Health Association and a board-certified cardiothoracic surgeon, found that his physician colleagues were quick to embrace telehealth and that most are looking at ways to further embrace it. One of the groups within the association went from 100 virtual patient visits a day before the pandemic to as many as 2,000 visits a day after.

 vice president of UPMC Presbyterian in Pittsburgh, shared the unique way they’re using telehealth, in which they “offer telehealth critical care services to New York Presbyterian, along with other hospitals inside of our system. I think that's going to be another way that [the industry] sees telehealth grow—not just yourself and not just outpatient, but how can you help others.”

One of the biggest issues with starting elective procedures is letting patients know that it’s safe for them to come back to the hospital or clinic. 

, CEO of Clay County Medical Center in Kansas said:

“I believe patients and consumers are going to be cautious to step into a hospital. It’s already unsettling for them, so I think perception is really going to hinder the things we do in healthcare during this pandemic.”

To help regain patient confidence, they’ve been posting on Facebook and other social media outlets outlining what patients can expect when they come in. They’re also providing patients with masks if they need them.

Dr. Roth found that while his facilities were ready to ramp back up, patients weren’t ready to return. The association started a series of public service announcements with local media outlets to reinforce that it’s safe to come back and to not put off needed care. Communication has been key in building patient confidence and getting them to return, Roth said.

With layoffs, furloughs, and a pandemic, this is as stressful a time for healthcare workers as it is for patients. Maintaining clear communication with employees is key—keeping them updated on what is going on will help to calm fears. Creating more flexibility during this time is also important to keep your employees engaged.

At CompHealth, we found we needed to communicate more often than we were used to. The CEO of our parent company implemented weekly video chats with the entire company as well as sending out regular messages about the status of our business and working from home.

Whether you’re meeting in person or virtually, it’s important to create avenues to both share information and receive feedback from employees.

Healthcare facilities are implementing similar efforts. Austin Gillard said. “I feel like I’ve increased my daily presence through department rounding dramatically. I’m out on the floor more seeing how everyone’s doing, just for their mental health, because I feel like it’s not only challenging for them at work, but their lives have changed. When I talk with our team members, everyone tries to seem happy. A lot of them aren’t used to having their kids home as school has moved online, so they’ve had to adjust their own lives.”

Whether you’re meeting in person or virtually, it’s important to create avenues to both share information and receive feedback from employees. Surveys or anonymous comment forms on your intranet are another way to keep the pulse of your employees and learn how they’re handling the pandemic, their work, and their personal lives. Listening and implementing changes based on what you’re hearing will help keep your employees engaged in their work while staying focused on your patients.

Leaders from several organizations explain how they’re meeting the needs of their patients and employees.