Brian Ansay
Even before the COVID-19 pandemic hit the United States, physicians in this country were confronting a different kind of epidemic: burnout. The strain is having a widespread negative impact on all aspects of medical care. In fact, one in every three physicians is experiencing burnout at any given time across medical specialties,1 which manifests in emotional exhaustion, loss of enthusiasm for their work, and even a diminished sense of personal accomplishment.
Burnout can affect a doctor’s professional relationships with fellow colleagues and their ability to make good decisions at work. It also can harm the viability of a medical practice and, more importantly, patient care, by leading to higher rates of turnover, medical errors and malpractice risks.
The problem has become a particularly critical issue for gastroenterologists, among whom, according to a recent survey, 45% reported that they were experiencing burnout. The main factors contributing to burnout in gastroenterology across all generations—millennials, Generation X and baby boomers—include spending too much time on bureaucratic tasks like billing and working overtime.
Having to navigate the increased computerization of practices also has contributed to burnout, particularly among older physicians who began to practice before the era of electronic health records (EHRs).1,2 Independent community GI practices must take steps to reduce physician burnout by allocating time and resources to educating and cross-training staff to alleviate pressure on physicians; efficiently using technology to streamline tasks; and implementing processes that ensure consistency across departments.
Although nearly half of gastroenterologists report feeling burned out from their work, physicians in different age groups are experiencing different pressures. Gastroenterologists in the baby boomer generation, for example, reported computerization of standard record keeping and procedures—EHRs—as one of the key factors contributing to burnout.1
Increasing computerization was not reported as a top factor contributing to burnout among younger clinicians, perhaps because they had to adapt to EHRs and other technologies earlier in their careers. Whatever the reason, practices should encourage tech-savvy staff to work closely with struggling doctors to input information into EHRs and work through other technology-driven tasks.
Practices also can implement team documentation, rather than relying on physicians to record all information, by training the rest of their staff to manage some of the more time-consuming tasks. This approach also can help relieve doctors of the more technology-driven tasks. For example, staff could enter patients’ medical histories into EHRs and allow physicians to concentrate on present illnesses and physical exams. Staff can also assist with order entry, prescription processing and charge capture. Delegating such tasks across the practice team has led to greater physician and staff satisfaction, improved revenues, and has allowed practices to manage more patients but also leave work earlier.3,4
Use Tech to Make Time
All three generations identified bureaucratic tasks, such as charting and paperwork, as the top factor contributing to burnout.1 While some physicians may not welcome increased computerization, it’s necessary for practices to shift toward technology-driven solutions to keep pace with the evolving industry.
When employed strategically, technology can streamline the jobs of physicians rather than create an additional burden on them. Practices should invest in technologies customized to their specific needs, which will help ensure their staff and doctors aren’t having to do unnecessary work.
An EHR system should be customized to a gastroenterology practice’s reporting requirements in order to streamline the process by only requiring the input of relevant and necessary data tailored to the practice’s respective workflow. The practice can work with an EHR company to modify standard fields or forms to prioritize information that’s most important to their workflow.
Also, practices should select EHRs that include mobile capabilities, so doctors aren’t tethered to a computer. EHRs with a dictation option are helpful, too. These features will ensure doctors don’t have to spend three to four hours per day inputting information in the EHR and can instead spend that time with patients.
Once a year, practice owners should designate a champion or team leader who can review the data capture and reporting solutions across all departments. This person should trace how information moves and is leveraged throughout the practice, looking for inconsistencies or gaps, particularly between different patient touchpoints or processes that ultimately inform billing and reimbursement. This simple exercise can help identify issues that are leading to missed charges, over- or underbilling, reimbursement challenges and more problems, all of which could be putting unnecessary strain on the practice and its members.
If leveraging internal resources is not feasible, the practice could engage an industry consultant to evaluate key parts of their business, such as revenue cycle management, inventory management and financial reporting. A consultant can use his or her assessment to identify the source of existing issues or detect a problem before it has a detrimental impact on a practice’s viability. There are also tools that can help with the annual analysis. For example, one practice used InfoDive, IPN Solutions’ web-based business intelligence tool, to identify an issue that started with miscoding at the front desk and resulted in incorrect billing and missed reimbursement. These issues were threatening the practice’s viability, but once the problem was known, leaders created and executed an action plan that changed the direction of their practice.
Ultimately, the lesson is maintaining practice viability and eliminating physician burnout can go hand in hand. An efficient and profitable practice will lead to happier, less stressed physicians, which then leads to better care and more efficiency. By addressing physician burnout and considering the different and similar burnout factors affecting each generation, a practice can create a compounding positive momentum that eventually supports both the health of the practice and its patients.
Mr. Ansay is the president of Specialty Physician Group Purchasing at AmerisourceBergen.
References
- Kane L. Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. Medscape. www.medscape.com/ slideshow/ 2020-lifestyle-burnout-6012460. Published January 15, 2020. Accessed April 13, 2020.
- Kane L. Medscape Gastroenterologist Lifestyle, Happiness & Burnout Report 2019. Medscape. www.medscape.com/ slideshow/ 2019-lifestyle-gastroenterologist-6011114. Published February 20, 2019. Accessed April 13, 2020.
- Bodenheimer T, Willard-Grace R, Ghorob A. Expanding the roles of medical assistants: who does what in primary care? JAMA Intern Med. 2014;174(7):1025-1026.
- Reuben DB, Knudsen J, Senelick W, et al. The effect of a physician partner program on physician efficiency and patient satisfaction. JAMA Intern Med. 2014;174(7):1190-1193.