Physician Burnout

“If things don’t change, I am taking early retirement.” That was the sentiment from a physician in a Midwestern hospital. Sadly, she’s not alone. When posed with the question as to what is causing burnout, several physicians told us the solution was retirement. Others expressed passion about fixing a broken system. Reaction heard from over 250 physicians across the nation to find out what is causing them stress and, more importantly, what they would prescribe to heal it.

Participants by Specialty

We received a tremendous response from physicians in a wide variety of specialties. Regardless of their discipline, all are frustrated to one extent or another. A pediatric pulmonologist told us, “We need to think of our mission and why we are here. Our mission should always have patient care in the center of any plan.” That is a common theme that has emerged. The patients aren’t causing burnout. It’s all of the activities, politics, and business issues that take the focus off of those they made a pledge to “do no harm” to. A cardiothoracic vascular surgeon added, “Vertical integration and corporate behavior has an
adverse effect on physician behavior.” So, without further suspense, here are the top reasons physicians are reaching the end of their tethers.

Causes of Burnout

EHRs, dealing with payers and pre-auth, regulatory compliance, and bureaucracy all came within mere percentage points of one another as the main culprits. All have a common theme: they are time consuming and prevent the physician from providing care for the patient. Patients, not surprisingly, were only mentioned by 2% as causing an undue burden. (Orthopedic Surgeon)

“Our current healthcare non-system needs to be radically changed. Way too expensive and chaotic. Profit must be eliminated.”

- Orthopedic Surgeon

EHR Stress

Improving user-friendliness doubled the second closest source of EHR dissatisfaction. A pediatrician suggested that EHR vendors “Create one by and for physicians, not administrators and technogeeks.”

Regardless of specialty, EHR stressors are generally agnostic. Physicians want an easier system with dictation features that reduces the time required in the system. They want more face to face time with the patient, rather than staring at a monitor and a keyboard.

“Less requirements for unnecessary documentation. Having one EHR not linked to payment does not describe the quality of a patient encounter.”

- Hospital Chief of Staff

Current EHR Vendor

EHR stress appears to know no brand name loyalty. Regardless of which vendor is providing the solution, according to what physicians are telling us, none has yet to have built a better mousetrap.

“EHR seems to be predominantly a billing tool, secondarily a compliance tool. Start over and design EHR for patient care. Too many boxes to click, too many irrelevant alerts, soft or hard ‘stops’ (best practice alerts in Epic), create alert fatigue. Very little useful clinical decision support.”

-Emergency Medicine Physician

Payer Stress

Payer/pre-authorization stress emerged as a close second to EHR issues. Simplyput, clinicians feel hamstrung by the process of dealing with payers. One cardiovascular internist put it even more succinctly, “Eliminate the burden of getting pre-auths. (It) takes too much time away from patient care.”

“Stop allowing (payers) to play doctor by denying tests and care.”

- Chief Medical Officer

Current Payer

While several physicians indicated they would like to see a single payer system created to avoid payer issues, Medicare is still by far the largest payer mentioned. The government is the most commonly mentioned payer organization by a length, yet physicians are still struggling with payments and pre-authorization.

Compliance Stress

Healthcare is a highly regulated industry. Overwhelmingly, clinicians want fewer, and simpler rules. A Chief Medical Officer recommends something that could kill two birds with one stone: “Shift reporting to an automated system that retrieves data from the EMR rather than manual reporting.” And it doesn’t get any more basic than this from a surgeon: “Simplification.”

“Get rid of what seems to be unnecessary regs that don’t contribute to patient care or quality of care.”

-CMIO

Bureaucracy Stress

Woody Allen famously said in Annie Hall, “Those who can’t do, teach. Those who can’t teach, teach gym.” That appears to be the criticism physicians are directing at bureaucrats. Said a Neurosurgeon, “Most administrators are clinicians that (1) got tired of being a clinician and/or (2) never were that good at being a clinician. They lose sight of what it’s like in the trenches once they reach the inner sanctum.” On the flip side, a psychiatrist said, “Get doctors, or at least clinicians, to be managers.”

“Put me, the doctor back in control. Get rid of the business types, marketing, etc. Medicine is not a business and what has been done and what is going on is deplorable. Hospital systems are raping America!”

- Chief Medical Officer

Hopefully retirement won’t be the solution many physicians opt for to manage the burnout they are suffering. They’ve made it crystal clear – they want more face-to-face time with their patients. They want to spend more time with their patients than they do with their EHR. They want an end to the hostilities with their payers on want more input on the best treatment plans for their patients. As doctors speak up, perhaps the vendors, payers, and administrators will listen and become a bigger, and more positive, part of the solution.

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