Change will forever be a constant in the healthcare industry, an industry always working to become more patient-centered, more cost-efficient, and more value-based. These are worthy aspirations, and, it must be added, supremely challenging ones.

Healthcare reform in the U.S. and rapidly developing technology have helped drive this shift in the industry’s focus, which the Institute for Healthcare Improvement has named healthcare’s Triple Aim. Improving the patient experience, enhancing population health, and reducing costs are the legs of this three-part goal.

More recently, various voices in healthcare have spoken up to suggest an expansion to a Quadruple Aim for the industry, to include a pillar recognizing the need to prevent burnout among physicians and other healthcare workers. This need to recognize and eliminate burnout has become only more pressing as providers navigate the new demands associated with the Triple Aim.

Over the course of my 30-year career in healthcare management and consulting, the risk of physician burnout has always been a reality and an important topic to address— especially by the top levels of management within large healthcare organizations, where burnout is more likely to fester unnoticed. However, in recent years, as these organizations have worked to rapidly implement technology and adjust to the value-based healthcare model, I’ve seen new levels and intensity of burnout among physicians. Research supports my impression: Medscape’s 2018 National Physician Burnout & Depression Report finds that 42 percent of the 15,000 physicians surveyed reported burnout. Twelve percent said they felt depressed.

What are the specific causes of this intensifying stress, and how should organizations be responding?

An often-cited frustration I’ve heard from physicians in recent years is the mushrooming amount of time they must spend on administrative work over the course of their workday—often connected to electronic health record (EHR) technology. A 2013 study of emergency medicine physicians found that they spent nearly half of their days (44 percent of their time) on data entry, logging 4,000 EHR clicks per day—and barely over a quarter of their day with patients. For all the efficiency and transparency benefits of EHRs—and there are many—they have undoubtedly made some physicians’ jobs more cumbersome and stressful.

As administrative demands on physicians have increased, the need to cut costs has meant that, in many organizations, supporting administrative staff has simultaneously decreased. The fact is, however, that delivering high-quality patient-centered care requires the support of an entire team. To work to the top of their licenses and develop rapport with patients, physicians need to focus fully on patients and their needs during appointments.

Physical, mental and emotional stress associated with long work hours and on-call schedules add to physician job dissatisfaction as it relates to maintaining work/life balance and their ability to make sound medical decisions for their patients. This impacts the safety and wellbeing of patients, as well as staff and the physicians themselves.

The good news is that in the face of challenges both new and old that contribute to physician burnout, there are steps that leaders within healthcare organizations can take:

Work hard to recognize burnout. This comes down to prioritizing communication between leadership, physicians, and staff. There are many telltale signs that should not and cannot be ignored.

Ask for physician feedback whenever possible when instituting new systems and policies. Ask for feedback, facilitate conversations, and make sure physicians are heard and include them in decision-making whenever possible. This will help to make physicians feel more engaged in their work.

Implement processes to monitor and address the adequacy of staff support. Find ways to allow physicians to work at the top of their license and concentrate on what they were trained to do: care for patients.

Find ways to address work/life balance concerns. This may be accomplished through creative scheduling as well as providing support services and training to physicians to help them mitigate stress and decrease burnout.

Most important of all, however, is the shift that makes all these other measures possible: Senior leadership must be willing to see this period of healthcare industry transformation as a time to invest in physician satisfaction. Healthcare organizations themselves are under pressure because of new incentives, and they may be looking for a direct cost-benefit for every new investment they make. While this is understandable, they need to relax that mindset when it comes to investing in measures that improve physician satisfaction. Given the direct link of physicians to individual patients and their successful outcomes, the improved health of our country depends on it.

Karen Schechter, Director and Assistant Professor in the Online Healthcare Management and Health Administration Programs at Maryville University

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