Addressing Physician Burnout: How to Engage Physicians ... · MAYO STUDY “In this large national...
Transcript of Addressing Physician Burnout: How to Engage Physicians ... · MAYO STUDY “In this large national...
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Addressing Physician
Burnout: How to Engage
Physicians, Enhance Morale
and Reduce Turnover
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Physicians
Burned Out &
Detached?
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Signs of Burnout
• Exhaustion
• Depersonalization
• Sense of low personal
accomplishment
• High stress
• Low motivation
• Work-life interference
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Okay, Doctors are Upset So Are a Lot of People
Why Does It Matter?
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Because Everyone Needs A Doctor
The first person you see coming in
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Because Everyone Needs A Doctor
…the last person you see
going out.
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Physician Burnout is a Public Health Crisis
Source: Health Affairs, March 2017
Costs of burnout are
significant and affect
patient safety, quality of
care, and health care costs
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MAYO STUDY
“In this large national study, physician burnout, fatigue, and work unit
safety grades were independently associated with major medical
errors. Interventions to reduce rates of medical errors must
address both physician well-being and work unit safety.”
Physicians reporting errors were more likely to have symptoms of
burnout, fatigue and recent suicidal ideation. In multivariate modeling,
perceived errors were independently more likely to be reported by
physicians with burnout or fatigue and those with incrementally worse
work unit safety grades”
Source: Mayo Clinic Proceedings. May, 2018
Physician Burnout is a Public Health Crisis
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The Physicians Foundation:
A Voice for Physicians
A Physician “State of the Union”
www.physiciansfoundation.org
• 8,774 responses
• Over 50O K data points
• 2,400 + written comments
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To What Extent Do Physicians Have Feelings of Professional Burnout?
Over 78% of physicians
sometimes often or always
have feelings of burnout in
their careers
Source: A Survey of America’s Physicians: Practice Patterns
and Perspectives, The Physicians Foundation/Merritt
Hawkins, 2018
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Physician Suicide
• An estimated 400 physicians
commit suicide each year, the
equivalent of one entire
medical school class.
• The physician suicide rate is
20% to 30% higher than the
general public.
Source: Louise Andrew, M.D. ET AL. Physician Suicide, Medscape Reference,
March 8, 2012
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How Did We Go From This
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…To This
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After 4 Years of College, 4 Years of
Medical School, 3 to 7 Years or More
of Training
• Third parties control your fees
• Tell you how to treat patients
• Require hours of paperwork
• Sue you on a whim
• Require you to change their
practice structure/processes
• Make you question your career
Welcome to This Work Week
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Source: STAT; Medical school debts run $180,000 per on
average per student, Sept 5, 2017
Burnout Begins Early
Average medical school debt:
$179,000
(up from $161,739 in 2010)
Highest average debt by
specialty:
Emergency Medicine $194,000
Radiology $185,000
Psychiatry $184,000
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If you were to begin your
education again, would you
study medicine or would you
select another field?
Another field….22%
Burnout Begins Early
Source: Merritt Hawkins 2017 Survey of Final Year Medical Residents
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Compensation Conundrum
New Alternative Payment Models
• Accountable Care Organizations
(ACOs)
• Bundled Payments
• Pay-for-Performance
• Patient Centered Medical Home
• Hospital Readmission Reduction
Program (HRRP)
• Pay for Prevention
• MACRA
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Doctors Are Disengaging
Physician satisfaction levels are
decreasing due to various
mechanisms of healthcare
reform including:
• Quality-based payments
• Electronic health records
(EHR)
• ICD-10
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Documenting Quality
• Physicians spend 2.6 hours
per week documenting quality
measures
• $40,069 per physician spent
on documenting quality
• $15.4 billion annually
Source: Health Affairs, March 2016
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Primary Pain Points
What do you find LEAST satisfying
about medical practice?
Source: A Survey of America’s Physicians: Practice Patterns and
Perspectives, The Physicians Foundation/Merritt Hawkins, 2018
Regulatory/paperwork burdens 58.3%
Erosion of clinical autonomy 31.8%
Inefficient EHR 26.8%
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Result: Physician Turnover
Annual Physician Relocation/Turnover
Rates by Specialty
Source: SK&A Healthcare Provider Move Rates, October 2015
Oncology 17.9%
Psychiatry 14.6%
Family Medicine 13.5%
General Surgery 11.2%
OB/GYN 10.7%
Orthopedic Surgery 10.6%
Internal Medicine 9.3%
Average 12.0%
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Supply
803,000
Demand924,300
The Coming Gap Between Physician Supply & Demand (2020)
Source: AAMC March 2018
Bad Timing:The Coming Shortage
Supply
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Now, the Good News
Most physicians love the
“heart” of medicine:
patient relationships
(74% of physicians find
this “most satisfying”)
How can you enhance
the rest?
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Step One: Know Their Value
Despite the growing number of providers,
physicians are at the center of the system
and control 87 percent of all spending on
personal health
QualityCost
EffectivenessAlignment
Are largely in your hands
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Economic Impact
Each physician supports:
• Per capita economic output of
$3.2 million
• About 17 jobs
• Total of $1.4 million in wages and
benefits
• $126,129 in local and state tax
revenuesSource: The National Economic Impact of Physicians, IMS Health
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Physician Generated Revenue
All Physicians $1,560,688
Primary Care $1,402,268
Specialists $1,607,750
Source: Merritt Hawkins 2016 Physician Inpatient/Outpatient Revenue Survey
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Employed vs. Independent
About 1/3 of
physicians identify
as independent.
The majority are
employed.
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Physician Turnover
The employed model is a game changer.
Annual Relocation Rates
Oncology 18%
Radiology 17%
Psychiatry 15%
Family Medicine 13%
Internal Medicine 12%
Source: SK&A Healthcare Provider Move Rates – August 2015
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Moral: As Physicians Go, So Goes
the Facility
Understand the central role
you play both clinically and
economically
Employers should make the
practice environment as
appealing as possible
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Does your workplace offer a
program to reduce burnout?
Source: Medscape
Step Two: Formalize the Program
Academic, research, government 61%
Hospital 45%
Multispecialty group practice 31%
Outpatient clinic 31%
Single-specialty group practice 17%
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Request routine assessments
using a questionnaire or
survey:
• Physician Well-Being Index
• Stanford Physician Wellness
Survey
• Mini Z Burnout Survey
• Maslach Burnout Inventory
Human Services Survey
Step Three: Seek Input
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Merritt Hawkins Physician Engagement Survey
Level of satisfaction with:
• Your practice
• Your compensation
• Your relationship with them
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• How many patients do you see per month?
Too many?
Too few?
The right number?
• How far are you booked out?
• Do you have trouble referring?
• What additional services/specialties are
needed?
• How would you rate the need for additional
physicians in certain specialties?
• Efficiency of EHR?
• Retirement plans?
Their Practice
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Variety of sources that track
physician earnings
Your Compensation:Is it “Customary & Competitive?”
Average Compensation
(Family Medicine)
Sullivan Cotter $266,562
AMGA $244,799
ECG Management $249,087
Merritt Hawkins $241,000
Compdata $235,100
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• Physician starting salaries
• Signing bonuses
• Relocation allowances
• Continuing medical
education (CME)
allowances
• Other incentives
Your Compensation:Is it “Customary & Competitive?”
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How compensation is
structured may be more
important than the amount
How often is the formula
changed?
Why was it changed?
Do you understand it?
Is the formula fair?
What quality metrics are
used?
Can they be tracked?
Compensation Structure
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Physician Contract Structure
Salary 17%
Salary w/ Bonus 75%
Income Guarantee 3%
Other 5%
Source: Merritt Hawkins 2018 Review of Physician
and Advanced Practitioner Recruiting Incentives
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If Salary + Production, on what is bonus based?
RVU 50%
Net Collection 10%
Gross Billings 1%
Patient Encounters 4%
Quality 43%
Other 4%
Source: Merritt Hawkins 2018 Review of Physician
and Advanced Practitioner Recruiting Incentives
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The Geisinger Model
Straight salaries only
A “values compact”
• Take great care of patients
• Optimize access for patients
• Help recruit, develop and retain
talented individuals
• Teach and participate in research
• Be a good citizen
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• Do they understand the
strategic vision/direction your
organization is taking?
• Is their voice heard?
• Is there someone with whom
they can speak?
• Is there a mentorship program
or opportunity for leadership?
Your Relationship with Them
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What direction would you
like to see the hospital/group
take in terms of:
Medical staff development?
Support for medical staff?
Adding physician leaders?
Transition to value/new
compensation models?
Your Relationship with Them
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Insist on a Positive Culture
• Leadership support
• Resources to support
wellness
• Recognition and appreciation
• Transparency and a clear
vision
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Enhancing the “Workshop”
First and foremost consider the
“primacy of the workshop”
Find a haven
Efficient EHR
Scribes
Physician communication
(formal and informal)
Physician employment
Pay for ED call
Hospitalist program
Gain Sharing/Joint Ventures
Appropriate nurse staffing
Timely test turnaround
Access to patient data
Consistent OR availability
Enhanced ER triage
Convenient parking
Marketing/Contracting
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Bring Back the Doctor’s Lounge
“As an example of frayed bonds, Dr.
Shanafelt points out that hospitals’
physician lounges, where doctors could
meet, unwind and discuss cases, have
largely vanished. While two new
Stanford hospitals have them, Dr.
Shanafelt, associate dean at the
Stanford School of Medicine, would like
gathering places for doctors throughout
his institution and at other hospitals as a
low-cost effort “to help drive
community.” Wall Street Journal
June 8, 2018
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Teamwork Models of Practice
THE “CONE OF COMPLEXITY”
The Age of Teamwork
Medical specialists
Primary care physicians
Pharmacists (PharmD)
Advanced practice Nurses/PAs
Nurse specialists
Therapists
LPNs
Nurses aides
Case managers
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• Concede the less complex
patients to PAs and NPs
• Have medical scribes
enter patient data for EHR
Source: AANP and AAPP
Redefine Roles
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• “7 days on, 7 days off”
• Allow for flexibility around
the beginning and end of
work shifts
• Work-life integration
• Designated “paperwork”
time
• Self-care
Flexible Schedules More Common
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• Telemedicine
• E-mails
• Telephone Calls
Doctors will have to be
compensated outside of
the traditional billable
appointment.
Extracurricular Pay
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Independent Physicians
• The Practice Leasing Model
• Use of Locum Tenens
• State Medical Societies(See Texas Medical Association’s
Practice Edge program)
• Direct pay/concierge
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What can hospitals and groups
do to manage physician
resiliency?
Request support and continual communication
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• Child-care programs
• Financial management
counseling
• Peer support groups
Resiliency Programs
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• Monthly breakfast/lunch
meetings
• After-hours meals
• “Ice cream conferences”
• Medical staff surveys
• Stay Interviews
Improving Physician Communication
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Examine the Recruitment Process
• Effective onboarding
practices start well before the
doctor gets to town
• “70/30 Rule”
• Onboarding checklists
increase productivity, make
the new physician happier,
and provide cost savings
• Incorporate family onboarding
into the checklist system
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A Raised Hand – Blog by Kurt Mosley
Follow on Twitter: @Kurt_Mosley
Continue the Conversation
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Ten Keys to Enhancing
Physician/Hospital
Relations and Reducing
Physician Turnover
Physician Recruiting
and Emotional
Intelligence
The Cost of a Physician
Vacancy
Continue the Conversation
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If you have any questions, please
contact Kurt Mosley at:
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Addressing Physician
Burnout: How to Engage
Physicians, Enhance Morale
and Reduce Turnover