Welcome to PMI’s Webinar Presentation · Welcome to Practice Management Institute’s Webinar and...

Welcome to PMI’sWebinar Presentation

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Averting Burnout in Your Practice

Welcome to PMI’s Webinar Presentation:

Jan Hailey, CMC, CMIS, CMOM, CMCO

Welcome to Practice Management Institute’s Webinar and Audio

Conference Training. We hope that the information contained herein will

give you valuable tips that you can use to improve your skills and

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Averting Burnout in Your Practice

Jan Hailey, MHL, CMCO, CMC, CMIS, CMOM

Clinician Burnout

• The World Health Organization defines burnout as a problem associated with chronic workplace stress; it is not an individual mental health diagnosis, nor the same as depression

• Burnout: emotional exhaustion, depersonalization, and low sense of personal accomplishment

• Quadruple Aim

Improve health for our population

Improve patient

experience Lower Costs

Improve provider

satisfaction

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Practice Management Institutewww.pmiMD.com

Webinar/Audio ConferenceMarch 11, 2020

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Causes of Burnout

(Ahrq.gov)

Causes of Burnout

The practice of clinical medicine

High stress

Great responsibility; little control

Provider’s specific jobJob specific stresses, call‐rotation, compensation, leadership

Work / Life balance

Conditioning of medical education

Traits of success also set up for burnout

Leadership

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Why Burnout Needs to be Addressed

• Burnout is estimated to be as high as 50% in some studies

• Access to Care Providers leaving practice

• Patient Safety

• Quality

• Increases risk of malpractice litigation

The MEMO Project

• Agency for Healthcare Research and Quality (AHRQ) funded project Minimizing Error, Maximizing Outcome

• Survey 422 PCPs (family physicians and internists)

119 ambulatory clinics

1,795 patients

• Medical records reviewed for quality and medical errors

(Ahrq.gov)

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The MEMO Project • 50% of the physicians reporting time pressures when conducting exams

• One third felt they needed 50% more time than was allotted for patient care

• One fourth state they needed at least 50% more time for follow up appointments

• Work conditions Chaotic Low control Unfavorable organizational culture leading to dissatisfaction, stress, burnout, and intent to leave practice

• Physician reaction did not translate to poorer quality of care because they act as buffers between work environment and patient care

• When lower quality care was seen, the investigators found it was the organization that burned doctors out that led to lower quality care, rather than the burned‐out doctors themselves

• Electronic Health Record (EHR) contributes to burnout

(Ahrq.gov)

How Can We Reduce Burnout?

Work / home life balance

Flexible schedulesHigh functioning care

teams

More time with patients

Creating standardized workflow

Responsive IT team

Providing administrative time to complete required

documentation

Organizational leadership support

Ensuring values align between clinicians

and leaders

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How Can We Reduce Burnout?

MANAGE TIME EFFICIENTLY

ANTICIPATE / EMBRACE CHANGE

LEAVE WORK AT WORK

FIND A MENTOR CARE FOR YOURSELF

FIND YOUR PASSION

Burnout and the Electronic Health Record

• Survey conducted by researchers at the University of New Mexico Forty percent of physician burnout is attributable to EHRs, up from the previously estimated 13 percent

EHRs are largely to blame for the physician burnout and stress epidemic that runs rampant in the medical industry

Clinical process design and clinical structure, both of which are highly impacted by EHRs, contribute to clinician stress

Physicians spend two minutes at the computer for every one minute spent with patients

Workdays have extended into the physicians’ homelives

Face‐to‐face time with the patient is turning into face‐to‐screen

(Jason, 2019)

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The Cost of Burnout

• The annual cost of physician burnout is conservatively estimated at $4.6 billion per study in the Annals of Internal Medicine Physician turnover: The researchers tried to account for two components of the cost associated with burned‐out doctors leaving their jobs. The first component was the cost linked to physician replacement for search expenses, hiring, and new physician startup. The second cost was lost income from open physician positions.

Reduced clinical hours: To approximate the cost of physicians lowering their clinical hours, the net cost of turnover was adjusted by a fraction representing the average percentage difference in weekly work hours between physicians who were burned‐out and physicians who were not burned out.

(Cheney, 2019)

National Academy of Medicine

Action Collaborative on Clinician Well‐Being and

Resilience

• Launched In 2017, with a network of more than 60 organizations committed to reversing trends in clinician burnout

The Collaborative has three goals:

• Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide

• Improve baseline understanding of challenges to clinician well‐being

• Advance evidence‐based, multidisciplinary solutions to improve patient care by caring for the caregiver

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• Six working groups will meet over four years and identify evidence –based strategies to improve clinician well‐being Action Collaborative Leadership Leadership Engagement Working Group

Breaking the Culture of Silence Working Group

Organizational Best Practices and Metrics Working Group

Post‐2020 Sustainability Working Group

Action on Consensus Report Recommendations Working Group

Organizational Strategy

• Organizational leadership must implement changes to promote clinician well‐being

• Many organizational factors play a role in clinician burnout: Culture Compensation Mission, vision, values Diversity and inclusion Workload Unrealistic expectations

• Organizations can address dissatisfaction and retention with clear communication and workflows

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Burnout by Specialty

Highest rate of burnout

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52

49

48 48

45

46

47

48

49

50

51

52

53

54

55

Urology Neurology PhysicalMedicne &Rehab

InternalMedicine

EmergencyMedicine

FamilyMedicine



Lowest rate of burnout

28

3233

36 36

0

5

10

15

20

25

30

35

40

Public Health Nephrology Pathology ENT Plastic Surgery


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It’s Not Just the Physician

Non Physician Practitioners

Management

Front Office Staff

Clinical Staff

Billing Staff

Ancillary Staff

It’s Not Just the Physician

Nurses report starting shifts already fatigued

Mandated overtime

Excessive workloads

Insufficient staffing

Long hours – 12 ‐hour shifts

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Tips for Preventing Staff Burnout

Be proactive – Engage employees to reduce turnover

Boost morale

Training

Motivate

Incentivize

Tips for Preventing Staff Burnout

Active management role

Social engagement

Take a break

Continuous education

Healthy habits

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Case Study – Medical Economics

Pediatrician Karen Ailsworth, MD, began her career with a multi‐specialty practice in Baraboo, Wisc. She enjoyed the job at first, but a couple of years after she started an HMO bought the practice, and soon afterward conditions began to change for the worse.

“They wanted us to be more and more productive, like we had to see a patient every 15 minutes,” she recalls. It wasn’t long before she began experiencing a common symptom of burnout: anger at her patients. “I started feeling like, ‘don’t tell me your problems, I don’t have the time. Just make my life easy.’ And that wasn’t the way I wanted to practice.”

Ailsworth stuck it out for 16 years, finally quitting in 2010 and pursuing locum tenens work before landing a less stressful position at an Indian Health Center.

“It felt like the bean counters were in charge, and it wasn’t about patient care any longer,” she says of her former practice. “I didn’t feel like we got recognized for what we did. It wasn’t like I wanted an award, but more like recognizing not every patient fits into a 15‐minute slot, and doctors aren’t just widgets in a factory.

(Bendix, 2019)

Summary

Lack of sufficient face‐to‐face time with patients, complicated patients, lack of control, electronic health record stress, and poor work‐home balance can lead to clinician burnout

Burnout can lead to clinicians leaving their practice, poor patient outcomes, and shortage in primary care

Burnout takes a toll on physicians, their patients, and their practices; however, we can help alleviate burnout with organizational strategies, individual awareness and resources readily available to help the clinician

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Thank You!

References

Drummond, MD, D. (2018, November). The five main causes of physician burnout. Retrieved from https://home.svmic.com/resources/newsletters/169/the‐five‐main‐causes‐of‐physician‐burnout

Physician burnout. (2017, July). Retrieved from https://www.ahrq.gov/prevention/clinician/ahrq‐works/burnout/index.html

Cheney, C. (2019, May 30). Annual physician burnout costs estimated at $4.6 billion. Retrieved from https://www.healthleadersmedia.com/clinical‐care/annual‐physician‐burnout‐costs‐estimated‐46‐billion

Berg, S., & Berg, S. (2019, January 24). Physician burnout: Which medical specialties feel the most stress. Retrieved from https://www.ama‐assn.org/practice‐management/physician‐health/physician‐burnout‐which‐medical‐specialties‐feel‐most‐stress

Bendix, J. (2019, January 6). The real reason physicians burnout. Retrieved from https://www.medicaleconomics.com/business/real‐reason‐docs‐burn‐out

Action collaborative on clinician well‐being and resilience. (n.d.). Retrieved from https://nam.edu/initiatives/clinician‐resilience‐and‐well‐being

https://www.healthcarefinancenews.com/news/7‐tips‐preventing‐staff‐burnout‐healthcare

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