January 06, 2016
Area(s) of Interest: Physician Wellness
Being a physician is for many a calling. They are drawn to the practice of medicine, motivated by a deep-seated desire to help and heal. "Being a physician is not just something we 'do,' it is something we 'are,'" says Ruth E. Haskins, M.D., president of the California Medical Association. "What brings us joy, almost universally, is caring for patients."
Yet 75 percent of California doctors are showing signs of burnout, according to a 2016 Physicians Foundation study. This survey, conducted biennially since 2008, has consistently demonstrated that the professional morale of physicians is declining, due in large part to regulatory and paperwork burdens that limit the time physicians can spend with patients and a loss of clinical autonomy.
“We’d much rather have our hands on our patients than our hands on our keyboards,” says Dr. Haskins.
So how can physicians gain control of the things that burn them out and reclaim the joy in their practices? A 2013 study published in the Annals of Family Medicine looked at high-functioning primary care practices that had put into place innovations to help mitigate physician burnout. The authors found that a shift from a physician-focused care model to a "shared-care" model, with a greater focus on clinical support staff and more frequent daily staff and physician communication, could decrease the amount of tedious work that needs to be done, resulting in more personal satisfaction for physicians.
While the study’s authors said that no single practice they studied had solved every issue for physicians, they did find unifying themes that created greater physician satisfaction:
- Practices that build stable, well-trained teams that work together every day and meet regularly to improve their work can create efficient work flows and rewarding practice environments.
- Standardized work flows with higher levels of clinical support personnel can make practices less chaotic, save time and meet patients’ needs more quickly.
- Teamwork is facilitated by proximity of workstations and frequent forums for interaction. Thoughtful physical layout with co-location of staff and line of sight enhances communication.
- Face-to face verbal communication is often more effective, efficient and enjoyable than circulating asynchronous electronic messaging.
Researchers found that the most successful practices at balancing work/life for physicians had instituted changes like these:
- All patients received pre-visit planning that included lab tests. Lab tests were scheduled and performed several days in advance of the patient visit so that the results could be discussed. The pre-planning was done in conjunction with the physician by a medical assistant or nurse. In one practice, the medical assistant's role was expanded to include medication review, agenda setting, form completion and closing care gaps.
- Six of the practices entrusted support personnel to serve as a physician scribe for each patient visit. They captured the physician’s medical notes for the patient record, entered orders, prepared the after-visit summaries and reinforced the care plan with the patient.
- Prescription renewals were re-engineered so that stable prescriptions were renewed for a year during an annual comprehensive care visit. This prevented unnecessary interval handling of renewals.
- At many practices, nurses and medical assistants were entrusted, while operating under physician-designated protocol, with filtering electronic and paper information that would normally pass to physicians. These "physician extenders" passed on only information that specifically required a physician’s level of expertise. The physician was kept up-to-date verbally so nothing was lost between patient and physician. This decreased inbox work for physicians substantially and helped filter out normal laboratory results, prescription renewals and other requests that could be handled by delegates or well-trained assistants.
- Some practices allowed time in their schedules for brief team meetings throughout the day. In one large practice, physicians decided to co-locate their work stations so they sat side by side with their nurses and medical assistants, allowing for an easy flow of information between physicians and team members.
To see the full study, click here.