- Problems with EHR design and interoperability are primary causes of physician dissatisfaction, according to a September 2018 survey of America’s Physicians by the Physician’s Foundation.
The Physician’s Foundation and physician search and consulting firm Merritt Hawkins gathered responses from 8,774 physicians from April to June of 2018 to gain insight into the physician workday, physician burnout, physician compensation, and other aspects of the medical profession.
Researchers found rates of physician burnout are trending upward, with 77.8 percent of respondents reporting experiencing feelings of physician burnout in 2018 compared to 74 percent in 2016.
Feelings of physician burnout vary by physician type. Physicians aged 45 and below experience burnout at a higher rate than physicians 46 and older. Additionally, 84.8 percent of female physicians reported experiencing physician burnout sometimes, often, or always, compared to 74.1 percent of male physicians.
“Employed physicians report higher rates of burnout than do practice owners, suggesting employment may not be the haven from practice related stress it often is thought to be, though, in general, employed physicians display a more positive attitude about medicine that do practice owners,” wrote researchers in the report.
Researchers prompted physicians to choose the most significant source of workplace dissatisfaction from a list of three primary pain points.
EHR design and interoperability was cited as the number one cause of dissatisfaction among surveyed physicians, with 39.2 percent of physicians identifying these factors as being the least satisfying aspects of practicing medicine.
“Physicians are increasingly obliged to document patient encounters through EHRs as the healthcare system moves toward quality-based payments and their attendant ‘paperwork’ requirements,” researchers stated.
Poor EHR usability augments provider frustrations with clinical documentation and can have a negative effect on clinical efficiency. While EHR systems were intended to boost clinical efficiency and promote better-informed care delivery, 56 percent of surveyed physicians said EHR use has reduced efficiency.
Meanwhile, more than 65 percent of respondents indicated EHR use has detracted from the patient-provider relationship.
The administrative burden of regulatory and insurance requirements ranked second-highest on the list of physician pain points.
About 37 percent of physicians cited these factors as contributors to dissatisfaction.
“These requirements, now often implemented through EHRs, also detract from the physician/patient relationship,” wrote physicians.
Given that 78.7 percent of respondents cited the patient-provider relationship as their primary source of professional satisfaction, the association between EHR use and reduced face time with patients is a significant source of concern for providers.
Finally, 23.1 percent of physicians listed loss of clinical autonomy as their most significant source of frustration.
“Physicians spend four years in college, four years in medical school and three to ten years in residency or fellowship training in order to practice in their chosen specialty,” explained researchers. “They then often find that their ability to make what they believe are the best decisions for their patients is obstructed or undercut by bureaucratic requirements or third parties who are non-physicians.”
This lack of clinical autonomy may contribute to growing concerns among medical professionals that they have little influence over the direction the healthcare system is going. In 2018, 62.5 percent of physicians reported feeling they had little or very little ability to influence the healthcare system, compared to 59.2 percent of physicians in 2016.
“As the responses above indicate, there is a fundamental disconnect in medicine today between what provides physicians with the most professional satisfaction and what third parties require them to do,” researchers maintained.
“A variety of external factors including EHR implementation and use, excessive documentation requirements, liability concerns and others are eroding the physician/patient relationship,” researchers continued.
Overall, 12 percent of physicians plan on finding a non-clinical job in the next one to three years — down one percent from 2016. Twenty-two percent plan to cut back their hours in the near future.
“An additional 8.5 percent of physicians indicate they will move to a part-time practice working 20 hours or fewer,” wrote researchers.
While rates of burnout are on the rise, physicians on average are working fewer hours and seeing fewer patients than in years previous. The amount of non-clinical paperwork and administrative burden physicians must complete to fulfill reporting requirements likely contributes to this trend.
“Physician satisfaction and physician practice patterns are matters of public health and should be considered as a part of any comprehensive policy to ensure patient access to timely, quality care,” concluded researchers.