- In response to a new study about high levels of physician burnout among family physicians, Ohio State University Wexner Medical Center family physician Donald O. Mack, MD, suggested the recent transition to a value-based care system and increased EHR use may have augmented the problem.
“Burnout is associated with lower patient satisfaction and care quality, higher medical error rates and malpractice risk, higher physician and staff turnover, physician substance abuse/addiction, and physician suicide,” he wrote.
“The causes are numerous, and in many cases physicians point to the increasing demands of electronic medical records, quality metrics, administrative tasks such as prior authorization, and value-based payment requirements, which take time away from direct clinical care,” Mack continued.
Mack’s commentary came in response to a recent study by Hansen et al. that showed levels of physician burnout vary significantly between states, with Michigan and Minnesota physicians reporting the highest rates of exhaustion.
In 2016, researchers surveyed 2,069 young physicians three years out of residency training. Respondents provided information about their levels of emotional exhaustion and depersonalization.
Overall, an average of 39.8 percent of young, newly-practicing physicians reported significant and consistent feelings of emotional exhaustion. Additionally, 23.7 percent reported high levels of depersonalization.
Young physicians in Michigan and Minnesota demonstrated the highest rates of burnout, with approximately 55 percent of physicians reporting feeling emotional exhaustion once a week or more frequently. Meanwhile, respondents in South Carolina reported the lowest levels of both emotional exhaustion and depersonalization, with rates of only 16.1 percent and 9.7 percent, respectively.
In addition to variation between states, researchers also found variation between levels of emotional exhaustion and depersonalization within states. In Minnesota — though levels of emotional exhaustion were high — only 30.4 percent of survey respondents reported feeling frequent depersonalization. By contrast, Colorado reported the highest rate of depersonalization at 35.3 percent, while the rate of emotional exhaustion in the state fell only slightly above average at 41.2 percent.
Researchers suggested the significant variation of physician burnout within and between states is a result of several state-level policies and cultural factors.
“Variation among states suggests that there may be state-level factors, such as policies, payer-mix, or even culture that affect burnout,” wrote researchers. “There may be general contributors to physician burnout, but these results indicate that to adequately frame solutions, further exploration of state-level factors is needed.”
While all physicians are experiencing some level of burnout, Mack stated family physicians are particularly susceptible. A 2017 State of Family Medicine study showing 63 percent of family physicians experience burnout as compared to 54 percent of all physicians. Young family physicians may be at an even higher risk of exhaustion, he suggested.
“Although new physicians usually have fresh experience and skills from their training program in avoiding burnout, they often have additional stressors of relocation, adaptation to a new practice setting, financial adjustments of increased income/debt repayment, and ‘catch up’ on personal and family obligations after navigating medical school and residency,” Mack stated.
In addition to increased EHR use associated with value-based care, Mack suggested physicians have also been too willing to accept the administrative burden associated with running a practice. Mack referenced comments by family physician Rebekah Bernard, MD, about the depersonalization of medicine.
“[Physicians] have accepted increasing tasks of checking boxes, and completing even more administrative tasks to improve practice metrics with the end result that physicians are now working for practice managers rather than patients,” he wrote.
As one potential solution to the problem of physician burnout, Mack advocated for direct primary care (DPC).
“This allows physicians to stop the many administrative tasks inherent to the fee for service system and value-based payment programs,” maintained Mack. “Family physicians can manage these reduced management requirements and focus on patient care while patients pay a monthly retainer that covers all or most primary care services.”
According to Mack, family physicians practicing DPC report feeling an improved sense of autonomy and more control in their practice. Most significantly, these physicians also report spending more time with patients.
These findings further support previous studies showing almost half of practicing physicians believe they will have trouble maintaining their workload in the long term. While a variety of factors are likely responsible for high rates of physician burnout, EHR technology has been named a key contributor to the problem.
Modified policies related to federal reporting requirements, improved EHR usability, and reduced administrative burden could help to deter the negative effects of EHR use on physicians.