By Christopher Cheney
It is imperative for healthcare organizations to address physician burnout, the chief medical officer of a Dallas-based clinically integrated network says.
Burnout is one of the top challenges facing physician and other healthcare workers nationwide. A report published in September by The Physicians Foundation found that the coronavirus pandemic has worsened physician burnout. Research published in September 2018 indicated that nearly half of physicians across the country were experiencing burnout symptoms.
“Burnout is real. If we do not address the causes of burnout, we are going to lose good providers, and we cannot afford that as a country,” says Jason Fish, MD, senior vice president and CMO of Southwestern Health Resources in Dallas. The clinically integrated network features nearly 5,000 physicians and advanced practice providers.
Fish says four actions can ease physician burnout.
1. Streamlining communications
Reducing unnecessary emails and noncritical data can help reduce physician burnout, he says.
“For email and communication in general, as providers we are being completely overwhelmed from so many different angles. Everybody wants a piece of the physician. So, what we have tried to do is to streamline our communication. If we are not asking what is valuable to the providers, then we are missing the mark,” Fish says.
Physicians should not be overloaded with email, he says. “For us, when we communicate, we do not want 20 different people communicating with our providers. We want to streamline our email. We try to step back and see how we can combine those communications or find communications that we can let go of if there is no value in them. Or we try to direct communications to somebody else because those communications may not be of value to the provider—they may be of value to the office manager.”
Similarly, physicians should be presented with critical data, he says.
For example, Southwestern Health Resources has used predictive analytics to harness data related to their efforts for coronavirus vaccination. “Here in Texas, when coronavirus vaccines became available, the first people who were eligible for vaccine were everyone who was 65 years old or older. But there were groups within that age cohort who were at higher risk than others. So, we were able to run our patients through a predictive algorithm based on where they lived, social determinants, medical conditions, and past utilization patterns to prioritize who should get the vaccine,” Fish says.
Focusing on high-risk patients has allowed Southwestern Health Resources physicians to manage vaccination data, he says. “If primary care provider had a panel of 2,500 adult patients, with 1,800 patients over age 65, it is not helpful to send the provider a list of all 1,800 patients. Instead, we sent a tiered list of patients. So, if there were 200 patients at highest risk, we told the provider to get them in for vaccination. The provider could get on the phone and answer questions about the vaccine and tell patients where they could get vaccinated. All 1,800 of the older patients are important, but we wanted to guide providers with a hierarchy.”
2. Vocalizing appreciation
Acknowledging good performance can be a powerful tool to reduce burnout, Fish says. Southwestern Health Resources recognizes top performers during regular “pod meetings,” which are organized by large physician practices or combinations of smaller practices, he says. “For example, we had a practice during the early phase of the pandemic that was the first out of the gate doing testing in the parking lot. It was new. We showcased that—we highlighted that. We celebrated that in our network through our pod meetings, through our newsletters, and through our website.”
Vocalizing appreciation promotes the sharing of best practices and effective initiatives, Fish says. “When you have teams that are doing great work, rather than just giving out accolades, you want them to share their stories. You want to share how they did great work with other practices. That is another way you can celebrate the good work. You want to permeate that good work across the organization.”
3. Implementing team-based models of care
Promoting teamwork is another way to combat physician burnout, he says. “One thing we have done is to help engineer team-based models of care in the clinics. We have a performance improvement team that goes into the clinics and helps them build team-based models of care. The PI team can help clinics design daily huddles and move clinics to team-based models of care within their staff.”
Team-based models of care help physicians manage medically complex patients, Fish says. “You bring in all of the adjunct staff—the care management team, the utilization team, the disease management team, and the quality team for the coders for clinical documentation. You wrap these individuals around the providers to form a team, which brings value to the providers, then the providers do not feel like they are on a journey with complex patients alone.”
Including care managers and social workers in a physician practice team can also reduce burnout, he says. “When you add a care manager and a social worker to the team, you can find out what is going on in the home or what is going on in the neighborhood. You can find out barriers that patients have to living their optimal health and to have their best quality of life. You can connect patients to community resources. That kind of team is incredibly important to driving success and taking burdens off providers.”
4. Working at top of medical license
To limit burnout, healthcare organizations should ensure that physicians are working at the top of their medical license, Fish says.
“If you want providers to Google community resources for their patients or sift through a list of 2,000 patients to figure out which ones are at risk, you are going to have physician burnout. You need to use the analytics platform, and you need to use the team that you have such as social workers and care managers. The physician’s job should be working with the patient around counseling for optimal health, diagnosing critical disease, and managing critical disease. The minute you pull a physician into other things, they are not working at the top of their license.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.