Fatigue, scheduling, data all contributors to pervasive physician burnout epidemic

It's now widely acknowledged that physician burnout is a common and pervasive issue in healthcare, one that's affecting the business side of care delivery. The root cause of burnout is multifactorial, inspiring a range of different methods to combat it, from addressing fatigue to facilitating easier scheduling and data maintenance.

New statistics on burnout crop up often these days. A Medscape report earlier this year found that close to half of U.S. physicians feel burnout symptoms, and a significant amount, 15 percent, feel depressed.

Curtis Reisinger, corporate director of Northwell Health's Employee Assistance Program, points to simple exhaustion as one of the causes of what has become an epidemic in healthcare.

"The fatigue component is central," said Reisinger. "When you leave that core concept the reasons get a little fuzzy and less distinct, but most people agree on exhaustion. That's an easier concept to measure than burnout, per se. If you can measure something, there's a better chance you can do something about it."

One way for administrators to ascertain the level of fatigue in their organization is to ask physicians about it directly, but then there's the risk of getting a subjective answer. 

To more objectively make the determination, Reisinger pointed to some innovative ideas that have emerged, such as gauging a physician's reaction time by measuring their pupillary reflex, a practice known as pupillometry. It's a more scientific way of ascertaining a doctor's fatigue levels.

"That's creepy for some people, a little 'Big Brother,' but the mistake people make is they measure indices of burnout every year, or every two years, but you can't change very much with that kind of approach," he said.

Not that change is easy under any circumstance. Internal dialogues are common among physicians, said Reisinger, and this can be exacerbated by the emergence of ever more complex technology and data collection.

"A lot of what we get fatigued on are our own arguments in our own head," he said. "This is where the psychologist comes out in me. If you see an electronic health record, new residents are very savvy with that. They were raised with computers, they type quickly -- it fits. Older physicians tend to say, 'I can write this by hand 20 times faster, this is ridiculous.' That inner dialogue can be fatiguing."

Scott McFarland, president of HealthBI and the former president of population health at the Cleveland Clinic, said technical data entry is a large part of why burnout is so common in healthcare.

That data entry, said McFarland, "would create longitudinal records that are sometimes so overwhelming to the physician, who's having to make a call within 10 minutes of being in a room with a patient. They're having to interact with an EHR, having to interact with staff and they're doing a lot more to advise and correct the system so they can get paid properly, as opposed to connecting with and empathizing with the patient."

HealthBI is paid by health plans so that it can offer practice transformation initiatives to providers without charging them, and the model has been meeting with some success, freeing up time on the back end so physicians can spend more time with patients -- which is why they got into medicine in the first place.

"Trying to see a block of patients, trying to see your practice put systems in place so you can be profitable as a practice -- they don't teach that in medical school," said McFarland. "You're having to adopt this new competency around practice management and practice workflow.

"The more we can make technology work on a practice level, the more satisfaction they'll have in their practice, and the more they'll be able to interface with their patients. That leads to the feeling of, 'Yes, I feel satisfied in the career I've chosen.'"

Suvas Vajracharya, CEO and founder of physician scheduling company Lightning Bolt, sees another element factoring into the burnout issue, the physician shortage. The number of retiring physicians and physicians older than 60 is greater than the number of physicians younger than 40. The Association of American Medical Colleges predicts an 80,000-100,000 physician shortage by 2030.

"I think the shortage is due to the aging baby boomer population," said Vajracharya. "There is a high number of people needing care, but the type of care is more acute than it has been in the past. It causes a great deal of stress on the doctors who are having to deal with more work. It has this ripple effect, where doctors feel the burden of taking on more work and those who stay … want to work fewer hours. They want a more flexible lifestyle."

Given his vocation, Vajracharya naturally gravitates toward overhauls to the physician scheduling system as a way to ease the stress on clinicians.

"Doctors have certain requirements for their work-life balance," he said. To that end, his company's software allows doctors to select their preferences for when they want to go on vacation, when they prefer to do their shifts and whether they're available full- or part-time on certain days. The platform factors in things like the number of patients scheduled throughout the year and seasonal averages for patient volumes.

Giving physicians more control over their schedules, said Vajracharya, allows them to maintain consistent circadian rhythms and take time off when they need it, which loosens the grip that burnout can have.

But gauging any stress-reduction effort is difficult, said Vajracharya, because doctors are often stoic about such things.

"Typically it has been very difficult to conduct surveys with physicians, because doctors often don't complain about the condition they're in," he said. "They often take it upon themselves to take on more work, so the culture of doctors sometimes prevents good measures of how well they're doing."

According to Reisinger, the volume demands in healthcare require increasing sophistication in terms of how quickly physicians can conceptualize and make use of ancillary resources, whether it be scheduling automation or something with more clinical focus, such as automated methods for interpreting X-rays and radiological reports.

That can be a struggle for many, he said, because a good number of doctors and clinicians came of age in a time when technology was less ubiquitous, especially in their profession.

"There are some physicians who still haven't learned how to turn their own laptop on if they have one," said Reisinger. "It's not strange, it's just that we've evolved from a technological perspective more quickly than people anticipated."

When purchasing technology solutions, administrators should be mindful of usability, ensuring there's a smooth interface between human and machine. Something as simple as making two or three mouse clicks to get where they want, multiplied by 50 patients a day, can quickly add up, which slows down physician entry and adds to their frustration.

From an administrative and human resources perspective, one of the most crucial components of combating physician fatigue is ensuring clinicians' jobs are meaningful and rewarding to them. 

From a doctor's perspective, it's about taking proper care of themselves.

"Insist on taking the vacation that you deserve," said Reisinger.

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com