Keeping sane as Medicine is gone Crazy
Medicine is moving at Mach speed, and physicians are in the middle of its path. Regulation. Consolidation. New technologies. With so many forces bearing down on doctors, how do you stay sane?
We asked physician experts and consultants to talk about the leading causes of dissatisfaction and burnout among physicians, and to give practical advice on handling them.
Doctors Face Challenges From All Sides
There are plenty of overarching macroeconomic forces unsettling doctors: a sluggish economy, uncertainty about the impact of the Affordable Care Act, and the rise of narrow provider networks, just to name a few. But these big-picture stressors often take a backseat to the everyday headaches that fill a physician's long days.
Four out of 10 respondents to Medscape's 2013 Physician Lifestyle Report say they're burned out, and it isn't the distant, foreboding pressures that are primarily to blame. Instead, doctors cited a couple of everyday, pervasive reasons: "too many bureaucratic tasks" and "too many hours of work."
Not surprisingly, these common complaints share some underlying causes.
Overscheduling
Office visits squeezed into packed schedules are a constant strain on physicians, says Christine Sinsky, MD, an internist in Dubuque, Iowa. Clinical care has become much more complicated. Patients are older, sicker, and often more overweight, and physicians are expected to monitor and document far more information than in the past.
"We have to do all this frantic multitasking, which leads to paying less attention, which leads to stress, which leads to burnout," she says.
Paperwork
Monitoring and documenting care has become more complex as a result of increased regulation, PQRS (the Centers for Medicare & Medicaid Services' Physician Quality Reporting System), meaningful use, medical home criteria, and other requirements.
"It's not just about doing the right thing for your patients," Dr. Sinsky says. "It's about proving to someone else that you've done the right thing, and sometimes the proving takes longer than the doing."
Clinical documentation is only the beginning. Physicians currently spend almost one quarter of their time (22%) attending to nonclinical paperwork, according to a 2012 survey conducted by the Physicians Foundation.[1] With implementation of ICD-10 to take place in October, that percentage will likely increase.
“We spend too much time away from our patients dealing with checkbox-type medicine, and that really interferes with patient care," says Joseph Valenti, MD, a Denton, Texas-based ob/gyn and Physicians Foundation board member.
More Factors Straining Physicians' Sanity
EHR Woes
Although electronic record-keeping has been a boon to efficiency in many fields, it has significantly increased physicians' workloads. In addition to the headaches associated with mastering new systems, doctors spend a lot more time on data entry and a lot less time looking their patients in the eye than they used to.
Consolidation
Whether they've gone to work as employees of larger groups or are struggling to remain autonomous, physicians are feeling the effects of market consolidation. Many employed doctors bemoan the loss of clinical autonomy and struggle to adapt to new corporate cultures. Meanwhile, their colleagues in independent practices must constantly struggle with making ends meet given their limited resources and competition from larger provider groups, which have the clout to negotiate better contracts with insurers.
Twenty percent of the 2000-plus physicians surveyed by Physicians Wellness Services (PWS) and Cejka Search as part of their 2012 Physician Stress and Burnout Survey were not employees -- a number that closely aligns with the 14.2% of respondents who cited "financial issues such as the cost of running a practice, debt, etc." as a major cause of stress.[2]
Staying Calm, and Keeping Your Spirits Positive
Daunting as these challenges may be, experts say physicians can chip away at them if they're willing to reconsider their practices and adjust to shifting demands. Here are some steps you can take now to help you stay in control.
Build a Team
Dr. Sinsky, one of six researchers who studied nearly two dozen high-functioning primary care practices for an article published in the May/June 2013 issue of Annals of Family Medicine [3] says teamwork lies at the heart of addressing many of these frustrations.
"We can't deliver the outcomes we want for the future with the practice model and the staffing model of the past," she says.
For instance, a physician who works with a part-time medical assistant or a different medical assistant every day can't optimally delegate responsibilities because the gap in their training and licensing authority is too great, which forces the doctor to deal with a lot of administrative work, Dr. Sinsky says. Working with a team of nurses or physician assistants enables physicians to build a more flexible staffing model, she explains, because doctors can delegate more and team members can share tasks depending on what's needed.
Here's an example of smart streamlining of tasks: "During flu season, you don't want a physician spending a lot of time putting orders in for over a thousand patients," Dr. Sinsky says. "That's a lot of clerical work. Instead they can have a standing order saying, 'Anyone who agrees to a flu shot can have one.'"
In the interest of saving time -- including your time -- it makes sense to draft written protocols for your staff, recommends Melissa Stratman, CEO of Coleman Associates, a Boulder, Colorado-based consulting firm that helps physicians redesign work processes. "Implement a couple of protocols a week. It will make employees' jobs more interesting and satisfying, and enable you to delegate. Discuss the protocols at staff meetings, and ask employees for their comments and suggestions," she says.
Having a cross-functional team means a team member can handle patient documentation for the physician, Dr. Sinsky says. Although some practices may opt to hire designated medical scribes, Dr. Sinsky says it's advantageous to train team members to do the work, so that a practice has the flexibility to use them in other capacities when needs arise.
Reengineer Tasks
Ordering routine tests before an office visit saves the practice time and promotes better communication with patients, Dr. Sinsky says. With results already in hand, you can discuss the numbers with your patients and use the exchange as an opportunity to motivate them, set goals, and develop an action plan. Ordering tests in advance likewise eliminates the need to call patients with their results after the visit. Similarly, by providing multimonth prescriptions for patients with stable conditions, practices can avoid repeating the same work multiple times throughout the year.
Simply taking the time to educate your medical assistants about what you need and why you need it can save lots of time and free up staff to handle more clerical functions, says Stratman.
Shelly Reese/ Freelance writer, Cincinnati, Ohio
adamfoxie blog advise:
To the Doctor:
Ronald Groat, MD, a Minneapolis psychiatrist and consulting physician for PWS, reminds physicians to practice what they preach: Eat right, exercise, and spend time with your family and friends. "You have to remember your priorities," he says. "You can't forget -- and neglect -- the people and activities that are important to you and give your life meaning. If you can't find that balance in your existing situation, then you should consider how you can make changes. It may be worth your while to reduce your income if it translates to a better quality of life.”
To the Patient:
If your Doctor or new young Doctor shows signs of unhealthy habits like, smoking, obese or bad hygiene you need to take a second look.
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