EHR, prescriptions, values all contributed to physician burnout during COVID-19 pandemic

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Additional work in electronic health records was among the factors causing stress that contributed to physician burnout during the COVID-19 pandemic.

A new study reported results from a 2020 survey of 627 physicians that found 49.8% reported burnout symptoms due to several factors:

• A higher level of EHR stress
• Having more prescription reauthorization messages
• Not feeling valued or aligned in values with clinic leaders
• Practicing for less than 15 years
• Sleeping less than six hours a night

The survey took place among attending physicians at the University of California San Diego Health System from April to September 2020. There were three questions relating to the amount of time spent on documentation, the amount of time spent on EHR at home, and the amount of frustration physicians experienced with EHR during the workday. A five-point rating scale ranged from excessive to minimal or none.

The physicians also reported on self-care practices such as sleep, exercise, and mindfulness practices, and individual characteristics such as inpatient or outpatient work setting, clinical work hours, and years in practice.

The survey differentiated COVID-intense specialties by frequency of caring for patients with COVID-19, such as infectious disease, pulmonary and critical care, anesthesiology, hospital medicine, and emergency medicine.

Among the specialties, psychiatry reported the largest proportion of physicians with burnout at 60%. COVID-intense specialties were at 55%; primary care, 54.9%; obstetrics-gynecology, 48.7%; surgeons, 44.7%; hospital-based, 43.5%; and medical subspecialties, 42%.

“Unsurprisingly, the subjective measure of perceived EHR work stress was significantly associated with burnout,” the study said. “Interestingly, physicians directly receiving MyChart messages, compared to those using a pool to screen messages first, were not associated with having higher odds of burnout.”

The researchers suggested more support be given to physicians. UC San Diego Health System has implemented a pharmacist-run prescription refill and prior authorization program “aimed at improving physicians satisfaction and quality of care in all primary care areas,” the study said.

The authors said their findings were consistent with previous studies regarding burnout because physicians did not feel valued or who felt their values were not aligned with those of institutional leaders. When physicians and administrators join efforts, they can create practical and sustainable solutions with appropriate staffing, the study said.

There were several possible influences on higher levels of burnout for younger or mid-career physicians. They may have had young children at home requiring care and distance learning during the pandemic, and may have had student loans and home payments due, the study said.

At work, those physicians may have less control over scheduling and may have taken on more frontline care so older colleagues could reduce their risks to COVID-19 exposure.

“Meaningful support of early career faculty could include mentoring, career coaching, leadership training, and engagement with peers and colleagues who can relate to similar stressors and provide mutual support,” the study said.

Some may view the amount of sleep as a personal choice, but it is a foundation of health and institutions should “structure service delivery and work expectations” to ensure sufficient sleep for worker and patient well-being, the study said.

“Association of physician burnout with perceived EHR work stress and potentially actionable factors” was published in the Journal of the American Medical Informatics Association.