MGMA 2022: Organizational changes, U.S. health care revisions needed to alleviate physician burnout

Organizational changes are needed to alleviate burnout for physicians and other health care changes.

After dealing with pandemic conditions, evidence has become clear that physician resilience training will not solve systemic problems contributing to burnout, said Michael Tutty, PhD, MHA, FACMPE, and group vice president for professional satisfaction and practice sustainability for the American Medical Association (AMA). He outlined the latest research and potential solutions in the presentation “Understanding and Addressing Physician Burnout in the Post-COVID Era,” 2022 Medical Practice Excellence Leaders Conference of the Medical Group Management Association.

It's true that physicians’ physical and mental well-being contributes to feelings of burnout on the jobs, characterized by:

1. Emotional exhaustion
2. Feelings of decrease personal achievement and a lack of empathy for patients
3. Depersonalization, including cynical or negative feelings toward patients

But now is the time for physicians, staff, and administrators to look at organizational revamping and large-scale revisions within the U.S. health care system, two larger systems that encircle the work of individual workers.

“I would argue though that the best place for us to be investing our needed time and resources is working in the outer two circles, working on those environmental issues that make it harder to practice medicine than it should,” Tutty said.

Studies have shown physicians are more resilient than the general population. Focusing on the individual can feel like blaming individuals for not being resilient enough, “and we know that’s not the case,” Tutty said.

“It’s the organization,” he said. “It’s the health system we all work in. We all know how dysfunctional it is and how frustrating that can be. We know it’s not an individual problem.”

Individual resilience training, such as a mindfulness course, is great, but really serves as a coping mechanism when participants return to a chaotic work environment, Tutty said.

The AMA has created the STEPS Forward program with practical lessons about what to do and what to avoid in improving medical workplaces. Tutty referred to that program and its “Saving Time Playbook” for more resources to alleviate conditions that contribute to burnout.

Some ways to start improving organizational well-being, can be:

• Recognize the cost. AMA has a calculator that can tally the real dollars and cents effects of physician turnover, especially in larger institutions. “When you have a health care leader who says, ‘I don’t think we have the funds to work on this type of issue,’ the issue is, ‘Do you have the funds not to work on the issue?’ because of the coast to the institution,” Tutty said.
• Get input by surveying the team. It appears some organization leaders don’t want to survey staff because they are afraid of the results. “Well, trust me, that’s how people feel whether you survey them or not,” Tutty said. It’s a powerful tool, though Tutty advised waiting to read results on Monday morning, instead of a Saturday morning so as not to ruin the weekend because the first impression can be overwhelming.
• Do a GROSS project. GROSS is Get Rid Of Stupid Stuff. “It’s not gross at all, it’s a pretty good idea,” Tutty said. He added not every idea needs a study committee and some ideas are so obvious they should just be done.
• Examine electronic health record (EHR) metrics. Administrators could be surprised at variations in documentation time among physicians. It may be that physicians who spend more time on EHR need more training.
• Consider team-based documentation. Adding scribes to a practice can be expensive, but finding new opportunities in EHR documentation can free time physicians while letting other staff get involved with patient care.

Tutty noted email inbox messages have increased in the last year or two for physicians and that is adding to workplace dissatisfaction. For emails, EHR, and other computer programs, vendors tout the speed of programs, but if those add two minutes to the work week, the programs should cut two minutes somewhere else.

He proposed a four-question test for evaluating new technology:

1. Does it work?
2. Will I receive proper payment?
3. Will I be liable?
4. Will it work in my practice?

Building a team

Finding or implementing potential solutions for may not be as successful as you hoped, but could have a beneficial side effect. By working together to solve a problem, physicians and staff can build camaraderie that is powerful on its own, Tutty said.