AMA: 8 Tips to Reduce Physician Burnout

She burned out, he flamed out…so many references to fire in colloquial conversation these days…but why? Because what we all have is a fire in our souls that propels us through our days. And many of us, physicians included, are stretched so thin that we are left with only a spark.

According to the American Medical Association (AMA), 44% of physicians have experienced at one time or another, burnout.

Courtesy of the American Medical Association and its Vice President of professional satisfaction, Christine Sinsky, M.D., here are eight tips that hospitals, clinics and other healthcare providers can use to tamp down the fires of physician and staff burnout.

Tip #1: Measure burnout

Measure burnout? Yes, and as Dr. Sinsky reminds us, if you want to tackle any problem, a good place to start is by measuring it.

According to Dr. Sinksky, you need to gather baseline data.

“We deploy a ten-question survey that has been benchmarked nationally and can be used by leaders to further understand the degree of burnout and its key drivers at their organization. The survey results in two sub-scores, one for work environment (supportive or not) and the other for work pace and stress brought on by electronic health records (EHR). In addition, we have built an ‘organizational biopsy’ which also assesses aspects of organizational culture, such as leadership, teamwork and safety.”

Tip #2: Improve workflow

Once a clinic or hospital has some baseline data regarding stress or burnout then, says Dr. Sinsky, it’s time for interventions, such as the AMA’s STEPS Forward™ program. That program, according to Sinsky, gives a practice assessment tool to providers which identifies workflow stress points.

For example, the Steps Forward program can help dig into details about how pre-visit bloodwork is done, how to systematically close any existing gaps in care, how prescriptions are handled, medication management, team meetings, and each physician’s sense of personal well-being.

Sinsky explained to OTW that “Eight of the over 50 Steps Forward modules address these basic building blocks of an efficient, effective practice; each module includes practical, actionable guidance, tips from experts, downloadable resources such as a sample team meeting agenda and inspiring stories of how other organizations have implemented the particular practice fundamental concept.”

“To date, one of the most powerful interventions that has been implemented at multiple sites is the concept of advanced team-based care with in-room support. This involves a co-visit, with real-time documentation support provided by a medical assistant, nurse or another individual. The most powerful model employs a clinically trained individual who can provide both clinical and clerical assistance.”

Tip #3: Evaluate the impact of the program

You’ve got the baseline data, you’ve implemented the AMA’s Steps Forward program, now how are you doing? Tip #3 is, evaluate how these different initiatives are affecting physicians and staff members.

Even the process of setting up and conducting monthly or quarterly meetings on the subject of physician and staff burnout for the purpose of walking through the surveys and other information coming from the AMA programs will have an effect on any institution’s level of stress, anxiety and, yes, burnout.

Tip #4: Work with your state medical society

According to Dr. Sinsky, the AMA’s Practice Transformation Initiative, which includes many state medical societies is a great resource for hospitals and clinics.

“The AMA’s newest program, the Practice Transformation Initiative, involves the Physicians Foundation and several state medical societies, the role of the latter being to recruit health systems and practices to participate in order to field test various burnout reduction initiatives and derive evidence-based research which can then inform our efforts to improve physician care.”

Tip $5: Don’t blame the doctor

This is probably the most important tip of all. And this applies to BOTH the hospital or clinic and the physicians themselves.

In reality, as Dr. Sinsky states, “Approximately 80% of burnout among physicians is driven by systems factors, while only 20% is driven by individual factors.”

As a result, any program that is trying to reduce burnout must, according to Dr. Sinsky, “focus on external factors such as reducing the administrative burden and working with health systems to create the conditions where joy, purpose and meaning in work are possible for physicians and other health professionals.”

“When an organization begins its interventions by addressing individual factors it risks saying to physicians that they are the problem. Thus, as much as I endorse yoga, meditation, etc., I don’t think that is where an organization should begin their anti-burnout efforts. Instead, organizations can begin by addressing the numerous ways to improve workflow, EHR [electronic health records] time, and teamwork so that doctors can spend the majority of the day on work for which they are uniquely trained.”

Tip #6: Triage the inbox

Who among us couldn’t use this tip?

Dr. Sinsky recounted to OTW a particular project she was working on that highlighted the notorious inbox problem.

“In one research project, we are working with a system deploying a model of nurse management of inboxes. For many doctors, their inbox is a Sisyphean task…and they are typically the first to respond.”

“We are flipping that model so that the staff person responds first, managing what they can and doing background work on the more complex messages before reviewing them with the physician.”

“In addition, if doctors or nurses are frustrated with their inboxes, for example, saying, ‘All I do all day is renew prescriptions’ we have a how-to module on streamlining prescription management. Doing this saves 30-60 minutes per day.”

“Another pilot effort involves a virtual documentation assistant where the assistant is not in the room but is connected digitally via a microphone and is listening in real time and drafting visit notes.”

Tip $7: Estimate the cost of burnout

Want to get buy-in from your hospital’s chief accounting officers? Give them numbers. When it comes to the cost of physician and staff burnout, it is scary how much this costs the overall healthcare system.

Dr. Sinsky has some excellent advice for providers who want to understand the costs of burnout. “We have a calculator that practice leaders can use to estimate the costs they currently incur due to physician burnout.”

“The calculator is based on an article written with a Harvard Business School economist incorporating published data on variables contributing to the costs of burnout. The calculator gives one the ability to input local data.”

“For example, if a 1,500-physician hospital with average rates of burnout can expect to lose 32 doctors per year due to burnout and that would cost approximately $16 million each year. This concrete information makes it easier for leadership to understand current costs, invest some of this into burnout prevention and reduction, and thus set themselves up for future success.”

Tip #8: Debunk regulatory myths

Finally, don’t fall prey to some common regulatory myths. And, in this regard as well, the AMA has information that can help.

According to Dr. Sinsky, “The AMA now provides a section titled “Debunking Regulatory Myths” on its site. For example, it is commonly thought that physicians must redocument elements of the patient’s history that were documented by a student, patient or staff member. This is no longer required, and we provide links to the federal policy that addresses this situation.”

For more information, please visit STEPS Forward.