Fayola Edwards-Ojeba, MDNovember, 2019

It's Not Burnout, it's CHAOS1

Navigating The Impact of Physician Disengagement on Healthcare Delivery

© 2019, RechargedMD 1: Chronic Healthcare-Associated Occupational Stress

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➢ Physician Burnout Review

➢ Impact of Physician Burnout

➢ Systems-based Solutions

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3

2

2

Key Points

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My Story of Burnout

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EHR Billing

NotesTax Credits

Coverage Options

Healthcare Landscape

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The Facts about Physician Burnout

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50 – 54%

Burnout

U.S. physicians reporting symptoms of burnout1,2

1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-1613.; 2. Medscape Internist Lifestyle report, 2013 – 2018

Physician Burnout

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PUBLIC HEALTH CRISIS

Consensus

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New Diagnosis

© 2019, RechargedMD 1. Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 2015;90:1600-1613.

➢ Burnout described as one of three symptoms

o Emotional Exhaustion

o Depersonalization

o Diminished Sense of Personal Accomplishment

➢ New term “Moral Injury” is gaining popularity

Current Paradigm1

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Definition of Burnout

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Physician Burnout – The Numbers

10Source: Medscape National Physician Burnout & Depression Report, 2013, and 2017; American Medical Association Wire1. Based on survey results from over 15,000 physicians across 29 specialties; 2. Based on participants’ self-identification

0% 20% 40% 60%

Emergency Med

Ob/Gyn

Family Med

Internal Med

Infectious

Rheumatology

Critical Care

Cardiology

Urology

Neurology

Pediatrics

Anesthesiology

Gastroenterology

Nephrology

Orthopedics

Surgery

Pulmonary

Radiology

Oncology

Dermatology

Diabetes & Endo

Pathology

Ophthalmology

Mental Health

Changes in Burnout by Specialty: 2013 - 20171

2013 2017

0% 10% 20% 30% 40% 50% 60%

Internal Med

Family Med

Ob/Gyn

Emergency Med

2013 2017

=2

=

=

=

1

6

14

8

5

2

10

6

4

4

3

9

2

6

1

7

21

1

=#Ranking decrease

Ranking increase

# Same rank

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Physician Burnout – The Numbers

11Source: Medscape National Physician Burnout & Depression Report, 2013, and 2017; American Medical Association Wire1. Based on survey results from over 15,000 physicians across 29 specialties; 2. Based on participants’ self-identification

Female

Male

8%

12%

2013 2017

Gender DisparityPercentage of Female vs. Male Physicians Impacted by Burnout2

Female

Male

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Physician Burnout – The Causes

12Source: Medscape National Physician Burnout & Depression Report, 2018

62%

40%

24% 23% 23% 23%20% 18%

15% 15%12% 11%

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What Contributes to Physicians’ Burnout

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The Impact of Physician Burnout

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© 2019, RechargedMDSource: Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction A Systematic Review and Meta-analysis, 20181. Based on meta-analysis of 47 relevant studies and more than 42,000 physicians, (59% men; median age, 38 years; range, 27 - 53 years)

2.4X 2.3X

3.4X

4.5X

Patient safety incident Poor quality care Poor quality care - Early career Low patient satisfaction

Impact of Burnout on Patient Care1

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Impact of Physician Burnout

© 2019, RechargedMDSource: Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction A Systematic Review and Meta-analysis, 20181. Based on meta-analysis of 47 relevant studies and more than 42,000 physicians, (59% men; median age, 38 years; range, 27 - 53 years); 2. The Business Case for Investing in Physician Well-being, Tait Shanafelt, Joel Goh, Christine Sinsky; 3. Atrius Health report

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➢ Increases likelihood of leaving 2X

➢ $500,000 – $1 million estimated replacement cost per position $

Impact of Physician Burnout

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Financial Impact of Physician Burnout

$4.6 Billion

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?

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What Are Doctors Doing Instead?

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Why else should we care about physician burnout?

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Physician Suicide

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300 physician suicides per year

Female physician suicide rate 2.5-4x higher than general population

Higher rates of depression, anxiety, and substance use

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Why are physicians reluctant to seek help?

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Increasingly Litigious Environment

210% 10% 20% 30% 40% 50% 60% 70%

Psychiatry

Pediatrics

Internal medicine subspecialities

Internal medicine

Family practice

Surgical subspecialities

General Surgery

Ob.gyn.

Percentage of physicians sued for malpractice by specialty1

Ever sued Sued two or more times

Source: Association Medical Association 1. Based on data from the AMA’s 2016 benchmark survey

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Lawsuits Based on Burnout

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A health-care facility that failed to help a doctor who was suffering from burnout may also be responsible for harm to

the patient

If you or a loved one was harmed by a burnt-out doctor, you may be entitled to compensation for your losses. You don't need to go it alone. – Contact Our Firm to find out

how we can help on your pathway to justice

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Culture of Safety

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Building a culture of safety is impossible without engaged and healthy clinicians

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If you’re still not convinced, consider the business case for addressing burnout

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Reducing Burnout

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Associated with increased patient satisfaction scores

Improved employee engagement

Decreased recruitment costs

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ROI for Addressing Burnout

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AMA calculator provides a useful tool to look at the

financial impact of addressing burnout

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How can we address this crisis?

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Solutions

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➢ Conduct Internal Surveys

➢ Wellness Initiatives for Individual Clinicians

➢ Bonuses Based on Productivity

➢ Budget for Recruitment

Current Paradigm—Traditionally Thought of as Individual Issue of Resilience

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Current Paradigm

➢ Conduct Internal Surveys

➢ Wellness Initiatives for Individual Clinicians

✓ Some focused attention on individual physicians

✓ Services to help with work-life balance

✓ Incentivize meeting RVU goals

✓ Attract great talent

? Current surveys make it difficult to identify at risk employees

? Costly

? Financial incentives might not be as inherently motivating

? Limited budget for retention of current employees

➢ Bonuses Based on Productivity

➢ Budget for Recruitment

Pros Cons

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What are we missing when we frame burnout as a

resilience issue?

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Canary in Coalmine

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© 2019, RechargedMD 32Source: American Medical Association Wire; submitted by Maria Panagioti, PhD

Approaches that address “structural changes, fostering communication between members of the health care team, and cultivating a sense of teamwork

and job control” can be most effective

Evidence Based Solutions

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Crucial Factors for Success

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Support and Commitment from senior leadership

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Crucial Factors for Success

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Need accurate data

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Comprehensive Plan

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Potential Frameworks: StanfordWellMD

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Our Framework

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Creates a roadmap that addresses these crucial domains

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Organization

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Provide physicians with leadership opportunities

Support and commitment from senior leadership

Making physician wellbeing a priority (Quadruple Aim)

Involving clinicians in key policy changes

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Self & People

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Professional development opportunities

Peer group coaching

Confidential Counseling services

Opportunities to create culture change

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Practice of Medicine

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Practice transformation

Initiatives to improve EHR and Workflow

Team based approach

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Healthcare System

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Pushing back on regional and national policy issues that are negatively impacting your physicians

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Addressing Burnout Takes time and commitment, but it can be done

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Need an internal champion in leadership position

Quadruple Aim must be an organizational priority with resources to support necessary change

Start with accurate data about sources of clinician burnout

Solutions aimed at addressing root causes of burnout (with less emphasis on individual fixes)

Evidence-Based Solutions/Take Home Points

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Questions?

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