A look at EHR use and regulatory requirements will help address physician burnout and patient care access issues, according to Gary Price of the Physicians Foundation.
Physician burnout is reaching new heights. And as more doctors look to make their next moves in a career that leaves them stressed and unsatisfied, the industry faces threats to patient care access.
The physician burnout epidemic has reached unprecedented levels, data shows. The Biennial Survey of America’s Physicians, conducted in partnership between the Physicians Foundation and Merritt Hawkins, recently found that as many as 78 percent of physician respondents have experienced symptoms of burnout.
Other surveys have drawn similar conclusions. A 2018 report published in the New England Journal of Medicine Catalyst found that 83 percent of healthcare organizations are feeling the consequences of physician burnout.
This problem goes beyond doctors being unhappy at their jobs. With more and more clinicians experiencing feelings of burnout, patients may begin to see fewer opportunities to receive care, according to Gary Price, MD, the president of the Physicians Foundation.
“The level of decline in morale and incidents of burnout symptoms continues to be a very serious problem,” Price told PatientEngagementHIT.com in an interview. “At this point it will threaten patients’ access to care as physicians either leave clinical responsibilities or cut back on their hours, retire, or in the most tragic of circumstances, commit suicide. That is the most direct, perhaps largest threat to the physician-patient interaction, just the physician no longer being there.”
Physicians leaving the workforce is quickly becoming the reality in healthcare. Forty percent of the respondents in the Physicians Foundation survey said they are considering retiring or cutting back their hours, up from 36 percent of physicians saying the same in the 2016 survey. Forty-six percent of respondents said they want to change career paths.
That presents a bit of a conundrum, Price explained. Most providers say interacting with patients is the best part of their job (79 percent, according to the Physicians Foundation survey). But with technology and reporting demands flooding provider workflows, that patient-provider relationship is going away.
“The cause that physicians consistently rank number one is the way that the electronic health record interferes with their care of patients,” Price said.
The EHR is inefficient, has too many regulatory check boxes, and physically and metaphorically serves as a barrier between doctors and patients, he explained.
“That directly affects the experience the patient has, because it takes away the physician’s time that they could spend not only building that relationship with their patients, but also using that relationship to take better care of the patient.”
Reducing EHR presence during patient interactions could be one solution to this relationship-building barrier, one may conclude. After all, patients don’t love when providers stare at the EHR, either, and eliminating technology could create more satisfaction for both patient and provider.
But that’s just not the reality doctors live in, Price asserted.
“The problem is that physicians have been placed in an untenable position in that relationship,” he noted. “The mandates that have been added on to them as far as reporting and documentation go are arduous and come from multiple directions. There’s no way around satisfying them, other than opting out.”
Doctors face mandates from payers, government insurance plans such as Medicare and Medicaid, and other programs that require multiple documentations. Providers can either meet these demands, or not receive optimal payment for services.
Therein lies the problem, Price said. Although the EHR bears the brunt of physician frustration, the technology itself is not entirely to blame for increasing physician burnout.
“The electronic record is part of patients’ care and it’s not all bad,” Price said. “Physicians and patients all like the access to data that the EHR gives. But short of not carrying the computer into the room and only doing data entry outside of the room, that’s the only way you can get that third party out of the room with the patient.”
Of course, there is some room for improvement as far as EHR usability and design is concerned. These tools were not necessarily designed with patient care in mind; instead, they originated as billing tools intended for bureaucratic use.
“A lot more could be done to make that interface with the computer more efficient,” Price said. “We have to have a total turn around in the system, where the EHR is looked at as a tool that physicians use to take of patients, and totally re-engineering it so it facilitates that care instead of detracts from it.”
But even if the health IT sector could reconfigure the EHR to make it more conducive to patient care, the onslaught of reporting requirements still poses a challenge. Data from the American Medical Association shows that for every hour a physician spends with a patient, they spend another two hours on documentation.
That isn’t an indictment on the EHR, but instead on the never-ending reporting requirements providers face.
Some providers solve this problem by simply not meeting reporting requirements, Price said.
“Doctors can do that in a couple of ways, first by refusing to accept insurance,” he explained. “There are strategies such as direct primary care and some organizations have figured out strategies for structuring practices that can, in a cost-effective way, provide care without letting all these third parties get into the exam room. It involves economic sacrifices on the physicians’ part, but it leads to much greater satisfaction with how their practicing.”
It’s the notion of physicians declining to accept insurance that is the most concerning for Price, considering the exceptional cost of healthcare.
“For many, if not most, patients seeking medical care right now without insurance coverage is just economically untenable,” he stated. “Driving physicians to stop accepting insurance will reduce access for a lot of people to their services.”
Other providers, including Price, are choosing to accept penalties for non-compliance with reporting requirements. That is a less financial burdensome option than using practice time to adhere to reporting requirements, Price said.
“Of course there’s a downside to that, too,” he acknowledged. “Many physicians are running small independent businesses, and sooner or later they have to look at the reimbursement they’re getting for services versus whether they want to do that anymore. And, of course, the decision to reduce services is not good for patients. It takes away their access.”
Ultimately, both private and government payers need to rethink their quality measurement requirements, Price said.
“There’s an old adage in quality improvement that if you can’t measure it, you can’t improve it,” he stated. “I think we have to come one step further and realize that just because you can measure something, doesn’t mean it’s important.”
The first step in identifying quality metrics that are worth measuring is consulting with physicians, Price said. These individuals are on the frontlines of care and have tremendous insight into what indicates quality healthcare.
To be fair, the government has begun to acknowledge that fact, Price conceded. Federal payer programs have noted that certain regulatory requirements have not accomplished what policymakers initially intended.
But more action will be necessary to redesign regulatory requirements in such a way that it will have an impact on the physician burnout epidemic, Price said. Foremost, policymakers should acknowledge that patient-provider relationships and the work inside the office are important indicators of quality care.
“We need a total mindset realignment as far as how we look at all these burdens that are imposed on the work a physician does do,” he said. “We have to realize that what the physician is doing at the point of care with their patient in trying to provide them with good care. That is the actual work. That is the product that we all want them to do to end up with a healthier society.”
When designing healthcare regulations, policymakers and industry leaders should look at the impact certain mandates have on the patient-provider relationship.
“We need to think about how those actually do interfere with the process of care, and give that some importance in the decisions,” Price said.
“Physicians are at the point where, for many of them, they’ve had the one final straw that broke the camel’s back,” he concluded. “And others are getting close to that point. I’m pleased to see that some attention is being drawn to this issue, but we need to move beyond the consciousness and start working hard on figuring out ways to make it better.”
Date: November 9, 2018