Desktop Medicine & Physician Burnout

#1 contributor to burnout among many

By Wael Barsoum, MD

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It’s called “desktop medicine” – the amount of time a physician spends in front of a computer after seeing patients, and it includes everything from entering medical information collected during appointments to authorizing prescriptions to ordering diagnostic tests. Much of this information is entered into patients’ electronic health records, which purportedly, improve patient care.

Desktop medicine is increasingly becoming a problem. In its annual survey of internists, Medscape identified the bureaucratic tasks associated with the practice of medicine as the number one contributor to physician burnout. Separate studies came to the same conclusion: that many physicians spend half of their workday doing what amounts to data entry. In one survey conducted by the American Medical Association, hundreds of primary care physicians reported slightly more time (less than ten minutes) in front of their computers than with patients.

No one is happy about it; certainly not physicians, and certainly not the patients who talk about reduced eye contact and less engagement while their doctor tries to keep up with inputting data into their EHR.

Causes of burnout

There are many causes of physician burnout. Reports of this malady are everywhere, and online, physician comments during a recent Twitter chat were quite telling:

  • There is an impact from taking people [physicians] used to long hours of patient care and making them do long hours of charting instead.
  • Why are we using the most expensive part of healthcare to do data entry?

Helping to mitigate these issues are scribes, which are the latest novelty in many medical practices. Doctors report higher satisfaction and less worry about completing their charts when using a scribe.

However, according to HealthAffairs, EHRs are only one of the factors causing the spike in burnout. Others causes are:

  • Loss of control over work
  • Increased performance measurement including quality, cost, patient experience
  • Increasing complexity of medical care,
  • Sheer volume of medical knowledge, which by 2020, is expected to double every 73 days,
  • Lack of work-life balance, and
  • Profound inefficiencies in the practice environment which have altered work flows and patient interactions.

Midcareer blues

In an article released by the American Academy of Family Practice, a 16-year practitioner said that “practicing medicine has become more tedious.” This midcareer doctor is particularly frustrated by utilization management rules created by health insurance companies.

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Not surprisingly, family medicine doctors are among the specialists that report the most burnout, along with urologists, and physical medicine and rehabilitation physicians. Measured by years of practice, midcareer physicians report the highest rate of burnout, although professionals across all specialties reported lower satisfaction with work-life balance in 2014 (with the exception of general surgeons and OB/GYNs).

Burnout impacts beyond individual physicians

Physician burnout is an issue that has far-reaching consequences. If physicians leave the profession or retire early, or they are too tired to engage with patients, or they are experiencing depression, we risk reversing all of the improvements in quality and safety we have made in recent years.

As a society we need to engage in a broader conversation around what causes burnout at a more foundational level. There is a large body of evidence that shows how personality can be predictive of whether or not someone has a tendency to burnout. In fact, the “gold standard” to assess burnout is the Maslach Burnout Inventory®, which measures many factors associated with these issues.

There are many resources that address the symptom, but as caregivers, our goal is to try to prevent negative outcomes — including burnout — before they occur. For example, if a physician has a specific personality profile that puts them at greater risk for burnout, we can provide tools and resources to assist.

What Cleveland Clinic is doing

At Cleveland Clinic, we’ve taken action to ensure our physicians’ satisfaction and well-being, because it’s the right thing to do for the talented and devoted individuals that lead our caregiving teams. It’s also good medicine, good for our organization and good for our patients. Our initiatives include:

  • Providing increased IT support to help physicians use EHR more successfully.
  • Increasing use of voice recognition software, which is eight times faster than typing.
  • Holding hundreds of town hall meetings with our caregiving teams to solicit their input. Many of their suggestions are now being incorporated.
  • Hiring more pharmacists to decrease the amount of time physicians spend writing prescriptions.
  • Ensuring that all of our caregivers, especially the advanced practice professionals, are practicing at the top of their licensure.
  • Building more flexibility into our employment models. Roughly 13 percent of our physicians now work part-time.
  • Preparing caregivers for a participatory role in their future by offering leadership courses.
  • Designating one day as Physician Wellbeing Day, where physicians are encouraged to get their physicals.

As leaders, we have an opportunity to rise to the challenge and address the issue of burnout with our medical staff. The American Medical Association (AMA) has created an extensive training website with learning modules to help our industry address the crisis. Called STEPS Forward™, the goal is to provide physicians with proven strategies to improve practice efficiency and help physicians reach the Quadruple Aim — the Holy Grail of medicine — which is better patient experience, better population health and lower overall costs with improved professional satisfaction.

Resiliency is the right focus

I’m particularly glad to see the focus on resiliency, which is the capacity to recover from difficulties, the ability to spring back into shape or the ability to withstand stress and catastrophe. We need to do more and start earlier related to providing the tools and resources to our caregivers-in-training and the professionals we task with ensuring that we are producing a well-balanced healthcare workforce.

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Additionally, the topic of wellness and burnout is now integrated into how medical/surgical residents are trained in the United States.

We value our physicians and the impact they have on our communities, from Florida to Ohio and many parts far and wide. We must support our caregivers as the healthcare landscape continues to become increasingly varied and complex. One thing remains certain: practicing medicine is still one of the most valuable and rewarding professions. We must do all we can to ensure that our colleagues continue to share this sentiment.

Learn to become a physician leader with Cleveland Clinic Global Executive Education programs, including The Cleveland Clinic Way: IntensivesSamson Global Leadership Academy and the Executive Visitors’ Program.

Dr. Barsoum is President of Cleveland Clinic Florida and staff in the Department of Orthopaedic Surgery.