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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
© 2019, RechargedMD
➢ Physician Burnout Review
➢ Impact of Physician Burnout
➢ Systems-based Solutions
1
3
2
2
Key Points
3
My Story of Burnout
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© 2019, RechargedMD 4
EHR Billing
NotesTax Credits
Coverage Options
Healthcare Landscape
5
The Facts about Physician Burnout
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© 2019, RechargedMD 6
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
9
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
© 2019, RechargedMD
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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isre
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Pro
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Cert
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What Contributes to Physicians’ Burnout
13
The Impact of Physician Burnout
© 2019, RechargedMD
© 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
14
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
15
➢ 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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?
17
What Are Doctors Doing Instead?
18
Why else should we care about physician burnout?
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© 2019, RechargedMD
Physician Suicide
19
300 physician suicides per year
Female physician suicide rate 2.5-4x higher than general population
Higher rates of depression, anxiety, and substance use
20
Why are physicians reluctant to seek help?
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© 2019, RechargedMD
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
© 2019, RechargedMD
Lawsuits Based on Burnout
22
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
23
Building a culture of safety is impossible without engaged and healthy clinicians
24
If you’re still not convinced, consider the business case for addressing burnout
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© 2019, RechargedMD
Reducing Burnout
25
Associated with increased patient satisfaction scores
Improved employee engagement
Decreased recruitment costs
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ROI for Addressing Burnout
26
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?
27
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
29
30
What are we missing when we frame burnout as a
resilience issue?
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© 2019, RechargedMD
Canary in Coalmine
31
© 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
33
Support and Commitment from senior leadership
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Crucial Factors for Success
34
Need accurate data
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Comprehensive Plan
35
Potential Frameworks: StanfordWellMD
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Our Framework
36
Creates a roadmap that addresses these crucial domains
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Organization
37
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
38
Professional development opportunities
Peer group coaching
Confidential Counseling services
Opportunities to create culture change
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Practice of Medicine
39
Practice transformation
Initiatives to improve EHR and Workflow
Team based approach
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Healthcare System
40
Pushing back on regional and national policy issues that are negatively impacting your physicians
41
Addressing Burnout Takes time and commitment, but it can be done
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© 2019, RechargedMD 42
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
43
Questions?
© 2019, RechargedMD