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Welcome to PMI’sWebinar Presentation
Brought to you by:Practice Management Institute®
pmiMD.com
Averting Burnout in Your Practice
Welcome to PMI’s Webinar Presentation:
Jan Hailey, CMC, CMIS, CMOM, CMCO
Welcome to Practice Management Institute’s Webinar and Audio
Conference Training. We hope that the information contained herein will
give you valuable tips that you can use to improve your skills and
performance on the job. Each year, more than 40,000 physicians and office
staff are trained by Practice Management Institute. For 30 years, physicians
have relied on PMI to provide up-to-date coding, reimbursement,
compliance and office management training. Instructor-led classes are
presented in 400 of the nation’s leading hospitals, healthcare systems,
colleges and medical societies.
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including national conferences for medical office professionals, self-paced
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intended to serve as legal advice. The opinions expressed are those of the
individual presenter and do not necessarily reflect the viewpoint of Practice
Management Institute. The information provided is general in nature.
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Practice Management Institute®
8242 Vicar | San Antonio, Texas 78218-1566
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Averting Burnout in Your Practice
Jan Hailey, MHL, CMCO, CMC, CMIS, CMOM
Clinician Burnout
• The World Health Organization defines burnout as a problem associated with chronic workplace stress; it is not an individual mental health diagnosis, nor the same as depression
• Burnout: emotional exhaustion, depersonalization, and low sense of personal accomplishment
• Quadruple Aim
Improve health for our population
Improve patient
experience Lower Costs
Improve provider
satisfaction
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Causes of Burnout
(Ahrq.gov)
Causes of Burnout
The practice of clinical medicine
High stress
Great responsibility; little control
Provider’s specific jobJob specific stresses, call‐rotation, compensation, leadership
Work / Life balance
Conditioning of medical education
Traits of success also set up for burnout
Leadership
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Why Burnout Needs to be Addressed
• Burnout is estimated to be as high as 50% in some studies
• Access to Care Providers leaving practice
• Patient Safety
• Quality
• Increases risk of malpractice litigation
The MEMO Project
• Agency for Healthcare Research and Quality (AHRQ) funded project Minimizing Error, Maximizing Outcome
• Survey 422 PCPs (family physicians and internists)
119 ambulatory clinics
1,795 patients
• Medical records reviewed for quality and medical errors
(Ahrq.gov)
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The MEMO Project • 50% of the physicians reporting time pressures when conducting exams
• One third felt they needed 50% more time than was allotted for patient care
• One fourth state they needed at least 50% more time for follow up appointments
• Work conditions Chaotic Low control Unfavorable organizational culture leading to dissatisfaction, stress, burnout, and intent to leave practice
• Physician reaction did not translate to poorer quality of care because they act as buffers between work environment and patient care
• When lower quality care was seen, the investigators found it was the organization that burned doctors out that led to lower quality care, rather than the burned‐out doctors themselves
• Electronic Health Record (EHR) contributes to burnout
(Ahrq.gov)
How Can We Reduce Burnout?
Work / home life balance
Flexible schedulesHigh functioning care
teams
More time with patients
Creating standardized workflow
Responsive IT team
Providing administrative time to complete required
documentation
Organizational leadership support
Ensuring values align between clinicians
and leaders
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How Can We Reduce Burnout?
MANAGE TIME EFFICIENTLY
ANTICIPATE / EMBRACE CHANGE
LEAVE WORK AT WORK
FIND A MENTOR CARE FOR YOURSELF
FIND YOUR PASSION
Burnout and the Electronic Health Record
• Survey conducted by researchers at the University of New Mexico Forty percent of physician burnout is attributable to EHRs, up from the previously estimated 13 percent
EHRs are largely to blame for the physician burnout and stress epidemic that runs rampant in the medical industry
Clinical process design and clinical structure, both of which are highly impacted by EHRs, contribute to clinician stress
Physicians spend two minutes at the computer for every one minute spent with patients
Workdays have extended into the physicians’ homelives
Face‐to‐face time with the patient is turning into face‐to‐screen
(Jason, 2019)
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The Cost of Burnout
• The annual cost of physician burnout is conservatively estimated at $4.6 billion per study in the Annals of Internal Medicine Physician turnover: The researchers tried to account for two components of the cost associated with burned‐out doctors leaving their jobs. The first component was the cost linked to physician replacement for search expenses, hiring, and new physician startup. The second cost was lost income from open physician positions.
Reduced clinical hours: To approximate the cost of physicians lowering their clinical hours, the net cost of turnover was adjusted by a fraction representing the average percentage difference in weekly work hours between physicians who were burned‐out and physicians who were not burned out.
(Cheney, 2019)
National Academy of Medicine
Action Collaborative on Clinician Well‐Being and
Resilience
• Launched In 2017, with a network of more than 60 organizations committed to reversing trends in clinician burnout
The Collaborative has three goals:
• Raise the visibility of clinician anxiety, burnout, depression, stress, and suicide
• Improve baseline understanding of challenges to clinician well‐being
• Advance evidence‐based, multidisciplinary solutions to improve patient care by caring for the caregiver
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• Six working groups will meet over four years and identify evidence –based strategies to improve clinician well‐being Action Collaborative Leadership Leadership Engagement Working Group
Breaking the Culture of Silence Working Group
Organizational Best Practices and Metrics Working Group
Post‐2020 Sustainability Working Group
Action on Consensus Report Recommendations Working Group
Organizational Strategy
• Organizational leadership must implement changes to promote clinician well‐being
• Many organizational factors play a role in clinician burnout: Culture Compensation Mission, vision, values Diversity and inclusion Workload Unrealistic expectations
• Organizations can address dissatisfaction and retention with clear communication and workflows
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Burnout by Specialty
Highest rate of burnout
54
53
52
49
48 48
45
46
47
48
49
50
51
52
53
54
55
Urology Neurology PhysicalMedicne &Rehab
InternalMedicine
EmergencyMedicine
FamilyMedicine
Burnout by Specialty
Burnout by Specialty
Lowest rate of burnout
28
3233
36 36
0
5
10
15
20
25
30
35
40
Public Health Nephrology Pathology ENT Plastic Surgery
Burnout by Specialty
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It’s Not Just the Physician
Non Physician Practitioners
Management
Front Office Staff
Clinical Staff
Billing Staff
Ancillary Staff
It’s Not Just the Physician
Nurses report starting shifts already fatigued
Mandated overtime
Excessive workloads
Insufficient staffing
Long hours – 12 ‐hour shifts
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Tips for Preventing Staff Burnout
Be proactive – Engage employees to reduce turnover
Boost morale
Training
Motivate
Incentivize
Tips for Preventing Staff Burnout
Active management role
Social engagement
Take a break
Continuous education
Healthy habits
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Case Study – Medical Economics
Pediatrician Karen Ailsworth, MD, began her career with a multi‐specialty practice in Baraboo, Wisc. She enjoyed the job at first, but a couple of years after she started an HMO bought the practice, and soon afterward conditions began to change for the worse.
“They wanted us to be more and more productive, like we had to see a patient every 15 minutes,” she recalls. It wasn’t long before she began experiencing a common symptom of burnout: anger at her patients. “I started feeling like, ‘don’t tell me your problems, I don’t have the time. Just make my life easy.’ And that wasn’t the way I wanted to practice.”
Ailsworth stuck it out for 16 years, finally quitting in 2010 and pursuing locum tenens work before landing a less stressful position at an Indian Health Center.
“It felt like the bean counters were in charge, and it wasn’t about patient care any longer,” she says of her former practice. “I didn’t feel like we got recognized for what we did. It wasn’t like I wanted an award, but more like recognizing not every patient fits into a 15‐minute slot, and doctors aren’t just widgets in a factory.
(Bendix, 2019)
Summary
Lack of sufficient face‐to‐face time with patients, complicated patients, lack of control, electronic health record stress, and poor work‐home balance can lead to clinician burnout
Burnout can lead to clinicians leaving their practice, poor patient outcomes, and shortage in primary care
Burnout takes a toll on physicians, their patients, and their practices; however, we can help alleviate burnout with organizational strategies, individual awareness and resources readily available to help the clinician
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Thank You!
References
Drummond, MD, D. (2018, November). The five main causes of physician burnout. Retrieved from https://home.svmic.com/resources/newsletters/169/the‐five‐main‐causes‐of‐physician‐burnout
Physician burnout. (2017, July). Retrieved from https://www.ahrq.gov/prevention/clinician/ahrq‐works/burnout/index.html
Cheney, C. (2019, May 30). Annual physician burnout costs estimated at $4.6 billion. Retrieved from https://www.healthleadersmedia.com/clinical‐care/annual‐physician‐burnout‐costs‐estimated‐46‐billion
Berg, S., & Berg, S. (2019, January 24). Physician burnout: Which medical specialties feel the most stress. Retrieved from https://www.ama‐assn.org/practice‐management/physician‐health/physician‐burnout‐which‐medical‐specialties‐feel‐most‐stress
Bendix, J. (2019, January 6). The real reason physicians burnout. Retrieved from https://www.medicaleconomics.com/business/real‐reason‐docs‐burn‐out
Action collaborative on clinician well‐being and resilience. (n.d.). Retrieved from https://nam.edu/initiatives/clinician‐resilience‐and‐well‐being
https://www.healthcarefinancenews.com/news/7‐tips‐preventing‐staff‐burnout‐healthcare
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