Professional burnout has become a crisis in health care, and the situation is getting worse. More than 50 percent of U.S. family physicians suffer from at least one symptom of burnout.
AAFP Leadership Conference speaker Paul DeChant, M.D., M.B.A., left, talks with Krishnan Narasimhan, M.D., of Washington, D.C. DeChant, former CEO of the Sutter Gould Medical Foundation, spoke about how lean management can address the root causes of burnout and restore joy to patient care.
The question many are struggling with is what to do about it. Two speakers at the AAFP Leadership Conference -- the combined Annual Chapter Leader Forum and National Conference of Constituency Leaders -- offered answers, including resources the AAFP is preparing and tips that physicians can act on immediately.
Paul DeChant, M.D., M.B.A.,(www.pauldechantmd.com) outlined those immediate actions in an April 26 presentation. According to DeChant, who is former CEO of the Sutter Gould Medical Foundation -- a 300-physician multispecialty medical group in California's Central Valley -- and co-author of Preventing Physician Burnout: Curing the Chaos and Returning Joy to the Practice of Medicine, the solution could lie in the concept of lean transformation.
Although many associate lean transformation with manufacturing and productivity, DeChant said the concept's principles actually focus on respecting people (including the clinical care team), maximizing value for customers (in this case, patients) and minimizing waste.
"The care of the patient is most important thing we do," he said. "We have to give people doing the work an opportunity to do their work."
- Causes of physician burnout and paths to physician well-being were covered in two different sessions at the AAFP's 2017 Leadership Conference held recently in Kansas City, Mo.
- Speaker Paul DeChant, M.D., M.B.A., focused on overcoming burnout during his session, suggesting that lean transformation was one solution.
- AAFP Senior Vice President for Education Clif Knight, M.D., presented a breakout session on physician well-being during which he gave an overview of an AAFP initiative dubbed Physician Health First that will launch later this year.
"I love EHRs, and I hate EHRs," DeChant said. "I love everything it provides. It's legible, it shows us trends and gives us warnings. But I hate the interface, the lack of interoperability and the fact that people are using it against us. We have to do meaningless things to prove we are using our EHRs in a meaningful way. We have to fix this beast."
Dysfunctional systems, not people, are the problem, DeChant said, and the U.S. health care system needs to eliminate physician frustrations and fix broken patient care processes. Doing so correctly, he said, requires a physician-led effort.
"To address our frustrations, we have to be at the table."
Identifying Processes for Improvement
Physician leaders, DeChant noted, can help if they "go where the work is being done and learn it." This could mean anything from shadowing other physicians to learning how to schedule patient appointments by working with staff. By doing so, administrators can humbly learn how others do their jobs, what their challenges are and what those individuals think could be done to improve things. This "undercover boss" approach also builds trust with employees, he said.
Health care systems should also embrace the plan-do-study-act cycle or other systems for continual improvement, said DeChant. Something as simple as daily huddles can make a difference.
He offered examples of the effect such improvement efforts can have. In 2013, the average hold time for Sutter Gould patients who phoned one of the group's office locations was roughly 45 seconds, and the satisfaction score related to that service was at 70 percent. In less than a year, the satisfaction score climbed to 100 percent because wait times dropped to less than five seconds.
In another improvement effort, the health system cut its urgent care wait time in half.
But better results may not come immediately. As Sutter Gould implemented a lean approach, physician satisfaction scores initially dropped from 62 percent in 2010 to 45 percent in 2011 and again in 2012. The scores then rose steadily, reaching 87 percent in 2015. At the same time, Sutter Gould was awarded the Highest in Overall Care rating by Consumer Reports among 170 California medical groups in 2014 and 2015.
Beyond lean transformation, DeChant said every health system needs a physician wellness program and should offer wellness coaching. But those steps alone aren't enough.
"Things like mindfulness yoga and eating well are good, but we need to do more to address issues that make them needed in the first place," he said.
Eye on the Bottom Line
AAFP Senior Vice President for Education Clif Knight, M.D., listens to a question from the audience during his presentation on family physician well-being at the AAFP Leadership Conference.
For physicians working in health systems that aren't eager to invest in change, DeChant offered this thought: Faced with overwhelming administrative burden, many primary care physicians are, out of necessity, cutting back on the number of patients they see. The average is dropping from more than 90 patients a week to a little more than 80 a week. Consider that the average family physicians is worth $1.5 million to $2 million in net revenues to an affiliated hospital, and it's clear that this reduction in patient volume could have a noticeable effect on a hospital's bottom line.
"That's your argument to increase investment in primary care," he said.
DeChant started his presentation with a slide showing a medical student and asking people to remember how they felt on their first day of med school.
"How much did you think you would be loved by your patients and valued as a vibrant member of the community?" he asked. "Now … how do you feel today? What's changed? For many doctors, this isn't what we signed up for."
Later, after detailing the numerous causes of burnout and declining professional satisfaction rates among physicians, DeChant concluded by returning to that opening slide and revealing that the med student it showed was his own daughter.
"Let's do it for her, if not for us," he said.
AAFP Focus on Physician Well-being
Two days later at the conference, AAFP Senior Vice President for Education Clif Knight, M.D., presented a breakout session that highlighted the Academy's long-term plan to dig deep, engage and help family physicians regain a sense of well-being, happiness and professional satisfaction.
Like DeChant, Knight offered a plethora of facts, charts and research articles about why family physicians are feeling distressed and overwhelmed. But one slide that appeared on the giant screen at the front of the room cut straight to the heart of the situation.
That slide simply stated that "lack of burnout" does not equate to wellness.
"Let's focus on improving well-being and professional satisfaction, not simply decreasing burnout," Knight told his family physician colleagues.
He noted that the CDC defines well-being as "judging life positively and feeling good." That sounds great, but it's easier said than done.
And that's where the AAFP comes in -- starting with the creation of an official new strategic priority statement: "The AAFP will assist members in achieving well-being in order to enjoy a sustained career in family medicine."
Knight said that statement is just the beginning. An extensive initiative dubbed Physician Health First is set to launch in coming months. In fact, a number of resources related to the initiative already are in the works, including, but not limited to,
- planning of the AAFP's first health and well-being conference, scheduled for mid-April 2018;
- work on a chapter workshop series in 2018;
- expansion of related CME tracks and workshops at the 2017 Family Medicine Experience to be held Sept. 12-16 in San Antonio;
- ongoing publication of timely and informative journal articles on topics related to physician well-being;
- creation of an enhanced well-being portal on the Academy's website;
- development of a web-based well-being planning tool; and
- offering access to the Maslach Burnout Inventory(www.mindgarden.com).
In addition, noted Knight, the AAFP is proud to announce that it is a co-sponsor of the National Academy of Medicine's Action Collaborative on Clinician Well-Being and Resilience(nam.edu) that launched in December 2016 and, in June, became a founding member of the Health Society Leadership Council.
The council is affiliated with the Schwartz Center for Compassionate Healthcare,(www.theschwartzcenter.org) a Boston-based nonprofit organization focused on bringing compassion to every patient-caregiver encounter.
In short, the AAFP is humming with activity related to the creation of resources on physician well-being.
Knight sat down with AAFP News after his presentation to talk about why the Academy has placed this issue so high on its priority list.
"Our members are experiencing a complex and frustrating health care system, and this leads to high levels of burnout and professional dissatisfaction," said Knight. "Recognizing that, the AAFP Board of Directors has identified the well-being of our members as a top priority.
"And so the AAFP is committed to rolling out this initiative to address the systemic and organizational factors -- those 'hassles in practice' -- that we know create barriers to all of those dedicated family physicians who go to work every day wanting to provide high-quality and personalized care to their patients," he added.
Simply put, "The AAFP is committed to helping physicians find ways to sustain their energy and return the joy to practice," said Knight.
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