Amid growing concerns about physician burnout and the toll it's taking on the nation's physician workforce, one physician House member recently brought his medical colleagues together to raise awareness about the issue.
Rep. Phil Roe, M.D., left, co-chair of the GOP Doctors Caucus, speaks during a caucus event held to raise awareness of physician burnout. Clif Knight, M.D., AAFP senior vice president for education, was among physician leaders invited to participate in the event.
Rep. Phil Roe, M.D., R-Tenn., co-chair of the GOP Doctors Caucus,(roe.house.gov) convened the group on June 23 and invited multiple physician organizations -- including the AAFP -- to discuss the consequences of the burnout crisis.
In kicking off the meeting, Roe said legislators and the public are beginning to recognize the rising demands placed on the medical profession as older physicians enter retirement and a younger generation is worn down by a growing number of administrative tasks.
"Physician burnout is a huge issue around the country," he said. "It's a real issue."
Roe recalled a consultation he had four decades earlier with two long-time patients who both had ovarian cancer. After caring for them as they overcame that health challenge, he continues to see them in practice.
- Rep. Phil Roe, M.D., R-Tenn., co-chair of the GOP Doctors Caucus, recently convened the group and invited physician organizations -- including the AAFP -- to discuss physician burnout.
- Clif Knight, M.D., AAFP senior vice president for education, represented the Academy at the event.
- Participants discussed many factors that feed into physicians' professional dissatisfaction, including administrative tasks that drag them away from patient care.
"They got old just like me," he said. "That's why we do what we do. Now all of the bureaucracy took the joy away."
Clif Knight, M.D., AAFP senior vice president for education, represented the Academy at the event. According to Knight, discussions with physicians and a review of survey data have revealed that the top source of professional dissatisfaction are the regulatory and documentation burdens physicians struggle to carry each day. For example, private insurers often require them to report on quality measures that are different from those CMS uses. In response, the AAFP continues to strongly advocate that quality measures be standardized across all payers.
Another source of frustration physicians frequently cite, said Knight, is insurer demands that prior authorizations be obtained before certain services are provided. The AAFP recently adopted an official policy on prior authorizations, emphasizing that they create barriers to effective patient care.
Knight recalled how the introduction of evaluation and management coding requirements in the 1990s created the first of many layers of complexity. Now, meeting quality measures and satisfying reporting requirements demand an ever-larger portion of a physician's time each day. That administrative work is completed solely to benefit insurers and not patients, Knight noted.
"There is better medicine and improvements in technology that are helping with the diagnosis and knowledge that guides effective treatment, but the documentation and reporting requirements do not seem to be improving the quality of care, and we're not seeing better outcomes because of them," Knight told AAFP News after the meeting.
Physicians in their early to mid-careers who express frustration don't necessarily leave medicine entirely, but they might opt for a nonclinical position such as an administrative job with a government entity or an insurer, which widens the workforce gap in primary care. More than 50 percent of physicians report(www.mayoclinicproceedings.org) at least one symptom of burnout.
"Physicians are telling us, 'This is not what I signed up for,'" Knight said. "They went into medicine to practice high-quality care and build relationships with patients, so there's a disconnect."
Even without changes in state or federal policy, he noted, medical institutions can take major steps to improve the practice environment. Practices and hospitals can promote physician and clinician well-being by removing barriers to effective care. That could take the form of hiring scribes for physicians to handle note-taking, delegating more tasks to nurses and other clinical staff, conducting more visit preplanning, and co-locating the medical team to reduce reliance on email and electronic health records.
When even some of the above measures are initiated, administrative time for each physician can be reduced by one to three hours each day.
"It's not a problem of weak physicians or less dedication," Knight explained. "At times, it sounds like physicians are being blamed for burnout. What physicians are saying is, 'Don't fix me; fix the system!' They are practicing in a dysfunctional system."
In addition to improving organizational and practice factors, Knight suggests that physicians cultivate personal interests outside of medicine such as photography, music or sports to achieve greater work/life balance. Another technique that can reduce stress is to practice "intentional gratitude," where physicians take a step back by thinking about or even writing in a journal what they have to be grateful for each day, such as a healthy family or a comfortable home with sufficient food. Mindfulness and meditation may also be beneficial for many physicians.
In one sense, Knight observed, it is physicians' drive to excel that can do them a disservice when it comes to professional satisfaction. '"Physicians have a perfectionist personality and tend to focus on things that are not going well," he said.
The AAFP has determined that improving members' well-being is a top organizational priority and, among other steps it is taking to address the issue, is a sponsor of the National Academy of Medicine's initiative to change the culture of physician practice and reduce burnout. Specifically, the Action Collaborative on Clinician Well-Being and Resilience,(nam.edu) which is defined as "a collaborative platform for supporting and improving clinician well-being and resilience across multiple organizations," is set to continue its stakeholder engagement and public education activities into 2018.
For its part, the AAFP will be rolling out numerous member tools and other activities, as well as various CME opportunities, to support this key wellness priority in the coming months, said Knight, so stay tuned.
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