By: Steve Moberg
Executive VP and COO at Team Care Medicine, LLC
This article is the third in a three-part series on the costs of physician burnout. The first installment provided the financial perspective while the second examined the physician’s personal perspective. This third round focuses on the cost to patients resulting from physician burnout.
Most patients are unaware of the physician burnout epidemic and its causes. Nevertheless, it increasingly affects the care they receive. Patients may wonder why it has become more difficult to make an appointment with their primary care doctor or why their doctor seems distracted during the exam. Patients are surprised when they must ask their doctor, “Isn’t it about time for my next colonoscopy?” instead of the doctor identifying the care gap. They are frustrated when they cannot get in to see the doctor for an urgent issue, forcing them to visit the emergency room at far greater expense. Patients may not know to label these as consequences of physician burnout but they are aware of these changes and how it impacts their lives and care.
Dr. Peter Anderson, founder of Team Care Medicine and a 30-year primary care doctor, identified accessibility, attentiveness, and accuracy as the three pillars necessary to achieve patient satisfaction and quality of care. Physician burnout is now quickly eroding each of these three critical foundations upon which so many doctors have built their practices.
Access to care is the single most important determinant in patient quality of care — after all, there’s no care if the patient can’t see the doctor! An array of forces is driving a large and growing shortage of primary care doctors, and none is more insidious and preventable than physician burnout.
Demographic trends are driving increased demand for health care, with the US population growing and aging rapidly. While the total US population is projected to increase 10.3% by 2032, the population aged 65 and over is projected to grow by 48.0%, driving demand for care much more rapidly than the overall population growth would imply.
Meanwhile, physician burnout is eroding the supply of primary care on several fronts. First, burnout is causing practicing physicians to reduce their care hours. Physicians trade patient time for admin time to catch up on charts and other administrative tasks. Second, burnout is causing practicing physicians to retire earlier. With 42% of primary care physicians over age 55, this is an acute and growing risk. Third, as medical students perceive the high dissatisfaction of primary care physicians, fewer are choosing this career path.
Increasing demand and eroding supply conspire to paint a bleak picture for patient access to care. A primary care physician shortage of 38,000 physicians is projected by 2032. The AAFP found that an increase of one primary care physician per 10,000 population was associated with 15.1 fewer deaths per 100,000 as well as 39.7 fewer ACSC hospitalizations per 100,000 and 712.3 fewer ED visits per 100,000. Real solutions are desperately needed to unlock patient access to care and thereby reduce ED visits, hospitalizations, and deaths.
Patients reasonably expect their physician to be mentally present and focused during the exam. However, a common symptom of burnout is emotional disengagement. When patients feel their doctor is already under personal strain or overwhelmed, they tend to pull back and not share all their issues or ask all their questions. They do not want to add to the doctor’s level of stress, so they don’t. With less information available, the ability of the provider to offer quality patient care is obviously diminished.
One major contributor to burnout is the burden of administrative tasks and EHR Patient Chart documentation. To minimize the amount of chart documentation to be done later, many physicians feel compelled to enter data in the EHR even as they interact with the patient. Carrying on simultaneous “conversations” with the patient and the computer is exhausting for the physician and leaves all parties dissatisfied. So, not only is the burned-out physician emotionally unavailable to the patient during the visit, he/she exacerbates his/her emotional burnout by trying to maintain two conversations at once, continuing the vicious cycle. Meanwhile, the patient doesn’t feel heard and doesn’t share as much information, with dire consequences for health, not to mention patient satisfaction.
As detailed in an earlier TCM missive on the financial cost of burnout, quality of care is jeopardized when a physician begins to experience burnout. Patients need a physician practicing at the top of his/her capabilities in order to keep up with the increasing complexity of primary care. Otherwise, missed pre-emptive screenings for cancer, errors in judgement when developing care plans, or charting errors can emerge. The 2019 Medscape Survey revealed 26% of depressed doctors say they are less careful when completing the visit documentation and 14% said they are making errors they wouldn’t ordinarily make. Survey results in a recent Mayo Clinic Proceedings article suggest a burned-out doctor is 120% more likely to make a medical error than a doctor that is not.
Burned-out physicians do not need to learn new breathing techniques or other mechanisms to cope with stress. They need real solutions.
In the InCrowd 2019 Survey, doctors were asked what they needed from their administration to help combat burnout. The number one answer by 66% of the doctors was to add staff. They understand that many of the tasks they perform each day can be performed by support staff. However, this is only part of the solution. Physicians need to reconceptualize their own role while surrounding themselves with a well-coached and properly equipped exam room team.
The TCM Model eliminates burnout and restores the joy of medicine. In this system, the role of the physician is upgraded from overloaded work horse to team captain. The clinical support staff (usually MAs) are equipped to operate up to the limit of their license. They perform 7 new skills, including the bulk of the EHR documentation. This relieves the physician of all unnecessary administrative burdens before, during, and after the visit. With a larger team of higher functioning clinical support staff, the physician is able to concentrate on the patient (not the EHR), and focus on diagnosis and care decisions — the reasons they went to med school.
Access improves as daily visit volumes and work RVUs increase 20-40%. Patients can once again see their regular primary care doctor rather than a rotating cast of urgent care centers, emergency departments, etc.
Attentiveness improves as the provider is freed from EHR data entry. As one recent convert observed: “I never realized how stressful it was to have to carry on two conversations at once until I no longer had to do it.”
Accuracy improves as the provider’s emotional wellbeing is restored, boosting patient health and satisfaction.
Dr. Chaoui, president of the Massachusetts Medical Society, noted that “We need to take better care of our doctors and all caregivers so that they can continue to take the best care of us.” The TCM Model takes good care of the providers and, by extension, their patients.
Emotionally healthy physicians make a life-saving impact on their patients every day. Here’s just one example: When Dr. Peter Anderson developed the TCM Model, he equipped his Team Care Assistants (TCAs) to collect background data from each patient before the exam formally began, affording the TCA an opportunity to ask a number of profile questions that Dr. Anderson often ran out of time to ask himself. One day, Howard, a 54-year-old male, had an appointment to evaluate a lesion on his scalp. While the TCA was going through her routine data gathering, she asked Howard the profile questions for which he qualified: “Do you ever have any pain in your chest or shortness of breath when mowing the grass, carrying in the groceries, or going up stairs? And if you rest a minute, does the pain/shortness of breath subside?” Howard pondered for a moment then responded: “You know, I have had some pain in my chest the last couple of times I mowed the grass but it went away when I was done so I kind of just forgot about it.…so yeah, I guess I did!” The TCA made a note of it in the chart and during her presentation of Howard to Dr. Anderson, she passed the information on to him. Dr. Anderson asked a few more questions of Howard and told him he needed a stress test. Howard received a triple bypass three days later. Without the TCM Model, Dr. Anderson often did not have time for these profile questions orthogonal to the purpose of the visit. With the TCM Model, Howard’s life was saved through high quality care by an emotionally healthy provider supported by a high functioning exam room team.
For more information, go to www.teamcaremedicine.com.